Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (264 page)
(meth-il-pred-niss′oh-lone)
A-Methapred, Depo-Medrol, Medrol, Solu-Medrol
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Glucocorticoid, immediate acting
Do not confuse:
methylPREDNISolone
/predniSONE/medroxyPROGESTERone/methylTESTOSTERone
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization
Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis
Unlabeled uses:
Multiple myeloma, bronchospasm prophylaxis, airway-obstructing hemangioma, noncardiogenic pulmonary edema, idiopathic pulmonary fibrosis, carpal tunnel syndrome, temporal arteritis, Churg-Strauss syndrome, mixed connective-tissue disease, polyarteritis nodosa, relapsing polychondritis, polymyalgia rheumatica, vasculitis, Weg-ener’s granulomatosis,
Pneumocystis jiroveci
pneumonia in AIDS patients, acute spinal cord injury, severe acute res-piratory syndrome (SARS), acute interstitial nephritis
Hypersensitivity, intrathecal use, neonates
Precautions:
Pregnancy (C), breastfeeding, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, tartrazine, benzyl alcohol, corticosteroid hypersensitivity, viral infection, TB, traumatic brain injury, Cushing’s syndrome, measles, varicella, fungal infections
Calculator
• Adult:
PO
4-48 mg in 4 divided doses;
IM
10-80 mg (acetate);
IM/IV
10-250 mg (succinate);
INTRAARTICULAR
4-80 mg (acetate)
• Child:
IV
0.5-1.7 mg/kg in 3-4 divided doses (succinate)
• Adult:
PO
160 mg/day × 1 wk then 64 mg every other day × 30 days
• Adult:
PO
4-48 mg/day in 4 divided doses;
IM
10-120 mg (acetate);
IV
10-40 mg over several min (sodium succinate)
• Child:
PO/IM
0.5-1.7 mg/kg or 5-25 mg/m
2
/day in divided doses q6-12hr
• Adult and adolescent:
PO/IV
40-80 mg/day in 1-2 divided doses
• Child:
PO/IV
1 mg/kg in 2 divided doses (max 60 mg)
• Child:
PO
0.5-1.7 mg/kg or 5-25 mg/m
2
/day in divided doses q6-12hr
• Adult:
IV
1-2 g/wk or every other week
• Adult:
INJ
(local) 40-80 mg as a single inj
Available forms:
Tabs 2, 4, 8, 16, 24, 32 mg; inj 20, 40, 80 mg/ml acetate; inj 40, 125, 500, 1000, 2000 mg/vial succinate
•
Titrated dose; use lowest effective dose
•
With food or milk to decrease GI symptoms (PO)
•
Once-a-day dose should be given in
AM
to coincide with body’s normal cortisol secretion
•
IM inj deep in large muscle mass; rotate sites; avoid deltoid; use 21G needle; after shaking suspension (parenteral); inj site reaction may occur (induration, pain at site, atrophy)
•
In one dose in
AM
to prevent adrenal suppression; avoid SUBCUT administration; may damage tissue
Do not give Solu-Medrol intrathecally
•
Use only Solu-Medrol, never use acetate product
•
Use only methylPREDNISolone sodium succinate (Solu-Medrol) IV, never use methylPREDNISolone acetate suspension IV
•
After diluting with diluent provided; agitate slowly; give ≤500 mg/≥1 min directly over 3-15 min; doses ≥2 mg/kg or 250 mg should be given by intermittent IV infusion unless potential benefits outweigh risks
•
Dilute further in D5W, NS, D5NS; haze may form, give over 15-60 min; large dose (≥500 mg) should be given over 30-60 min
Syringe compatibilities:
Granisetron, metoclopramide
Y-site compatibilities:
Acyclovir, amifostine, amphotericin B cholesteryl, amrinone, aztreonam, cefepime, CISplatin, cladribine, cyclophosphamide, cytarabine, DOPamine, DOXOrubicin, enalaprilat, famotidine, fludarabine, grani-setron, heparin, melphalan, meperidine, methotrexate, metroNIDAZOLE, midazolam, morphine, piperacillin/tazobactam, remifentanil, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa
CNS:
Depression, flushing, sweating, headache, mood changes
CV:
Hypertension,
circulatory collapse, thrombophlebitis, embolism,
tachycardia
EENT:
Fungal infections, increased intraocular pressure, blurred vision, cataracts
GI:
Diarrhea, nausea, abdominal distention,
GI hemorrhage,
increased appetite, pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Acne, poor wound healing, ecchymosis, petechiae
MS:
Fractures, osteoporosis, weakness
Half-life >3½ hr (plasma), 18-36 hr (tissue); crosses placenta, enters breast milk in small amounts; metabolized in liver; excreted by kidneys (unchanged)
PO:
Peak 1-2 hr, duration 1½ days, well absorbed
IM:
Peak 4-8 days, duration 1-4 wk, well absorbed
Intraarticular:
Peak 1 wk
Increase:
side effects—amphotericin B, diuretics
Increase:
methylPREDNISolone action—oral contraceptives, estrogens
Increase:
adrenal suppression—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)
Decrease:
methylPREDNISolone effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
Decrease:
effects of antidiabetics, vaccines, somatrem
•
Avoid use with St. John’s wort
•
Do not use with grapefruit juice; level of methylPREDNISolone will be increased
Increase:
cholesterol, blood glucose
Decrease:
Calcium, potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS
False negative:
skin allergy tests
•
Potassium depletion:
parethesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
Edema, hypertension, cardiac symptoms
•
Mental status: affect, mood, behavioral changes, aggression
•
Potassium, blood glucose, urine glucose while receiving long-term therapy; hypokalemia and hyperglycemia
•
Joint mobility, pain, edema if product given intraarticularly
•
B/P q4hr, pulse; notify prescriber of chest pain, crackles
•
I&O ratio; be alert for decreasing urinary output, increasing edema; weight daily; notify prescriber of weekly gain >5 lb
Adrenal insufficiency:
weight loss, nausea, vomiting, confusion, anxiety, hypotension, weakness; plasma cortisol levels during long-term therapy (normal level: 138-635 nmol/L SI units when drawn at 8
AM
)
•
Growth in children receiving long-term treatment
•
Infection:
increased temp, WBC, even after withdrawal of product; product masks infection
•
Therapeutic response: ease of respirations, decreased inflammation; decreased symptoms of adrenal insufficiency
•
To increase intake of potassium, calcium, protein
•
To carry emergency ID as corticosteroid user
•
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed
Not to discontinue abruptly because adrenal crisis can result
•
To take PO with food, milk to decrease GI symptoms
•
To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber; to avoid vaccinations because immunosuppression occurs
•
Adrenal insufficiency:
nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain
•
Cushingoid symptoms:
buffalo hump, moon face, rapid weight gain, excess sweating
•
Infection:
to avoid persons with known infections; corticosteroids can mask symptoms of infection
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert