Long-Term Steroid Use? Teach Five (5) Things

Corticosteroids, or just steroids, can be prescribed for a wide-range of conditions. For patients with cancer, steroids can be prescribed for the following reasons:

Increase potency and effectiveness of some chemotherapy agents
Reduce nausea and vomiting caused by chemotherapy
Decrease risk of allergic reactions to chemotherapy
Stimulate appetite
Reduce pain associated caused by inflammation
Treatment for some bone marrow cancers

What are steroids?

Steroids mimic the effects of hormones produced by the adrenal glands. Some common examples are dexamethasone, hydrocortisone and prednisone, among others, which are used for anti-inflammatory effect. These are commonly prescribed for arthritis, asthma and other allergic and inflammatory conditions. These can also prevent organ rejection on patients who have undergone organ transplant.

Patient Teaching for Long Term Steroid Use

1. Administration: Instruct patient to take in the morning to coincide with the body’s natural cortisol secretion cycle. Take with food to avoid stomach upset. Adhere to a low-sodium diet secondary to fluid retention and increase in blood pressure

2. Monitor: for high blood pressure and weight gain. Report stomach pain and/or heartburn to medical team. Report black, tarry stools. Do not take with Aspirin or non-steroidal anti-inflammatory medications.

3. Avoid sick people! Steroids suppress the immune system. Report fever, chills, cough, increased fatigue, dizziness, pain with urination, frequent urination.

4. Never stop taking prescribed steroid abruptly. The prescription must be tapered down to prevent serious complications.

5. Where a Steroid-specific Medical Alert bracelet to notify first responders and others in the event of an emergency.

What are the side effects associated with long-term steroid use?

Here’s a quick way to remember them:

C – Cushing’s Syndrome
O – Osteoporosis
R – Retention of Water and Sodium
T – Teratogenic Effects
I – Insulin Resistance and diabetes
C – Cataracts and Glaucoma
O – Opportunistic Infections
S – Suppressed Immune System
T – Topical Steroid Addiction
E – Elevated Blood Pressure
R – Risk for Cardiac Diseases.
O – Obesity
I – Inhibits Growth Hormones
D – Depression
S – Stress

Cushing’s Syndrome. This is caused by excessive cortisol-like medications like Prednisone. This is characterized by round face, high blood pressure, abdominal obesity with thin legs and arms, stretchmarks, acne and fragile skin (Wikipedia).

Osteoporosis. Always watch out for signs of osteoporosis. Provide patient teachings on prevention of further bone loss.

Retention of Water and Sodium. Take the weight of the patient daily to determine the amount of excess fluid in the body. Patient teachings should include modifications on the diet i.e. low sodium.

Teratogenic Effects. Corticosteroids are contraindicated in pregnancy. Educate patients that their medication may cause birth defects, and therefore, birth control is encouraged.

Insulin Resistance and Diabetes Mellitus. Corticosteroids promote production of glucose, so if the patient does not have an existing diagnosis for DM, perform routine blood glucose checking to monitor signs of irregular glucose levels.

Cataracts and Glaucoma. Steroids can cause cataracts or glaucoma or worsen these conditions if already present.

Opportunistic Infections. Be sure to include infection control best practices in the patient teaching plan. Always monitor for signs of infections like fever and cough.

Suppressed Immune System. Encourage yearly flu and pneumonia vaccinations. Provide a list of foods that are good in boosting immune system like citrus fruits, red bell peppers, brocolli, garlic, ginger, spinach, etc (HealthLine).

Topical Steroid Addiction (TSA). TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription (Fukaya, "Topical steroid addiction in atopic dermatitis". Drug, healthcare and patient safety.)

Elevated Blood Pressure. Hypertension is caused by fluid and sodium retention. In some instances, diuretics are prescribed.

Risk for Cardiac Diseases. The risk for the development of atherosclerosis is significant on patients who have been taking steroid for more than a year and in high doses. Encourage the patient to modify lifestyle including diet and exercise to prevent heart diseases.

Obesity. Steroids slow down metabolism and increase appetite and lead to fat deposits on the abdomen. Teach patient how to count and limit daily caloric intake, and address self-esteem issues.

Inhibits Growth Hormones. Use of inhaled corticosteroids among children with asthma may result in decreased height.

Depression. Patients may experience neuropsychiatric effects like euphoria, anxiety or depression. Encourage patient to verbalize thoughts and establish support system.

Stress. Ability to respond to stress can be altered by steroids because adrenal glands may not react normally as they should in times of stress. Help the patient plan on effective coping strategies.

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References: Fukaya, M; Sato, K; Sato, M; Kimata, H; Fujisawa, S; Dozono, H; Yoshizawa, J; Minaguchi, S (2014). "Topical steroid addiction in atopic dermatitis". Drug, healthcare and patient safety. 6: 131–8. Zhang, L; Prietsch, SO; Ducharme, FM (Jul 17, 2014). "Inhaled corticosteroids in children with persistent asthma: effects on growth".Healthline: https://www.healthline.com/health/food-nutrition/foods-that-boost-the-immune-system#ginger https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp