Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (328 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pred-niss′oh-lone)
Flo-Pred, Millipred, Orapred, Orapred ODT, Veripred
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Glucocorticoid, immediate acting
Do not confuse:
prednisoLONE
/predniSONE
Decreases inflammation by the suppression of migration of polymorphonuclear leukocytes, fibroblasts; reversal to increase capillary permeability and lysosomal stabilization
Severe inflammation, immunosuppression, neoplasms
Hypersensitivity, fungal infections, viral infection, varicella
Precautions:
Pregnancy (C), breastfeeding, children, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, abrupt discontinuation, children, acute MI, GI ulcers, hypertension, hepatitis, psychosis
Calculator
• Adult:
PO
5-60 mg/day or in divided doses
• Adult:
PO
40-80 mg/day in 1-2 divided doses
• Child:
PO
1 mg/kg/day in 2 divided doses
Available forms:
Tabs 5 mg; oral dissolving tab 10, 15, 30 mg; oral sol 5 mg/5 ml, 10 mg/5 ml, 15 mg/5 ml, 25 mg/5 ml; syrup 5 mg/5 ml
•
Oral sol:
use calibrated measuring device
•
Orally disintegrating tabs:
place on tongue; allow to dissolve, swallow or swallow whole; do not cut, split
CNS:
Depression
, flushing, sweating, headache, mood changes
CV:
Hypertension
,
circulatory collapse, thrombophlebitis, embolism,
tachycardia
EENT:
Fungal infections, increased intraocular pressure, blurred vision
GI:
Diarrhea, nausea, abdominal distention
,
GI hemorrhage,
increased appetite,
pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Acne, poor wound healing, ecchymosis, petechiae
MS:
Fractures, osteoporosis, weakness, arthralgia, myopathy, tendon rupture
PO:
Peak 1-2 hr, duration 2 days
Increase:
side effects—alcohol, salicylates, indomethacin, amphotericin B, digitalis, cycloSPORINE, diuretics
Increase:
prednisoLONE action—salicylates, estrogens, indomethacin, oral contraceptives, ketoconazole, macrolide antibiotics
Increase:
toxicity—azole antifungals, cycloSPORINE
Decrease:
prednisoLONE action—cholestyramine, colestipol, barbiturates, rifampin, ePHEDrine, phenytoin, theophylline
Decrease:
effects of anticoagulants, anticonvulsants, antidiabetics, ambenonium, neostigmine, isoniazid, toxoids, vaccines, anticholinesterases, salicylates, somatrem
Increase:
cholesterol, sodium, blood glucose, uric acid, calcium, urine glucose
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 glucose, urine glucose while patient receiving long-term therapy; hypokalemia, hyperglycemia
•
Weight daily; notify prescriber if weekly gain of >5 lb
•
B/P q4hr, pulse; notify prescriber if chest pain occurs
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Plasma cortisol levels with long-term therapy; normal level: 138-635 nmol/L SI units when drawn at 8
AM
•
Infection:
increased temp, 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
• Adrenal insufficiency:
nausea, vomiting, lethargy, restlessness, confusion, weight loss, hypotension before, during treatment; HPA suppression may be precipitated by abrupt withdrawal
•
Therapeutic response: ease of respirations, decreased inflammation
•
That emergency ID as steroid user should be carried
•
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed
•
Not to discontinue abruptly; that adrenal crisis can result; to take product exactly as prescribed
•
To avoid OTC products: salicylates, cough products with alcohol, cold preparations unless directed by prescriber
•
About cushingoid symptoms
• About the symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(pred′ni-sone)
Rayos, Winpred
Func. class.:
Corticosteroid
Chem. class.:
Intermediate-acting glucocorticoid
Do not confuse:
predniSONE
/methylPREDNISolone/prednisoLONE/PriLOSEC
Decreases inflammation by increasing capillary permeability, and lysosomal stabilization, minimal mineralocorticoid activity
Severe inflammation, immunosuppression, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders
Unlabeled uses:
