Name of the Short Acting Glucocorticoids Drugs
- Hydrocortisone (cortisol)
Hydrocortisone (cortisol)
| Hydrocortisone (cortisol) |
| Availability Cream, gel, lotion, ointment, solution: various strengths Injection: 25 mg/ml, 50 mg/ml; 100 mg/ vial, 250 mg/vial, 500 mg/vial, 1,000 mg/vial Intrarectal aerosol foam: 90 mg Oral suspension: 10 mg/5 ml Retention enema: 100 mg/60 ml Spray (topical): 1% Tablets: 5 mg, 10 mg, 20 mg |
Indications and dosages ➣ Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer; arthritis; collagen diseases; dermatologic diseases; autoimmune and hematologic disorders; trichinosis; ulcerative colitis; multiple sclerosis; proctitis; nephrotic syndrome; aspiration pneumonia hydrocortisone, hydrocortisone cypionate— Adults and children: 20 to 240 mg/day P.O. hydrocortisone acetate (suspension)— Adults and children: 5 to 75 mg by intra-articular injection (depending on joint size) q 2 to 3 weeks hydrocortisone acetate (intrarectal foam)— Adults and children: One applicatorful of intrarectal foam daily or b.i.d. for 2 to 3 weeks; then one applicatorful every other day hydrocortisone sodium phosphate— Adults and children: 15 to 240 mg/day subcutaneously, I.M., or I.V., adjusted according to response hydrocortisone sodium succinate— Adults and children: 100 to 500 mg I.M. or I.V.; may repeat at 2-, 4-, or 6-hour intervals, depending on response and condition hydrocortisone retention enema— Adults and children: 100 mg P.R. at bedtime for 21 nights or until desired response; patient should retain enema for at least 1 hour. ➣ Itching and inflammation caused by skin conditions Adults and children: Thin film of topical preparation applied to affected area one to four times daily, depending on drug form and severity of condition |
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 cellular mediators of inflammatory response, such as cytokines, interleukins, and prostaglandins.
Administration
- Give oral form with food or milk to avoid GI upset.
- Give I.V. injection of sodium succinate form over 30 seconds to a few minutes.
- Know that drug may be given as intermittent or continuous I.V. infusion. Dilute in normal saline solution, dextrose 5% in water, or dextrose 5% in normal saline solution.
- Inject I.M. deep into gluteal muscle. Rotate injection sites to prevent muscle atrophy
- Be aware that subcutaneous administration may cause muscle atrophy or sterile abscess.
- Never abruptly discontinue highdose or long-term systemic therapy.
- Know that systemic forms typically are used for adrenal replacement rather than inflammation.
- Be aware that occlusive dressings, heat, hydration, inflammation, denuding, and thinning of skin increase topical drug absorption.
Contraindications
- Hypersensitivity to drug, alcohol, bisulfites, or tartrazine (with some products)
- Systemic fungal infections
- Concurrent use of other immunosuppressant corticosteroids
- Concurrent administration of livevirus vaccines
Precautions:
- Hypertension, osteoporosis, glaucoma, renal or GI disease, hypothyroidism, cirrhosis, thromboembolic disorders, myasthenia gravis, heart failure
- Pregnant or breastfeeding patients
- Children ages 6 and younger (safety not established).
