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|DRUG NAME||cortisone; hydrocortisone (Cortef, A-Hydrocort)||prednisone (Deltasone, Liquid Pred, Meticorten, Orasone); prednisolone (Orapred, Prelone, Pediapred); methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)||dexamethasone (Decadron, Dexasone, Solurex, Baycadron); betamethasone (Celestone, Celestone Soluspan, Betaject) |
|CLASS||Short-acting glucocorticoids||Intermediate-acting glucocorticoids||Long-acting glucocorticoids|
|MECHANISM of ACTION||Decrease inflammation by inhibiting the release of pro-inflammatory molecules, preventing the activation and migration of immune cells, and increasing the production and release of anti-inflammatory molecules|
|ROUTE(S) of ADMINISTRATION|
|CONTRA-INDICATIONS & CAUTIONS|
|DRUG NAME||fludrocortisone (Florinef)|
|MECHANISM of ACTION||Acts on the kidney tubules causing increased sodium and water retention, as well as increased loss of potassium and protons|
|ROUTE(S) of ADMINISTRATION||PO|
|CONTRA-INDICATIONS & CAUTIONS||Used with caution in clients with uncontrolled hypertension, congestive heart failure, and hypokalemia|
|NURSING CONSIDERATIONS for|
|ASSESSMENT & MONITORING||Assessment |
Glucocorticoids and mineralocorticoids are endogenous hormones normally produced by the adrenal glands. In clients with impaired adrenal function, these hormones can be administered as replacement therapy.
Synthetic glucocorticoids, also commonly known as corticosteroids, are medications that can be used in clients with decreased adrenal function, such as in adrenal insufficiency; this is also known as Addison disease, and specifically occurs when the adrenal glands don't make enough endogenous glucocorticoids, so these clients need hormone replacement therapy with synthetic glucocorticoids. In addition, glucocorticoids are used in the treatment of numerous inflammatory conditions, such as asthma, rheumatoid arthritis, and inflammatory bowel disease, as well as preventing organ rejection in transplant recipients.
Alright, now, based on the duration of action, synthetic glucocorticoids can be classified into three groups. The first group are short-acting glucocorticoids, such as cortisone and hydrocortisone. Cortisone needs to be converted into hydrocortisone in the liver in order to be active, so it can only be taken orally; while hydrocortisone can be given orally, intravenously, intramuscularly, and topically. The second group are intermediate-acting glucocorticoids, which include prednisone, prednisolone, and methylprednisolone. Prednisone can only be taken orally; while prednisolone can be administered orally, intravenously, or topically; and methylprednisolone can be given orally, intravenously, intramuscularly, or injected intra-articularly. The third and final group are long-acting glucocorticoids, which include betamethasone and dexamethasone. Both of these medications can be taken orally, intravenously, intramuscularly, or intra-articularly. In addition, betamethasone is also available for topical use.
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