Medicine & USMLE

Inhaled Steroids

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  1. Terbutaline
  2. Radioactive Iodine
  3. Ipratropium / Tiotropium
  4. Levothyroxine
  5. Second Generation Antihistamines
  6. First Generation Antihistamines (Diphenhydramine)
  7. Inhaled Steroids
  8. Antitussives
  9. Hypokalemia

Summary

Inhaled steroids include the drugs budesonide, fluticasone, and beclomethasone. They have anti-inflammatory effects that are useful in treating asthma. Inhaled steroids are long-acting drugs, meaning they act slowly and are best suited for maintenance treatment, and not for acute exacerbations. When prescribed together with a beta-2 agonist, the steroid should be taken after the beta-2 agonist. The biggest side effect of inhaled steroids is oral candidiasis, which can be prevented by rinsing out the mouth after each use.

Key Points

  • Inhaled Steroids (Glucocorticoids)
    • Key Drugs
      • Fluticasone
      • Beclomethasone
      • Budesonide
      • Mometasone
      • Ciclesonide
    • Mechanism
      • Anti-inflammatory
        • When inhaled, steroids work to reduce bronchial inflammation
    • Clinical Use
      • Asthma
        • Long-term management; Used for maintenance therapy.
        • Cannot treat acute exacerbations; not a rescue medication
        • When a client is prescribed both a beta-2 agonist and an inhaled glucocorticoid, the beta-2 agonist should be administered first, followed by the steroid
          • The beta-2 agonist will open the bronchioles, allowing for better absorption of the glucocorticoid
    • Side Effects
      • Oral Candidiasis
        • Also called thrush, caused by candida albicans
        • A white furry coating inside the mouth
        • Can be prevented by using a spacer and rinsing mouth after inhalation
      • Local irritation
        • Hoarseness
        • Dry mouth
        • Coughing