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.
The lecture Corticosteroids: Mineralocorticoids and Glucocorticoids (Nursing) by Prof. Lawes is from the course Endocrine Medications (Nursing). It contains the following chapters:
What is a major function of the mineralocorticoid aldosterone?
What is the goal when choosing a corticosteroid to treat inflammation?
While taking corticosteroids, it is important for the nurse to monitor for which condition?
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