Name of the Corticosteroids Drugs
- Prednisolone
- Dexamethasone
1.Prednisolone
| PREDNISOLONE |
| Availability: Oral solution: 5 mg/ml; Suspension for injection (acetate): 25 mg/ml, 40 mg/ml, 50 mg/ml Suspension (ophthalmic): 0.12%, 0.125%, 1%; Syrup: 5 mg/5 ml, 15 mg/5 ml Tablets: 5 mg; Tablets (orally disintegrating, sodium phosphate): 10 mg, 15 mg, 30 mg |
| Administration/handling: PO • Give with food or fluids to decrease GI side effects. Orally Disintegrating Tablets • Do not break, crush, or divide tablets. • Remove from blister just prior to giving; place on tongue. • Pt may swallow whole or allow to dissolve in mouth with/without water. Ophthalmic • For ophthalmic solution, shake well before using. • Instill drops into conjunctival sac, as prescribed. • Avoid touching applicator tip to conjunctiva to avoid contamination. |
| Be aware that prednisolone has many different formulations that may be given by various routes: P.O., I.M., or ophthalmic. Before administering, make sure formulation can be given by prescribed route. Don’t break ODT tablets. Place ODT tablet on tongue and either swallow tablet whole or allow it to dissolve in mouth with or without water. Inject I.M. form deep into gluteal muscle. Rotate injection sites. Avoid subcutaneous injection. In systemic therapy, don’t discontinue drug abruptly, even if inhaled steroid is added. Know that additional corticosteroids are needed during stress or trauma. |
| Usual Dosage PO: Adults, elderly: 5–60 mg/day in divided doses. CHILDREN: 0.1–2 mg/kg/ day in 3–4 divided doses |
| Treatment of Conjunctivitis, Corneal Injury Ophthalmic: Adults, elderly, children: 1–2 drops every hr during day and q2h during night. After response, decrease dosage to 1 drop q4h, then 1 drop 3–4 times/day. |
| Severe inflammation; immunosuppression: Adults: Dosage individualized based on diagnosis, severity of condition, and response. Usual dosage ranges from 5 to 60 mg P.O. (prednisolone) daily in two to four divided doses, or 4 to 60 mg I.M. (acetate) daily in divided doses, or 5 to 50 mg P.O. (sodium phosphate) daily in divided doses. |
| Acute exacerbation of multiple sclerosis: Adults: 200 mg P.O. daily for 1 week, followed by 80 mg every other day for 1 month |
| Refractory bronchial asthma Children: 1 to 2 mg/kg/day (sodium phosphate) as a single dose or in divided doses; may continue for 3 to 10 days or until symptoms resolve or patient achieves peak expiratory flow rate of 80% of personal best |
| Nephrotic syndrome in children : Children: 60 mg/m2 P.O. (sodium phosphate solution) daily in three divided doses for 4 weeks, then 4 weeks of alternate-day therapy at single doses of 40 mg/m2 |
| Various allergic conditions and dermatologic, endocrine, GI, hematologic, neoplastic, nervous system, ophthalmic, respiratory, and rheumatic disorders: Adults: Variable and individualized depending on condition being treated and patient response. Initially, 10 to 60 mg (ODT) P.O. daily. Children: Variable and individualized depending on condition being treated. Initial dosage range is 0.14 to 2 mg/kg/day P.O. in three or four divided doses. |
| Steroid-responsive inflammatory eye conditions: Adults: In severe cases, initially one to two drops (acetate or sodium phosphate) instilled into conjunctival sac q hour during day and q 2 hours at night. In mild or moderate inflammation or in severe cases that respond favorably, one to two drops q 3 to 12 hours |
Mechanism of Action:
Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by:
- Inhibiting neutrophil and monocyte accumulation at inflammation site and suppressing their phagocytic and bactericidal activity
- Stabilizing lysosomal membranes
- Suppressing antigen response of macrophages and helper T cells
- Inhibiting synthesis of inflammatory response mediators, such as cytokines, interleukins, and prostaglandins.
Indications:
Systemic:
- Endocrine, rheumatic, hematologic disorders
- Collagen, respiratory, neoplastic, GI diseases
- Allergic states
- Acute or chronic solid organ rejection.
Ophthalmic:
- Treatment of conjunctivitis
- Corneal injury (from chemical/thermal burns, foreign body).
Cautions & Contraindications:
- Hypersensitivity to prednisoLONE.
- Acute superficial herpes
- Simplex keratitis
- Systemic fungal infections
- Varicella
- Live or attenuated virus vaccines.
Cautions:
Hyperthyroidism, cirrhosis, ocular herpes simplex, respiratory tuberculosis, untreated systemic infections, renal/hepatic impairment, diabetes, cataracts, glaucoma, seizure disorder, peptic ulcer disease, osteoporosis, myasthenia gravis, hypertension, HF, ulcerative colitis, thromboembolic disorders, elderly pts.
Metabolism and half- life:
- Protein binding: 65%–91%.
- Metabolized in liver.
- Excreted in urine.
- Half-life: 3.6 hrs
Drug interactions:
- CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease effects.
- Live virus vaccines increase vaccine side effects, potentiate virus replication, decrease pt’s antibody response to vaccine.
- May increase effect of warfarin.
- May decrease therapeutic effect of aldesleukin.
- May increase hyponatremic effect of desmopressin.
- May increase serum glucose, lipids, sodium, uric acid.
- May decrease serum calcium, WBC, hypothalamic pituitary adrenal (HPA) axis function, potassium.
Side- Effects:
- Frequent: Insomnia, heartburn, nervousness, abdominal distention, acne, mood swings, increased appetite, facial flushing, delayed wound healing, increased susceptibility to infection, diarrhea, constipation.
- Occasional: Headache, edema, change in skin color, frequent urination.
- Rare: Tachycardia, allergic reaction (rash, urticaria), psychological changes, hallucinations, depression.
- Ophthalmic: Stinging/burning, posterior subcapsular cataracts.
Nursing Considerations
Baseline assessment
- Question medical history as listed in Precautions.
- Obtain baselines for height, weight, B/P, serum glucose, electrolytes.
- Check results of initial tests (tuberculosis [TB] skin test, X-rays, ECG).
Intervention/evaluation
- Monitor B/P, weight, serum electrolytes, results of bone mineral density test, height, weight in children.
- Be alert to infection (sore throat, fever, vague symptoms)
- assess oral cavity daily for signs of Candida infection.
- Watch for cushingoid effects (moon face, central obesity, buffalo hump, hair thinning, high blood pressure, frequent infections).
- Assess patient for depression and psychosis.
- Monitor blood glucose level carefully in diabetic patient.
- Evaluate for signs and symptoms of infection, which drug may mask or exacerbate.
- Monitor for signs and symptoms of early adrenal insufficiency (fatigue, weakness, joint pain, fever, anorexia, shortness of breath, dizziness, syncope) and Immunosuppression.
- Assess musculoskeletal status for joint, tendon, and muscle pain
- Avoid using prednisolone in patients with a history of active tuberculosis because drug can reactivate the disease.
- Give once-daily doses in the morning to mirror body’s normal cortisol secretion.
- Inspect injectable form for particulates and discoloration before administering.
- For I.M. injection, shake suspension well before withdrawing. Keep in mind that I.M. injections are contraindicated in patients with idiopathic thrombocytopenic purpura.
- For intra-articular injection, attach a 20G to 24G needle to empty syringe, using aseptic technique, so prescriber can remove a few drops of synovial fluid to confirm that needle is in the joint. The aspirating syringe is then exchanged with a prednisolone -filled syringe to inject drug into joint.
- Monitor growth pattern in children; prednisolone may retard bone growth.
- Prolonged use may cause hypothalamic pituitary- adrenal suppression.
- Withdraw drug gradually, as ordered, if therapy lasts longer than 2 weeks. Stopping abruptly may cause acute adrenal insufficiency or, possibly, death.
- Be aware that patient may be at risk for emotional instability or psychic disturbance while taking prednisolone, especially if predisposed to them or taking high doses.
Patient/family teaching
- Report fever, sore throat, muscle aches, sudden weight gain, swelling, loss of appetite, fatigue.
- Maintain fastidious oral hygiene.
- Do not abruptly discontinue without physician’s approval.
- Long-term use may significantly increase risk of serious infections.
- Instruct patient to take oral prednisolone with food to decrease stomach upset and to take once-daily dose in the morning.
- Stress need to take drug exactly as prescribed; taking too much increases risk of serious adverse reactions.
- Instruct patient taking orally disintegrating tablets to remove tablet from blister pack only when ready to take drug and to place tablet on tongue. Warn her not to split, cut, or break tablets.
- Urge patient to avoid alcohol during therapy because of increased risk of GI ulcers and bleeding.
- Urge patient to avoid hazardous activities until drug’s CNS effects are known.
- Advise patient to avoid people with contagious infections because drug has an immunosuppressant effect. Urge her to notify prescriber immediately about exposure to measles or chickenpox.
- Caution against receiving vaccinations or other immunizations and coming in contact with people who have recently received oral poliovirus vaccine.
- Teach patient about potential side effects of prednisolone therapy, including restlessness, mood swings, nervousness, and delayed wound healing.
- Instruct patient to notify prescriber immediately about joint pain, swelling, tarry stools, and visual disturbances. Also instruct her to report signs of infection or injury for up to 12 months after therapy.
- Advise patient to restrict joint use after intra-articular injection and to obtain activity guidelines from prescriber.
- Instruct diabetic patient to check her blood glucose level often because prednisolone may cause hyperglycemia.
- Advise patient to comply with follow-up visits to assess drug’s effectiveness and detect adverse reactions.
- Urge patient to carry medical identification revealing prednisolone therapy.
2.Dexamethasone
| DEXAMETHASONE |
| Availability : Elixir: 0.5 mg/5 mL. Injection, Solution: 4 mg/mL, 10 mg/mL. Ophthalmic Solution: 0.1%. Ophthalmic Suspension: 0.1%. Solution, Oral: 0.5 mg/5 mL. Solution, Oral Concentrate: (Dexamethasone Intensol): 1 mg/mL. Tablets: 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg |
| Administration/handling: IV: Dexamethasone sodium phosphate may be given by IV push or IV infusion. Rapid injection may cause genital burning sensation in females. For I.V. use, drug may be given undiluted as a single dose over 1 minute or added to dextrose or I.V. saline solutions and given as an intermittent infusion at prescribed rate. • For IV push, give over 1–4 min if dose is less than 10 mg. • For IV infusion, mix with 50–100 mL 0.9% NaCl or D5W and infuse over 15–30 min. • For neonates, solution must be preservative free. • IV solution must be used within 24 hrs. IM: Give deep IM, preferably in gluteus maximus. rotate sites as needed. PO : Give with milk, food (to decrease GI effect). Ophthalmic Solution, Suspension: Place gloved finger on lower eyelid and pull out until a pocket is formed between eye and lower lid. • Place prescribed number of drops or 14–12-inch ointment into pocket. • Instruct pt to close eye gently for 1–2 min (so that medication will not be squeezed out of the sac). • Instruct pt to apply digital pressure to lacrimal sac at inner canthus for 1–2 min to minimize systemic absorption. |
| Anti-Inflammatory: PO, IV, IM: Adults, elderly: 0.5–9 mg/day in divided doses q6–12h. Children: 0.02–0.3 mg/kg/day in divided doses q6–12h. Intra-articular: Adults, elderly: 0.4–6 mg/day |
| Cerebral Edema : IV: Adults, elderly: Initially, 10 mg, then 4 mg (IV or IM) q6h. PO, IV, IM: Children: Loading dose of 1–2 mg/kg, then 1–1.5 mg/kg/day in divided doses q4–6h. |
| Nausea/Vomiting in Chemotherapy Pts Note: Refer to individual protocols and emetogenic potential. IV: Adults, elderly: 8–20 mg 15–30 min before treatment. Children: 2 mg q12h up to 6 mg/m2/dose q6h |
| Usual Ophthalmic Dosage, Ocular Inflammatory Conditions: Adults, elderly, children: (Solution): Initially, 2 drops q1h while awake and q2h at night for 1 day, then reduce to 3–4 times/day. (Suspension): 1–2 drops up to 4–6 times/day |
| Macular edema following branch retinal vein occlusion or central retinal vein occlusion; noninfectious uveitis affecting posterior segment of eye: Adults: 0.7 mg by intravitreal implant |
| Allergic and inflammatory conditions: Adults: 0.75 to 9 mg/day (dexamethasone) P.O. as a single dose or in divided doses; in severe cases, much higher dosages may be needed. Dosage requirements vary and must be individualized based on disease and patient response. |
| Cerebral edema: Adults: Initially, 10 mg (sodium phosphate) I.V., followed by 4 mg I.M. q 6 hours. Then reduce dosage gradually over 5 to 7 days. |
| Suppression test for Cushing’s syndrome: Adults: 1 mg P.O. at 11 P.M. or 0.5 mg P.O. q 6 hours for 48 hours (with urine collection testing, as ordered) |
| Usual Ophthalmic Dosage, Ocular Inflammatory Conditions: Adults, elderly, children: (Solution): Initially, 2 drops q1h while awake and q2h at night for 1 day, then reduce to 3–4 times/day. (Suspension): 1–2 drops up to 4–6 times/day |
| Macular edema following branch retinal vein occlusion or central retinal vein occlusion; noninfectious uveitis affecting posterior segment of eye: Adults: 0.7 mg by intravitreal implant |
| Allergic and inflammatory conditions: Adults: 0.75 to 9 mg/day (dexamethasone) P.O. as a single dose or in divided doses; in severe cases, much higher dosages may be needed. Dosage requirements vary and must be individualized based on disease and patient response. |
| Cerebral edema: Adults: Initially, 10 mg (sodium phosphate) I.V., followed by 4 mg I.M. q 6 hours. Then reduce dosage gradually over 5 to 7 days. |
| Suppression test for Cushing’s syndrome: Adults: 1 mg P.O. at 11 P.M. or 0.5 mg P.O. q 6 hours for 48 hours (with urine collection testing, as ordered) |
Mechanism of Action:
Reduces inflammation by suppressing polymorphonuclear leukocyte migration, reversing increased capillary permeability, and stabilizing leukocyte lysosomal membranes. Also suppresses immune response (by reducing lymphatic activity), stimulates bone marrow, and promotes protein, fat, and carbohydrate metabolism.
Indications:
- Used primarily as an anti-inflammatory or immunosuppressant agent in a variety of diseases (e.g., allergic states, edematous states, neoplastic diseases, rheumatic disorders).
OFF-LABEL:
- Antiemetic, treatment of croup, dexamethasone suppression test (indicator consistent with suicide and/or depression), accelerate fetal lung maturation.
- Treatment of acute mountain sickness, high-altitude cerebral edema.
- Bacterial meningitis
- Bronchopulmonary dysplasia in preterm infants
- Hirsutism
- Suppression test for detection, diagnosis, or management of depression
Cautions & Contraindications:
- Hypersensitivity to drug, benzyl alcohol, bisulfites, EDTA, creatinine, polysorbate 80, or methylparaben
- Systemic fungal infections
- Active or suspected ocular or periocular infections, advanced glaucoma (intravitreal implant)
Use cautiously in:
Renal insufficiency, cirrhosis, diabetes mellitus, diverticulitis, GI disease, cardiovascular disease, hypoprothrombinaemia, hypothyroidism, myasthenia gravis, glaucoma, osteoporosis, infections, underlying immunosuppression, psychotic tendencies, pregnant or breastfeeding patients, children.
Metabolism and Half- Life:
- Rapidly absorbed from GI tract after PO administration. Widely distributed.
- Protein binding: High. Metabolized in liver. Primarily excreted in urine. Minimally removed by hemodialysis.
- Half-life: 3–4.5 hrs.
Drug Interactions:
- Amphotericin may increase hypokalemia.
- CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease concentration.
- CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole, ritonavir), macrolide antibiotics may increase concentration.
- May decrease therapeutic effect of aldesleukin.
- May increase hyponatremic effect of desmopressin.
- Live virus vaccines may decrease pt’s antibody response to vaccine, increase vaccine side effects, potentiate virus replication.
- Interferes with calcium absorption.
- May increase serum glucose, lipids, sodium levels.
- May decrease serum calcium, potassium, thyroxine, WBC
Side- Effects:
Frequent:
- Inhalation: Cough, dry mouth, hoarseness, throat irritation.
- Intranasal: Burning, mucosal dryness.
- Ophthalmic: Blurred vision.
- Systemic: Insomnia, facial edema (cushingoid appearance [“moon face”]), moderate abdominal distention, indigestion, increased appetite, nervousness, facial flushing, diaphoresis.
Occasional:
- Inhalation: Localized fungal infection (thrush).
- Intranasal: Crusting inside nose, epistaxis, sore throat, ulceration of nasal mucosa.
