Medications to Treat Inflammation: Glucocorticoids (Nursing)

00:01 Now we talked about medications to treat inflammation, glucocorticoids are things our body normally produces by the adrenal cortex.

00:09 They've got a really cool picture for you there.

00:12 See the adrenal gland just kinda snug right on top of the kidneys.

00:15 It's not part of the kidneys but that's where it lives so normally your body produces glucocorticoids from the adrenal cortex.

00:25 The adrenal gland has a medulla and a cortex but that's really easy to remember because I want you to underline the letters, C-O-R-T, cort and that will help you remember that this comes from the adrenal CORTex.

00:42 Now we can give these medications as inhalers, oral pills or by IV So the best route if we're dealing with respiratory is to get them inhaled because these drugs come with some side effects.

00:57 As you progress and take an oral medication or an IV, your body's gonna have more systemic effects of glucocorticoids and we'll talk about this in just a minute.

01:08 Again, NOT rescue medications.

01:11 These are ones that we use after. we've given if we're in an acute attack, we'll use these after we've given those.

01:18 So if I have an exam question asking you which medication was it important to give first? the short acting beta-2 adrenergic agonist first, the inflammatory meds whichever one they've chosen are given next.

01:30 Okay we give these on a fixed schedule, Remember my friend that I've talke to you about, right.

01:36 you don't take it PRN (pro re nata), as you think you need it, these have to be given on a fixed schedule so they control that inflammation.

01:45 Once the inflammation process has already started, it's a lot harder to get those horses back into the barn as they say so that's why you want them to take it everyday.

01:54 They might just take it seasonally if they have seasonal allergens that are irritating their asthma or their respiratory problems But some people take these year-round, 365 days a year.

02:06 They suppress inflammation and that's definitely what we want.

02:10 It helps both our COPD patients, and our asthmatic patients.

02:14 In fact as we roll through these, you'll see that we use a lot of the same medications to treat both asthma and COPD.

02:21 So looking back at this one, glucocorticoids are medications we give that mimic what my adrenal cortex does naturally in my body.

02:31 We can get it inhaled which is the best if we want to limit side effects, Oral, now you're gonna have systemic side effects or IV.

02:39 We use it to prevent attacks, we give it on a fixed schedule.

02:42 It could help both our COPD and our asthma patients.

02:46 Now when I have glucocorticoids on board because they suppress inflammation, I have less of those nasty mediators released.

02:54 Remember those leukotrienes, histamines, prostaglandins.

02:59 When those guys are running loose in my body and they connect with their receptors, I have that horrible side effects and all that inflammation that I don't want to have.

03:08 So when the glucocorticoids are consistently present, give them on a fixed schedule.

03:14 I'm gonna have less edema in the airway mucosa, that's cool.

03:18 Less edema means more open airways.

03:21 Remember that picture where you saw the difference in those swollen airways and open airways? That's what I'm looking for.

03:27 So a fixed dose of glucocorticoids on board, I'm gonna have less edema in the airway mucosa, fewer inflammatory responders like the neutrophils, and the leukocytes running around and wreaking havoc.

03:40 So as long as I keep it in my body consistently in the times when I'm exposed, I'm gonna have a much easier time breathing.

03:49 Now to minimize those glucocorticoid effects, you wanna be really careful of what we're giving in our patients, You want them on the smallest dose for the shortest period of time for the least systemic route.

04:01 That's why inhaled is always our first choice if we can and as we progress to oral or IV, you're gonna have systemic side effects.

04:09 The higer the dose of the patient's on, the longer the time they are on that dose, you're gonna have more systemic effects and a risk of suppressing that adrenal gland.

04:20 Now we'll go into glucocorticoids in more detail in a special video just on glucocorticoids but for now, I want to introduce you to that concept.

04:29 Okay so the adrenal gland normally puts out glucocorticoids.

04:33 When I give a patient glucocorticoids inhaled, via pill or IV, now I'm filling the body with extra substances.

04:44 So the adrenal gland isn't really stimulated to put out its own corticosteroids and it will become kinda lazy.

04:51 That's really what suppressed means.

04:53 So the higher the dose, the longer you're on glucocorticoids, the bigger the risk for adrenal gland suppression.

05:01 Inhaled? Not as big a risk.

05:03 Oral? Yeah, now we've got a risk.

05:05 And IV? Of course we've got an even bigger risk.

05:08 And the longer period of time the patient is on higher doses, then the more risk there is for adrenal gland suppression.

05:16 So, glucocorticoids adverse effects kinda look like the same effects as Cushing's disease.

05:23 We call it Cushing's Syndrome.

05:26 Okay, now I want to take a look at the glucocorticoids adverse effects because they're significant.

05:32 So we'll talk about this believe it or not in even more detail in our corticosteroid video but you need to understand this for patients that have respiratory problems because we use the glucocorticoids to suppress inflammation.

05:45 Now I'm gonna do something a little different with you and I know you're not gonna like it, I'm so okay with that but I want you to put your pencil down That's it, let go of the pencil or the pen, set it down for just a second.

06:00 Okay, all right, now we're ready.

06:02 So I want you to use your hand and do this with me.

06:05 So "moon face" got it? moon face, facial hair, mood swings, buffalo hump.

06:15 Okay, try it again with me - moon face, facial hair, mood swings, buffalo hump.

06:24 Okay, those are the first ones that I want you to think about.

06:28 If I have a patient that's on glucocorticoids, higher the dose, longer the time you're having it, these are the side effects that they're going to have.

06:38 They're gonna look like somebody who has Cushing's disease, but really it's just Cushing's Syndrome because we did it to them.

06:44 In Cushing's disease, that adrenal cortex just go crazy and pushes out all these hormones.

06:50 In Cushing's syndrome, we are putting more medications into the patient that mimic that disease.

06:56 So we're putting in corticosteroids.

06:59 So moon face, don't write anything down yet.

07:02 Moon face, got it? Super full face - they look like that, not because they're gaining so much weight, although they will, but their face just becomes really really full.

07:14 We'll be walking through them all and you can pick out people that you know are on costricosteroids.

07:18 Facial hair.

07:19 Hey if you're a guy, not that big a deal.

07:22 If you're a girl like me, this is a big deal.

07:26 Nobody wants to be seen as the bearded lady, right? So we've got... stay with me, don't write anything down yet.

07:32 Moon face, facial hair, mood swings, buffalo hump Now last two, mood swings? Wow! this can make you just wow, irritable, angry, cry, teary, doesn't matter, really messes with your moods.

07:51 And the buffalo hump, back here? That's the accumulation of fat right in the middle of your back in the back.

07:59 And that's why we call it a buffalo hump because it makes you look like a buffalo.

08:03 So, stay with me, resist the urge to write things down right now because the goal is that you get your body engaged, this will help you take a break and help it encode better.

08:14 Moon face, facial hair, mood swings, buffalo hump.

08:18 Good, alright now, we've done all the things up here, let's move down to cardiovascular.

08:24 There's a potential for increased fluids because we'll talk about this in more detail but just trust me on it now, some of the corticosteroids include aldosterone, right? And we have aldosterone that tells your body to hang on to sodium.

08:40 and wherever sodium goes, water follows.

08:43 So you have potential for increased fluids, which means that your blood pressure will likely be a little elevated because I have more volume, I have a higher blood pressure.

08:54 Changing fat distribution, we already talked about the buffalo hump in the back but these people put weight on right in the middle.

09:02 Again, not something anyone has, sometimes they just put weight right around the middle so they'll look kinda like a martini olive on little toothpick when they do that.

09:13 They've got this big fat distribution in the middle.

09:15 It can also be really hard on their bones and their skin.

09:18 So stay with me, we'll restart from the beginning.

09:21 Moon face, facial hair, mood swings, buffalo hump.

09:26 They've got cardiovascular, increased fluids, changing fat distribution, they put it on right around the middle.

09:32 It's really hard on their bones and their skin, and it suppresses growth in children.

09:39 So we want to give the tiniest bit that can be effective for children because we don't want to suppress their growth Okay, those are the major side effects that you need to be aware of in glucocorticoids.

09:51 I promise we'll go over it again in our other video but you need to know this for the respiratory videos, that these are the things that patients would experience.

09:59 Now what I want you to think about is, how would we write an online dating profile for somebody who has moon face, facial hair, mood swings, buffalo hump, increased fluids, fat distribution, really hard on their bones and skin and they're gonna be really really short if they're a kid.

10:19 So we'll look at that more in the endocrine drug presentation, but that's a good review for you to know that even my patients who don't have an endocrine problem, they have a respiratory problem, we put them on these corticosteroids.

10:31 Watch that adrenal gland, educate your patient that, hey if they start noticing these things about themselves: their face becoming fuller, facial hair, they're having a hard time monitoring and mediating their moods, we would expect that.