Corticosteroids are a class of drug that are used to reduce inflammation in the

body as well as to control overactive immune system activity and hormonal

imbalances.
Cortisol plays an important role in metabolism, as well as in immune and stress
response.There are two classifications of corticosteroids – glucocorticoids and
mineralocorticoids.

1. Glucocorticoids – a subclass of corticosteroids that are potent inhibitors of

inflammation. They prevent the release of chemicals associated with
inflammation.
2. Mineralocorticoids – these drugs act on the water and electrolyte balance in the
body.
Corticosteroids can also be categorized as systemic and localized corticosteroids.
Systemic corticosteroids are commonly given orally or through injection and their
effects are multi-systemic.

On the other hand, localized steroids are given topically, as drops, or inhaled to
particularly act on an organ or organ system.

Drug Interactions with Corticosteroids

The following are the medications that interact with corticosteroids:

 Erythromycin, ketoconazole, clarithromycin – these drugs reduce the metabolism

of corticosteroids in the liver. This metabolism increases the side effects of
corticosteroids as well as the drug levels in the blood.
 Phenobarbital, ephedrine, phenytoin, rifampicin – these drugs increase
metabolism of corticosteroids in the liver leading to reduced blood.
 Estrogen – decreases liver metabolism of corticosteroids leading to an increase in
blood levels.
 Warfarin – interacts with corticosteroids which brings the need for a more
frequent monitoring of blood coagulation.
Nursing Care Plans for Patients on Corticosteroids

1. Possible Nursing Diagnoses

2. Risk for Electrolyte Imbalance (Hypokalemia)
3. Risk for Fluid Retention
4. Disturbed Body Image
5. Risk of hyperglycemia
6. Risk for Sleep Deprivation
7. Risk for Infection related to slow wound healing as a side effect of
corticosteroids.

Nursing Planning and Intervention

Check the patient’s serum potassium levels.

Check for current medications that include diuretics, laxatives, high doses of certain
antibiotics and insulin as these should be used cautiously with corticosteroids.
An increased risk of hypokalemia may occur when corticosteroids are administered
with other medications that reduce potassium levels like diuretics, laxatives, high doses
of certain antibiotics and insulin.
Caution is highly warranted as hypokalemia is greatly associated with dysrhythmia and
heart failure.
Check medical history for diabetes or myasthenia gravis. Corticosteroids can increase
serum glucose levels. Corticosteroids given with anticholinesterase can cause severe
weakness in individuals diagnosed with myasthenia gravis.

Towards the end of the course of corticosteroids, inform the patient if the steroids need
to be tapered down.

Administer corticosteroids in the morning with breakfast.

For topical steroids, advise the lactating mother to wash off any steroid cream from the
skin prior to feeding the baby.

Routinely check for the blood glucose level of the patient, especially if they are diabetic
Monitor the patient’s response to corticosteroids.

Monitor the patient’s input and output. Corticosteroids may cause fluid retention as
evidenced by edema/ swelling.

Taking NSAIDs and steroids may increase the risk for internal gastrointestinal
bleeding and stomach ulcers. A PPI cover needs to be  considered prior to combining
these drugs,

Advise the patient to rinse the mouth with water after using steroid inhalers.

Monitor the patient’s serum electrolyte levels and renal function.