Corticosteroids

Corticosteroids can be prescribed in a variety of routes. Fluticasone is an example of a commonly used inhaled corticosteroid; prednisone is an example of a commonly used oral corticosteroid; and methylprednisolone is a commonly used IV corticosteroid. Additional information about corticosteroids and potential adrenal effects is located in the “Endocrine” chapter.

Mechanism of Action

Fluticasone is a locally-acting anti-inflammatory and immune modifier. The nasal spray is used for allergies, and the oral inhaler is used for long-term control of asthma. Fluticasone is also used in a combination product with salmeterol. It decreases the frequency and severity of asthma attacks and improves overall asthma symptoms. See Figures 5.12-5.12b^[1],^[2],^[3] for images of different formulations of fluticasone.

Oral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

Methylprednisolone IV prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Methylprednisolone requires reconstitution before administration. See Figure 5.12c^[4] for an image of methylprednisolone.

Indications for Use

Fluticasone inhalers are used to prevent asthma attacks.  In respiratory conditions, oral prednisone is used to control severe or incapacitating allergic conditions that are unresponsive to adequate trials of conventional treatment for seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, and drug hypersensitivity reactions. Methylprednisolone IV is used to rapidly control these same conditions.

Nursing Considerations Across the Lifespan

Fluticasone is safe for children aged 4 years and older. Prednisone and methylprednisolone are safe for all ages. Watch for potential mood changes such as irritability and possible hyperactivity in children.  Short term use can also lead to increase in blood pressure and blood sugar levels.

Adverse/Side Effects

Fluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Clients should rinse their mouths after use to prevent candidiasis (thrush).

Prednisone and methylprednisolone:  See more information about adverse effects of corticosteroids in the Endocrine chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as  hypernatremia (↑Na),  hypokalemia (↓ K+), and increased blood glucose with associated weight gain can occur. CNS symptoms include mood swings and euphoria. GI symptoms can include nausea, vomiting, and GI bleed.  In long-term therapy, bone resorption occurs, which increases the risk for fractures; the skin may bruise easily and become paper thin; wound healing is delayed; infections can be masked; and the risk for infection increases.  Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.^[5]

Client Teaching & Education

Clients should be advised that corticosteroids are not used to treat an acute asthma attack.  They can cause immunosuppression and suppress signs of infection.  Corticosteroids can also cause an increase in blood glucose levels.  Clients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes.  These occurrences should be reported to one’s healthcare provider.^[6]

Fluticasone Medication Card

Now let’s take a closer look at the medication card for fluticasone.^[7][8][9]