Corticosteroids: Mineralocorticoids and Glucocorticoids (Nursing)

00:01 So, with corticosteroids, we have 2 types: we have mineralocorticoids, and we have glucocorticoids.

00:08 So, that's why you see the 2 columns on your screen.

00:12 Mineralocorticoids are like aldosterone, and glucocorticoids are like cortisol.

00:20 So, let's look at what each one of these special group does.

00:25 Aldosterone controls electrolyte and water levels.

00:29 Think specifically, sodium.

00:31 So, write Na or spell out the word "sodium" above that just to help you remember.

00:37 Now, how it promotes sodium retention in the kidneys, which means when aldosterone is present, then that -- the kidneys know to reabsorb more sodium.

00:48 And wherever sodium goes, water follows.

00:51 So, now I have more volume on board.

00:54 Remember, when I have more volume in my intravascular space, my blood pressure is likely to be elevated.

01:02 Now, the second type of corticosteroids -- mineralocorticoids was aldosterone, glucocorticoids is cortisol.

01:10 And usually, the effect we're after is number 2.

01:13 So, put a star after that.

01:15 Most often, when we give corticosteroids, what we want to do is go after the cortisol effect.

01:21 Now, we end up with some carb, fat, and protein metabolism, but there's what we're looking for, that second point.

01:28 We want the anti-inflammatory response.

01:31 We want less eosinophil action.

01:33 We give glucocorticoids to suppress inflammation in lots of diseases and states.

01:41 So, make sure you make a special note that although we get all these other effects sometimes along with it, they're not the therapeutic intended effect.

01:52 Now, if the patient's adrenal gland is done, it's shot, then, yeah, we're going to have to replace all these things.

01:57 But for the majority of our patients, we're going to be looking for that anti-inflammatory effect.

02:03 That is the therapeutic goal for using corticosteroids.

02:08 Now, I put this chart up here, but I don't want it to overwhelm you.

02:11 I just want you to kind of see.

02:13 Look at the very top.

02:15 You have hydrocortisone or cortisol.

02:18 Its glucocorticoid potency is 1.

02:20 Its mineralocorticoid potency is 1, okay? So, the duration of hours is just kind of good-to-know information there.

02:27 But what I want you to focus in on are those first 2 columns.

02:31 Now you can see with that medication, we've got a 1:1 ratio.

02:34 We've got just as much glucocorticoid potency as we do mineralocorticoid.

02:40 Every drug listed under hydrocortisone is a comparison of that.

02:45 So prednisone has 3.5-5 a times of effect of glucocorticoid potency, and 0.8 of mineralocorticoid.

02:56 Hey, now, why would we do that? Well, we talked about what we're looking for is the anti-inflammatory effect.

03:03 We don't necessarily want the mineralocorticoid sodium water effect.

03:08 That's why, in making these new medications, you can see as we progress, look all the way at the bottom.

03:15 Dexamethasone is 25-80 for glucocorticoid potency, where we've got 0 for mineralocorticoid.

03:24 So, it depends on what effect we're trying to get from the patient.

03:28 Dexamethasone is a pretty strong one as far as glucocorticoid potency, and they've eliminated the mineralocorticoid.

03:35 Do not spend time memorizing this chart.

03:39 This is just here for you to have kind of the idea that we use cortisone as a standard, and that the other glucocorticoids that we have tend to have higher glucocorticoid potency, and lower mineralocorticoid potency.

03:54 Okay.

03:55 So, what specifically do we use to treat corticosteroids for? Well, hang on because there is a very long list here.

04:04 We can use it for joint pain and inflammation, arthritis, dermatitis, allergic reactions, asthma, hepatitis, lupus, inflammatory bowel disease, sarcoidosis, glucocorticoid replacement for Addison's disease.

04:18 And sometimes, I think we just give it when we don't know what else to do, we try corticosteroids, okay? So, we use it -- This is a partial list.

04:27 This isn't even a complete list of all the opportunities we use with corticosteroids.

04:33 But the undesired effect is that we end up with a drug induced Cushing's syndrome.

04:39 It's not what we want.

04:41 We'd love to be able to just be more selective about getting that anti-inflammatory response.

04:46 But remember back to that chart, we've tried to tweak that with medications, but you're still going to have some other undesired effects.