- Ophthalmic: Decreased vision; lacrimation; eye pain; burning, stinging, redness of eyes; nausea; vomiting.
- Systemic: Dizziness, decreased/blurred vision.
Rare:
- Inhalation: Increased bronchospasm, esophageal candidiasis.
- Intranasal: Nasal/pharyngeal candidiasis, eye pain.
- Systemic: Generalized allergic reaction (rash, urticaria); pain, redness, swelling at injection site; psychological changes; false sense of well-being; hallucinations; depression.
Nursing Considerations
Baseline assessment
- Question for hypersensitivity to any corticosteroids.
- Obtain baselines for height, weight, B/P, serum glucose, electrolytes.
- Question medical history as listed in Precautions.
Intervention/evaluation
- Monitor I&O, daily weight, serum glucose.
- Assess for edema.
- Evaluate food tolerance. Report hyperacidity promptly.
- Monitor daily pattern of bowel activity, stool consistency.
- Check vital signs at least twice daily.
- Be alert to infection (sore throat, fever, vague symptoms).
- Monitor serum electrolytes, esp. for hypercalcemia, hypokalemia, paresthesia (esp. lower extremities, nausea/vomiting, irritability), Hgb, occult blood loss.
- Assess emotional status, ability to sleep.
- Monitor blood glucose level closely in diabetic patients receiving drug orally.
- In long-term therapy, never discontinue drug abruptly. Abrupt withdrawal may cause adrenal insufficiency; Dosage must be tapered gradually.
- Monitor patient for increased IOP after intravitreal injection.
- Use dexamethasone cautiously in patients with congestive heart failure, hypertension, or renal insufficiency because drug can cause sodium retention, which may lead to edema and hypokalemia.
- Also use cautiously in patients who have had intestinal surgery and in those with peptic ulcer, diverticulitis, or ulcerative colitis because of the risk of perforation.
- Give once-daily dose of dexamethasone in the morning to coincide with the body’s natural cortisol secretion.
- Give oral drug with food to decrease GI distress.
- Be aware that dosage forms with a concentration of 24 mg/ml are for I.V. use only.
- Shake I.M. solution before injecting deep into large muscle mass.
- Avoid subcutaneous injection; it may cause atrophy and sterile abscess.
- Inject undiluted I.V. dose directly into I.V. tubing of infusing compatible solution over 30 seconds or less, as prescribed.
- Don’t give acetate form by I.V. injection.
- Shake nasal aerosol container well and hold it upright about 60 (15 cm) from area being treated. Keep spray out of patient’s eyes and advise her not to inhale it.
- Monitor fluid intake and output and daily weight, and watch for crackles, dyspnea, peripheral edema, and steady weight gain.
- Evaluate growth if patient is a child.
- Assess patient for evidence of osteoporosis, Cushing’s syndrome, and other systemic effects during long-term use.
- Monitor neonate for signs of hypoadrenocorticism if mother received dexamethasone during pregnancy. Be aware that some preparations contain benzyl alcohol, which may cause a fatal toxic syndrome in neonates and immature infants. Watch for hypersensitivity reactions after giving acetate or sodium phosphate form; both may contain bisulfites or parabens, to which some people are allergic.
Patient/family teaching
- Do not change dose/schedule or stop taking drug.
- Must taper off gradually under medical supervision.
- Report fever, sore throat, muscle aches, sudden weight gain, edema, exposure to measles/chickenpox.
- Severe stress (serious infection, surgery, trauma) may require increased dosage.
- Inform dentist, other physicians of dexamethasone therapy within past 12 mos.
- limit caffeine.
- Instruct patient not to store drug in damp or hot places and to protect liquid form from freezing.
- Instruct patient to take once-daily oral dose in the morning with food to help prevent GI distress.
- Caution against consuming alcohol during dexamethasone therapy because it increases the risk of GI bleeding.
- Advise patient to follow a low-sodium, high-potassium, high-protein diet, if prescribed, to help minimize weight gain, which is common with dexamethasone therapy. Instruct her to inform prescriber if she’s on a special diet.
- Advise patient to notify prescriber if condition recurs or worsens after dosage is reduced or therapy stops.
- Urge patient to have regular eye examinations during long-term use.
- Advise patient on long-term therapy to carry medical identification and to notify all health care providers that she takes dexamethasone.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
