Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (124 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(dex-ah-meth′a-sone)
Baycadron, Decadron, Dexasone
, DexPak, Maxidex
phosphate (Rx)
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Glucocorticoid, long acting
Do not confuse:
Decadron
/Percodan
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stabilization, suppresses normal immune response, no mineralocorticoid effects
Inflammation, allergies, neoplasms, cerebral edema, septic shock, collagen disorders, dexamethasone suppression test for Cushing Syndrome, adrenocortical insufficiency, TB, meningitis, acute exacerbations of MS
Hypersensitivity to corticosteroids, sulfites or benzyl alcohol; fungal infections, abrupt discontinuation, coagulopathy, ulcerative colitis, seizure disorders
Precautions:
Pregnancy (C), breastfeeding, diabetes mellitus, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, peptic ulcer, esophagitis, recent MI, hypertension, TB, active hepatitis, psychosis, sulfite hypersensitivity, thromboembolic disorders
Calculator
•
Adult: PO
0.75-9 mg/day in divided doses q6-12hr or phosphate
IM
0.5-9 mg/day divided q6-12hr
• Child: PO
0.024-0.34 mg/kg/day in divided doses q6-12hr
•
Adult: IV
(Phosphate) single dose 1-6 mg/kg or
IV
40 mg q2-6hr as needed up to 72 hr
•
Adult: IV
(Phosphate) 10 mg, then 4-6 mg
IM
q6hr × 2-4 days, then taper over 1 wk
• Child:
Loading dose 1-2 mg/kg
(PO/IM/IV)
then 1-1.5 mg/kg/day, max 16 mg/day divided q4-6hr for 2-4 days, then taper down weekly
•
Adult: PO
0.75-9 mg/day in divided doses
• Child: PO
0.03-0.3 mg/kg/day in 2-4 divided doses
•
Adult: PO
1 mg at 11
PM
or 0.5 mg q6hr × 48 hr
•
Adult: IM/IV
(phosphate) 0.5-9 mg/day in 2-4 divided doses
• Child: IM/IV
0.06-0.3 mg/kg/day or 1.2-10 mg/m
2
in divided doses q6-12hr
•
Adult: PO/IV
12-20 mg/day in divided doses
• Child and infant >2 mo: IV
0.15 mg/kg qid × first 2 days of antibiotics
Available forms:
Dexamethasone:
tabs 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elix 0.5 mg/5 ml; oral sol 0.5 mg/5 ml, 1 mg/1 ml;
sodium phosphate:
4, 10 mg/ml; ophth implant 0.7 mg; ophth susp drops/solution 0.1%
•
Titrated dose; use lowest effective dose
•
With food or milk to decrease GI symptoms
•
IM inj deeply in large muscle mass; rotate sites; avoid deltoid; use 21G needle
•
In 1 dose in
AM
to prevent adrenal suppression; avoid SUBCUT administration, may damage tissue
•
Undiluted direct over ≤1 min
•
Diluted with 0.9% NaCl or D
5
W, give as IV inf at prescribed rate
Acetaminophen, caffeine, dimenhydrAMINE, furosemide, granisetron, hyaluronidase, ketamine, metoclopramide, octreotide, oxyCODONE, palonosetron, ranitidine, salbutamol, SUFentanil, traMADol
Y-site compatibilities:
Acetaminophen, acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, ami
nophylline, amphotericin B cholesteryl, amphotericin B lipid complex, amphotericin B liposome, amsacrine, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, caffeine, CARBOplatin, carmustine, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefpirome, ceftaroline, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, chloramphenicol, cimetidine, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexmedetomidine, digoxin, diltiazem, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, DOXOrubicin liposomal, enalaprilat, ePHEDrine, EPINEPHrine, epoetin alfa, eptifibatide, ertapenem, etoposide, etoposide phosphate, famotidine, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, fosaprepitant, foscarnet, furosemide, ganciclovir, gatifloxacin, gemcitabine, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, lansoprazole, leucovorin, levofloxacin, lidocaine, linezolid, liposome, LORazepam, LR, mannitol, mechlorethamine, melphalan, meropenem, metaraminol, methadone, methicillin, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, milrinone, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxyCODONE, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, PEMEtrexed, penicillin G potassium/sodium, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, potassium chloride, procainamide, propofol, propranolol, pyridoxine, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, sargramostim, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tolazoline, topotecan, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voriconazole, zidovudine, zoledronic acid
CNS:
Depression, flushing, sweating
, headache, mood changes, euphoria, psychosis,
seizures,
insomnia,
pseudotumor cerebri
CV:
Hypertension
,
circulatory collapse,
tachycardia, edema, cardiomyopathy,
thromboembolism, heart failure, dysrhythmias
EENT:
Fungal infections, increased intraocular pressure, blurred vision, cataracts, glaucoma
ENDO:
HPA suppression, hyperglycemia, sodium, fluid retention
GI:
Diarrhea, nausea, abdominal distention
,
GI hemorrhage,
increased appetite
,
pancreatitis
HEMA:
Thrombocytopenia,
transient leukocytosis,
thromboembolism
INTEG:
Acne, poor wound healing, ecchymosis, petechiae, hirsutism,
angioedema
META:
Hypokalemia
MS:
Fractures, osteoporosis, weakness, arthralgia, myopathy
Half-life 1-2 days
PO:
Onset 1 hr, peak 1-2 hr, duration 2½ days
IM:
Duration 2 days-3 wk
Increase:
toxicity—cycloSPORINE
Increase:
side effects—alcohol, salicylates, amphotericin B, digoxin, cycloSPORINE, diuretics, NSAIDs
Increase:
dexamethasone action—salicylates, estrogens, indomethacin, hormonal contraceptives, ketoconazole, macrolide antiinfectives, NSAIDs
Increase:
tendinitis tendon rupture risk—quinolones
Increase:
effect of—antidiabetics
Decrease:
dexamethasone action—cholestyramine, colestipol, barbiturates, rifampin, ePHEDrine, phenytoin, theophylline, antacids, bosentan, carBAMazepine, ethotoin
Decrease:
anticoagulant effect—anticonvulsants, antidiabetics, ambenonium, neostigmine, isoniazid, toxoids, vaccines, anticholinesterases, salicylates, somatrem
Decrease:
potassium levels—thiazide diuretics
Increase:
cholesterol, sodium, blood glucose, uric acid, calcium
Decrease:
calcium, potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS, PBI
False negative:
skin allergy tests
•
Potassium, blood, urine glucose while receiving long-term therapy; hypo/hyperglycemia
•
Weight daily; notify prescriber of weekly gain >5 lb
•
B/P, pulse; notify prescriber of chest pain
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Cushingoid symptoms:
Assess for buffalo hump, moon face, increased B/P; monitor; plasma cortisol levels during long-term therapy (normal: 138-635 nmol/L SI units when drawn at 8
AM
); prolonged use can cause cushingoid symptoms
•
Infection:
fever, WBC even after withdrawal of medication; product masks infection
•
Potassium depletion:
paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
Edema, hypertension, cardiac symptoms
•
Mental status:
affect, mood, behavioral changes, aggression
•
Abrupt withdrawal:
acute adrenal insufficiency and death may occur following abrupt discontinuation of systemic therapy; withdraw gradually
•
Therapeutic response: decreased inflammation
•
That ID as corticosteroid user should be carried
•
To contact prescriber if surgery, trauma, stress occurs because dose may need to be adjusted
•
To notify prescriber if therapeutic response decreases because dosage adjustment may be needed
•
To take with food or milk
•
That bruising may occur easily
•
That if on long-term therapy a high protein diet may be needed
Not to discontinue abruptly because
adrenal crisis
can result
•
About symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain
•
To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber
•
About all aspects of product usage, including cushingoid symptoms; to notify health care provider of infection
•
To avoid exposure to chickenpox or measles, persons with infection