Corticosteroid Medication

Original Editor - Lucinda hampton Top Contributors - Lucinda hampton

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Introduction

Prednisone.jpg

Corticosteroids are hormones that are produced naturally in the body. They are necessary for the maintenance of homeostasis in the body.

Man-made corticosteroids are a man-made version of hormones normally produced by the adrenal glands. They are mainly used to treat inflammatory diseases and suppress the immune system.

They have a strong anti-inflammatory effect and reduce the swelling and pain in joints and other organs. They do not cure the disease. They should not be confused with male or female steroid hormones, which are known for their misuse among athletes.[1]

Corticosteroids are administered in various ways:

  • tablets (oral steroids)
  • injections – which can be into blood vessels, joints or muscles
  • inhalers – such as mouth or nasal sprays
  • lotions, gels or creams (topical steroids)[2]
The 9 minute video below gives a good overview
[3]

Uses

May be used to reduce inflammation or suppress the immune response. The following conditions are some of the conditions treated:

Corticosteroid.jpg

Corticosteroids with very little mineralocorticoid effect (ie little fluid retention) are used for conditions were fluid retention and oedema want to be kept to a minimum. Conditions include:

  • HACE (high altitude cerebral oedema)
  • Spinal Cord Injury ( within 8 hours)
  • Bacterial Meningitis[4]

Side Effects

Corticosteroids will only be prescribed if the potential benefits of treatment outweigh the risks, at the lowest effective dose for the shortest possible time.

Short term use has few side effects.eg steroid injections, a steroid inhaler, short course of steroid tablets.

Prolonged treatment at high doses – particularly with steroid tablets – cause side effects in some people. Potential side effects of long-term treatment include:[5]

  • loss of muscle mass and Osteoporosis. A 1988 study looking into the "Effects of moderate physical training on prednisone-induced protein wasting" found that moderate exercise training can prevent, at least in part, the protein loss induced by prednisone.ie the osteoporosis and muscle wasting caused by protein wasting.[6]
  • increased fatty deposits
  • reduction in zinc, Vitamin D, and C levels
  • loss of potassium, fluid retention.Corticosteroids with strong mineralocorticoid effects, such as fludrocortisone and hydrocortisone, produce the greatest amount of fluid retention. Corticosteroid-induced fluid retention can be severe enough to cause hypertension, patients with preexisting hypertension may develop a worsening of blood pressure control when commencing these drugs.[7]
  • hypertension, high cholesterol
  • hampering the body’s ability to handle blood sugars, diabetes
  • thinned skin that bruises easily
  • increased risk of infections
  • mood changes, mood swings and depression
  • withdrawal symptoms caused by suppression of the adrenal glands

Physiotherapy Implications

Clients presenting who are/have taken long term corticosteroids should be educated on the ways to help modify the side effects eg advise should be offered re-

  • Exercise older person.jpg
    Osteoporosis; A 2013 systematic review reporting that to to manage osteoporosis clients "may benefit from an exercise program at least 2 to 3 times per week over the course of at least 6 months, and physical therapists should consider helping their clients and patients to plan and design appropriate programs" The types of exercises recommended were high-force, non–weight-bearing exercise, such as progressive resistance training of the lower extremity, strength training and walking.[8]
  • Weight Gain: educate re healthy diet and advocate regularly exercising to try to prevent excessive weight gain.
  • Muscle wasting: starting a strengthening home exercise program to strengthen the major muscle groups would be ideal. The best exercise program would be one that benefited the bones, muscles and blood pressure.
  • Fluid Retention:  educate re swelling of ankles, and provide foot and ankle exercises and if appropriate compression stockings. Blood pressure should be checked regularly, especially if a history of hypertension exists. Dr may need to prescribe diuretics or other medications to manage these problems.
  • Their doctor should be monitoring for the side effects including high cholesterol, BP, blood sugars etc.

Links

Therapeutic Corticosteroid Injections

Corticosteroids in the management of RA

Corticosteroids in the treatment of spinal cord injuries

Conclusion

Corticosteroids (cortisone-like medicines) are used to provide relief for inflammatory conditions. Corticosteroids are very strong medicines. In addition to their helpful effects in treating medical problem, they have side effects that can be very serious. Take note if clients are on these medications and take appropriate precautions with treatment eg osteoporotic bones, fragile skin. Note any adverse effects and notify appropriate medical staff.

References

  1. Australian Rheumatology Association. PATIENT INFORMATION ON PREDNISOLONE & PREDNISONE. Feb 2016. Available from: https://rheumatology.org.au/patients/documents/Prednisolone_2016_005.pdf (last accessed 23.9.2019)
  2. 2.0 2.1 NHS Inform Corticosteroids Available from: https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/corticosteroids (last accessed 23.9.2019)
  3. Instructor Gwin Corticosteroid Medication Available from: https://www.youtube.com/watch?v=aR-Z06L-F10 (last accessed 24.9.2019)
  4. High-Yield Med Reviews Pharmacology - Main Difference in Corticosteroids - by Dr. Busti Available from: https://www.youtube.com/watch?v=SMM2nqwUPsM&app=desktop (last accessed 23.9.2019)
  5. IPPF Handling Prednisone’s Side Effects Naturally Available from: http://www.pemphigus.org/handling-prednisones-side-effects-naturally-2/ (last accessed 23.9.2019)
  6. Garrel DR, Delmas PD, Welsh C, Arnaud MJ, Hamilton SE, Pugeat MM. Effects of moderate physical training on prednisone-induced protein wasting: a study of whole-body and bone protein metabolism. Metabolism. 1988 Mar 1;37(3):257-62.Available from: https://www.ncbi.nlm.nih.gov/pubmed/3257806 (last accessed 23.9.2019)
  7. Medscape Drug-Induced Hypertension 2019.Available from:https://www.medscape.com/viewarticle/582385_4 (last accessed 24.9.2019)
  8. Palombaro KM, Black JD, Buchbinder R, Jette DU. Effectiveness of exercise for managing osteoporosis in women postmenopause. Physical therapy. 2013 Aug 1;93(8):1021-5. Available from: https://academic.oup.com/ptj/article/93/8/1021/2735493 (last accessed 24.9.2019)