Corticosteroids: Mineralocorticoids and Glucocorticoids (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides 07-02 Corticosteroids II.pdf
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      Review Sheet Side Effects of Corticosteroids Nursing.pdf
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      Review Sheet Corticosteroid Overview Nursing.pdf
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    00:01 So, with corticosteroids, we have 2 types: we have mineralocorticoids, and we have glucocorticoids.

    00:08 So, that's why you see the 2 columns on your screen.

    00:12 Mineralocorticoids are like aldosterone, and glucocorticoids are like cortisol.

    00:20 So, let's look at what each one of these special group does.

    00:25 Aldosterone controls electrolyte and water levels.

    00:29 Think specifically, sodium.

    00:31 So, write Na or spell out the word "sodium" above that just to help you remember.

    00:37 Now, how it promotes sodium retention in the kidneys, which means when aldosterone is present, then that -- the kidneys know to reabsorb more sodium.

    00:48 And wherever sodium goes, water follows.

    00:51 So, now I have more volume on board.

    00:54 Remember, when I have more volume in my intravascular space, my blood pressure is likely to be elevated.

    01:02 Now, the second type of corticosteroids -- mineralocorticoids was aldosterone, glucocorticoids is cortisol.

    01:10 And usually, the effect we're after is number 2.

    01:13 So, put a star after that.

    01:15 Most often, when we give corticosteroids, what we want to do is go after the cortisol effect.

    01:21 Now, we end up with some carb, fat, and protein metabolism, but there's what we're looking for, that second point.

    01:28 We want the anti-inflammatory response.

    01:31 We want less eosinophil action.

    01:33 We give glucocorticoids to suppress inflammation in lots of diseases and states.

    01:41 So, make sure you make a special note that although we get all these other effects sometimes along with it, they're not the therapeutic intended effect.

    01:52 Now, if the patient's adrenal gland is done, it's shot, then, yeah, we're going to have to replace all these things.

    01:57 But for the majority of our patients, we're going to be looking for that anti-inflammatory effect.

    02:03 That is the therapeutic goal for using corticosteroids.

    02:08 Now, I put this chart up here, but I don't want it to overwhelm you.

    02:11 I just want you to kind of see.

    02:13 Look at the very top.

    02:15 You have hydrocortisone or cortisol.

    02:18 Its glucocorticoid potency is 1.

    02:20 Its mineralocorticoid potency is 1, okay? So, the duration of hours is just kind of good-to-know information there.

    02:27 But what I want you to focus in on are those first 2 columns.

    02:31 Now you can see with that medication, we've got a 1:1 ratio.

    02:34 We've got just as much glucocorticoid potency as we do mineralocorticoid.

    02:40 Every drug listed under hydrocortisone is a comparison of that.

    02:45 So prednisone has 3.5-5 a times of effect of glucocorticoid potency, and 0.8 of mineralocorticoid.

    02:56 Hey, now, why would we do that? Well, we talked about what we're looking for is the anti-inflammatory effect.

    03:03 We don't necessarily want the mineralocorticoid sodium water effect.

    03:08 That's why, in making these new medications, you can see as we progress, look all the way at the bottom.

    03:15 Dexamethasone is 25-80 for glucocorticoid potency, where we've got 0 for mineralocorticoid.

    03:24 So, it depends on what effect we're trying to get from the patient.

    03:28 Dexamethasone is a pretty strong one as far as glucocorticoid potency, and they've eliminated the mineralocorticoid.

    03:35 Do not spend time memorizing this chart.

    03:39 This is just here for you to have kind of the idea that we use cortisone as a standard, and that the other glucocorticoids that we have tend to have higher glucocorticoid potency, and lower mineralocorticoid potency.

    03:54 Okay.

    03:55 So, what specifically do we use to treat corticosteroids for? Well, hang on because there is a very long list here.

    04:04 We can use it for joint pain and inflammation, arthritis, dermatitis, allergic reactions, asthma, hepatitis, lupus, inflammatory bowel disease, sarcoidosis, glucocorticoid replacement for Addison's disease.

    04:18 And sometimes, I think we just give it when we don't know what else to do, we try corticosteroids, okay? So, we use it -- This is a partial list.

    04:27 This isn't even a complete list of all the opportunities we use with corticosteroids.

    04:33 But the undesired effect is that we end up with a drug induced Cushing's syndrome.

    04:39 It's not what we want.

    04:41 We'd love to be able to just be more selective about getting that anti-inflammatory response.

    04:46 But remember back to that chart, we've tried to tweak that with medications, but you're still going to have some other undesired effects.

    About the Lecture

    The lecture Corticosteroids: Mineralocorticoids and Glucocorticoids (Nursing) by Rhonda Lawes, PhD, RN is from the course Endocrine Medications (Nursing). It contains the following chapters:

    • Aldosterone vs Cortisol
    • Overview of Corticosteroids
    • Treatment with Corticosteroids

    Included Quiz Questions

    1. Controls electrolytes and fluid levels
    2. Maintains protein, carbohydrate, and fat metabolism
    3. Fights inflammation
    4. Decreases eosinophil action
    1. Increase glucocorticoid potency and reduce mineralocorticoid potency
    2. Increase mineralocorticoid potency and reduce glucocorticoid potency
    3. Increase both glucocorticoid and mineralocorticoid potency
    4. Reduce both glucocorticoid and mineralocorticoid potency
    1. Drug-induced Cushing's syndrome
    2. Drug-induced Addison's disease
    3. Drug-induced pituitary suppression
    4. Drug-induced hypothalamus suppression

    Author of lecture Corticosteroids: Mineralocorticoids and Glucocorticoids (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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