Types of Corticosteroids
Prednisone (Orason, Meticorten, Deltasone, Cortan, Sterapred), a synthetic corticosteriod, is most often used to treat lupus. Others include hydrocortisone (Cortef, Hydrocortone), methlyprednisolone (Medrol), and dexamethasone (Decadron). Corticosteroids are available as a topical cream or ointment for skin rashes, as tablets, and as an injectable for intramuscular or intravenous administration.
Mechanism of Action and Use
The frequently prescribed corticosteroids are highly effective in reducing inflammation and suppressing the immune response. These drugs may be used to control exacerbation of symptoms and are used to control severe forms of the disease. The drug is usually administered orally. During periods of serious illness, it may be administered intravenously; once the patient has been stabilized, oral administration should be resumed.
Gastrointestinal: GI irritation, peptic ulcer, and weight gain.
Dermatologic: Thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism,* and urticaria.
Musculoskeletal: Muscle weakness, loss of muscle mass, and osteoporosis.*
Other: Immunosuppression and increased susceptibility to infection.
Pregnancy and Lactation
Corticosteroids cross the placenta, but can be used cautiously during pregnancy. They also appear in breast milk; patients taking large doses should not breastfeed.
Considerations for Health Professionals
Laboratory data: Electrolytes, serum glucose, WBC, cortisol level.
Physical: All body systems to determine baseline data and alterations in function, weekly weight gain of >5 pounds, GI upset, decreased urinary output, increased edema, infection, temperature, pulse irregularities, increased blood pressure, and mental status changes (e.g., aggression or depression).
Therapeutic response, including decreased inflammation and adverse effects.
With food or milk (to decrease GI symptoms).
Immunosuppressive agents are generally used to reduce rejection of transplanted organs. They are also used in serious, systemic cases of lupus in which major organs such as the kidneys are affected or in which there is severe muscle inflammation or intractable arthritis. Because of their steroid-sparing effect, immunosuppressives may also be used to reduce or sometimes eliminate the need for corticosteroids, thereby sparing the patient from undesirable side effects of corticosteroid therapy.