Adverse reactions
- CNS: headache, nervousness, depression, euphoria, personality changes, psychoses, vertigo, paresthesia, insomnia, restlessness, conus medullaris syndrome, meningitis, increased intracranial pressure, seizures
- CV: hypotension, hypertension, thrombophlebitis, heart failure, shock, fat embolism, thromboembolism, arrhythmias EENT: cataracts, glaucoma, increased intraocular pressure, epistaxis, nasal congestion, perforated nasal septum, dysphonia, hoarseness, nasopharyngeal or oropharyngeal fungal infections
- GI: nausea, vomiting, esophageal candidiasis or ulcer, abdominal distention, dry mouth,rectal bleeding, peptic ulceration, pancreatitis
- Hematologic: purpura
- Metabolic: sodium and fluid retention, hypokalemia, hypocalcemia, hyperglycemia, hypercholesterolemia, amenorrhea, growth retardation, diabetes mellitus, cushingoid appearance, hypothalamic-pituitary-adrenal suppression with secondary adrenal insufficiency (with abrupt withdrawal or high-dose, prolonged use)
- Musculoskeletal: osteoporosis, aseptic joint necrosis, muscle pain or weakness, steroid myopathy, loss of muscle mass, tendon rupture, spontaneous fractures
- Respiratory: cough, wheezing, rebound congestion, bronchospasm
- Skin: rash, pruritus, urticaria, contact dermatitis, acne, bruising, hirsutism, petechiae, striae, acneiform lesions, skin fragility and thinness, angioedema
- Other: altered taste; anosmia; appetite changes; weight gain; facial edema; increased susceptibility to infection; masking or aggravation of infection; adhesive arachnoiditis; injection site pain, burning, or atrophy; immunosuppression; hypersensitivity reactions including anaphylaxis
Patient monitoring
- In high-dose therapy (which should not exceed 48 hours), watch closely for signs and symptoms of depression or psychotic episodes.
- Monitor blood pressure, weight, and electrolyte levels regularly.
- Assess blood glucose levels in diabetic patients. Expect to increase insulin or oral hypoglycemic dosage.
- Monitor patient’s response during weaning from drug. Watch for adrenal crisis, which may occur if drug is discontinued too quickly
Patient teaching
- Instruct patient to take daily P.O. dose with food by 8 A.M.
- Urge patient to immediately report unusual weight gain, face or leg swelling, epigastric burning, vomiting of blood, black tarry stools, irregular menstrual cycles, fever, prolonged sore throat, cold or other infection, or worsening of symptoms.
- Tell patient using topical form not to apply occlusive dressing unless instructed by prescriber.
- Advise patient to discontinue topical drug and notify prescriber if local irritation occurs.
- Instruct patient to eat small, frequent meals and to take antacids as needed to minimize GI upset.
- Tell patient that response to drug will be monitored regularly. 2Caution patient not to stop taking drug abruptly.
- In long-term use, instruct patient to have regular eye exams.
- Instruct patient to wear medical identification stating that he’s taking this drug
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
Nursing Considerations
- Systemic hydrocortisone shouldn’t be given to immunocompromised patients, such as those with fungal and other infections, including amebiasis, hepatitis B, tuberculosis, vaccinia, and varicella.
- Give daily dose of hydrocortisone in morning to mimic normal peak in adrenocortical secretion of corticosteroids.
- When possible, give oral dose with food or milk to avoid GI distress.
- Don’t give acetate injectable suspension by I.V. route.
- Give hydrocortisone sodium succinate as a direct I.V. injection over 30 seconds to several minutes, or as an intermittent or a continuous infusion. For infusion, dilute to 1 mg/ml or less with D5W, normal saline solution, or dextrose 5% in normal saline solution.
- Inject I.M. form deep into gluteal muscle, and rotate injection sites to prevent muscle atrophy. Subcutaneous injection may cause atrophy and sterile abscess.
- Shake foam container vigorously for 5 to 10 seconds before each use. Gently withdraw applicator plunger past the fill-line on the applicator barrel while container is upright on a level surface. Administer rectal foam only with provided applicator. After each use, wash applicator, container cap, and underlying tip with warm water.
- High-dose therapy shouldn’t be given for longer than 48 hours. Be alert for depression and psychotic episodes.
- Monitor weight, blood pressure, and electrolyte levels regularly during therapy.
- Expect hydrocortisone to worsen infections or mask signs and symptoms.
- Monitor blood glucose level in diabetic patients, and increase insulin or oral antidiabetic drug dosage, as prescribed.
- Know that elderly patients are at high risk for osteoporosis during long-term therapy.
- Anticipate the possibility of acute adrenal insufficiency with stress, such as emotional upset, fever, surgery, or trauma. Increase hydrocortisone dosage, as prescribed
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
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