Adjunct for refractory seizures, infantile spasms, acute interstitial nephritis, amyloidosis, autoimmune hepatitis, Behçet’s syndrome, Bell’s palsy, carpal tunnel syndrome, Churg-Strauss syndrome, dermatomyositis, Duchenne muscular dystrophy, endophthalmitis, Lennox-Gastaut syndrome, lupus nephritis, mixed connective-tissue disease, pericarditis, pneumonia, polyarteritis nodosa, polychondritis, polymyositis, pulmonary fibrosis, rheumatic carditis, temporal arteritis, TB, Wegener’s granulomatosis
Fungal infections
Precautions:
Pregnancy (C), diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, cataracts, coagulopathy, abrupt discontinuation, children, corticosteroid hypertensitivity, Cushing’s syndrome, diabetes mellitus, ulcerative colitis
Calculator
• Adult:
PO
5-60 mg/day or divided bid-qid
• Child:
PO
0.05-2 mg/kg/day divided 1-4×/day
• Child:
PO
2 mg/kg/day in divided doses, max 28 days, then 1-1.5 mg/kg/day every other day × 4 wk
• Adult:
PO
200 mg/day × 1 wk then 80 mg every other day × 1 mo
Available forms:
Tabs 1, 2.5, 5, 10, 20, 50 mg; oral sol 5 mg/5 ml; syr 5 mg/5 ml, del rel tab 1, 2, 5 mg
•
For long-term use, alternate-day therapy recommended to decrease adverse reactions; give in
AM
to coincide with normal cortisol secretion
•
Titrated dose; use lowest effective dose
•
With food or milk to decrease GI symptoms
•
Oral sol:
use calibrated measuring device
•
Del rel tab:
swallow whole, do not break, crush, chew; give once a day
CNS:
Depression, flushing, sweating, headache, mood changes
CV:
Hypertension,
circulatory collapse, thrombophlebitis, embolism,
tachycardia
EENT:
Fungal infections, increased intraocular pressure, blurred vision
GI:
Diarrhea, nausea, abdominal distention,
GI hemorrhage,
increased appetite, pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Acne, poor wound healing, ecchymosis, petechiae
META:
Hyperglycemia
MS:
Fractures, osteoporosis, weakness
PO:
Well absorbed PO, peak 1-2 hr, duration 1-1½ days, half-life 3½-4 hr, biologic terminal half-life 18-36 hr, crosses placenta, enters breast milk, metabolized by liver after conversion, excreted in urine
Increase:
side effects—alcohol, salicylates, indomethacin, amphotericin B, digoxin, cycloSPORINE, diuretics
Increase:
predniSONE action—salicylates, estrogens, indomethacin, oral contraceptives, ketoconazole, macrolide antiinfectives
Decrease:
predniSONE action—cholestyramine, colestipol, barbiturates, rifampin, ePHEDrine, phenytoin, theophylline
Decrease:
effects of anticoagulants, anticonvulsants, antidiabetics, ambenonium, neostigmine, isoniazid, toxoids, vaccines, anticholinesterases, salicylates, somatrem
Decrease:
predniSONE effect—ephedra (ma huang)
Increase:
cholesterol, sodium, blood glucose, uric acid, calcium, urine glucose
Decrease:
calcium, potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS, PBI
False negative:
skin allergy tests
•
Adrenal insufficiency:
nausea, vomiting, anorexia, confusion, hypotension, weight loss before, during treatment; HPA suppression may be precipitated by abrupt withdrawal
•
Potassium, blood glucose, urine glucose while patient receiving long-term therapy; hypokalemia and hyperglycemia; plasma cortisol with long-term therapy, normal: 138-635 nmol/L SI units drawn at 8
AM
•
Weight daily; notify prescriber of weekly gain of >5 lb
•
B/P, pulse; notify prescriber of chest pain; monitor for crackles, dyspnea if edema is present; hypertension, cardiac symptoms
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Infection:
increased temp, WBC, even after withdrawal of medication; product masks infection
•
Potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
Mental status: affect, mood, behavioral changes, aggression
•
Therapeutic response: ease of respirations, decreased inflammation
•
That emergency ID as corticosteroid user should be carried; provide information about product being taken and condition
•
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed
•
To avoid vaccinations
Not to discontinue abruptly because adrenal crisis can result
•
To avoid OTC products: salicylates, cough products with alcohol, cold preparations unless directed by prescriber
•
Cushingoid symptoms:
moon face, weight gain; symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain
•
That product causes immunosuppression; to report any symptoms of infection (fever, sore throat, cough)
•
To notify prescriber if pregnancy is planned or suspected; cleft palate, stillbirth, abortion reported