NCLEX Review Guide: Pharmacology - Endocrine System: Glucocorticoids

Mechanism of Action & Classification

• Glucocorticoids are synthetic or natural corticosteroids that mimic cortisol, suppressing inflammatory and immune responses by inhibiting phospholipase A2 and reducing cytokine production.
• Common medications include prednisone, prednisolone, methylprednisolone, dexamethasone, and hydrocortisone, with varying potencies and durations of action.
• These medications have both glucocorticoid (anti-inflammatory) and mineralocorticoid (sodium retention) effects, though synthetic forms are designed to minimize mineralocorticoid activity.

Therapeutic Uses

• Primary indications include inflammatory conditions (rheumatoid arthritis, inflammatory bowel disease), allergic reactions, asthma exacerbations, and autoimmune disorders.
• Used for replacement therapy in adrenal insufficiency (Addison's disease) and congenital adrenal hyperplasia to replace deficient cortisol production.
• Emergency uses include severe allergic reactions, status asthmaticus, and cerebral edema where rapid anti-inflammatory action is critical.

Major Side Effects

• Immunosuppression increases infection risk, requiring monitoring for signs of infection and avoiding live vaccines during treatment.
• Metabolic effects include hyperglycemia, sodium retention, potassium loss, and increased appetite leading to weight gain.
• Long-term use causes Cushing's syndrome with moon face, buffalo hump, purple striae, osteoporosis, and muscle weakness.
• Psychiatric effects range from mood swings and euphoria to severe depression and psychosis, particularly with high doses.

Critical Nursing Actions

1. Administer with food or milk to minimize gastric irritation and reduce risk of peptic ulcer formation.
2. Monitor vital signs, especially blood pressure and blood glucose levels, as corticosteroids can cause hypertension and hyperglycemia.
3. Never abruptly discontinue long-term corticosteroid therapy - must taper gradually to prevent adrenal crisis.
4. Assess for signs of infection regularly, as corticosteroids mask inflammatory responses and increase susceptibility to infections.
5. Monitor electrolytes, particularly sodium and potassium levels, and watch for signs of fluid retention or hypokalemia.

NCLEX Success Strategies

• Remember the "3 S's" for steroid side effects: Susceptibility to infection, Sugar elevation (hyperglycemia), and Sodium retention.
• For tapering schedules, think "slow and steady" - abrupt discontinuation can cause life-threatening adrenal crisis.
• Associate morning administration with natural cortisol peaks to minimize sleep disturbances and HPA axis suppression.