Anti-inflammatory drugs used in the integumentary system help manage skin conditions like dermatitis, psoriasis, and eczema by reducing inflammation, relieving symptoms, and promoting tissue healing through topical or systemic formulations.
Name of the Anti-Inflammatory Drugs
- Betamethasone
- Hydrocortisone
- Dexamethasone
- Triamcinolone
| Betamethasone |
| Availability: Solution for injection: 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml Suspension for injection (acetate, phosphate): 6 mg (total)/ml Syrup: 0.6 mg/5 ml Tablets: 0.6 mg Tablets (effervescent): 0.5 mg Tablets (extended release): 1 mg |
| Indication &dosage 1. Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery Adults: 0.6 to 7.2 mg/day P.O. as single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate suspension. |
| 2. Bursitis or tenosynovitis Adults: 1 ml of suspension intramurally |
| Rheumatoid arthritis or osteoarthritis Adults: 0.5 to 2 ml of suspension intra-particularly |
| Mechanism of Action: Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines |
| Administration ● Give as a single daily dose before 9:00 A.M. ● Give oral dose with food or milk. ● Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy). 2Don’t give betamethasone acetate I.V. ● Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours. 2To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing. ● Know that drug may be given with other immunosuppressants. |
| Metabolism and half-life Metabolism: Extensively metabolized in liver Half-life : 6.5 hrs. Excretion : mainly in urine, minimally in bile |
| Contra-indications: 1. Hypersensitivity to drug 2. Breastfeeding |
| Precautions: systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability ● patients receiving systemic corticosteroids ● pregnant patients ● children younger than age 6. |
| Drug interactions anticholinesterase drugs: Possibly antagonized anticholinesterase effects in myasthenia gravis barbiturates: Possibly decreased effects of betamethasone cyclosporine: Possibly increased risk of cyclosporine toxicity digitalis glycosides: Possibly increased risk of digitalis toxicity |
Adverse Reactions
CNS: Fatigue, headache, increased intracranial pressure with papilledema, insomnia, malaise, neuritis, paresthesia, seizures, steroid psychosis, syncope, vertigo
CV: Arrhythmias, ECG changes, fat embolism, heart failure, hypertension, thromboembolism, thrombophlebitis
EENT: Cataracts, exophthalmos, glaucoma, increased intraocular pressure
ENDO: Cushingoid symptoms (buffalo hump, central obesity, decreased carbohydrate tolerance, fat pad enlargement, moon face), fluid retention, growth suppression in children, hyperglycemia, masked signs of infection, negative nitrogen balance, secondary adrenocortical and pituitary unresponsiveness (in times of stress)
GI: Abdominal distention, increased appetite, nausea, pancreatitis, peptic ulcer possibly with perforation, ulcerative esophagitis, vomiting
GU: Amenorrhea, glycosuria, menstrual irregularities
HEME: Leukocytosis
MS: Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, spontaneous pathologic and vertebral compression fractures, tendon rupture
SKIN: Acneiform lesions, allergic dermatitis, ecchymosis, facial erythema, hirsutism, impaired wound healing, increased sweating, petechiae, lupuslike lesions, purpura, subcutaneous fat atrophy, thin and fragile skin, urticaria
Other: Angioedema, hypocalcemia, hypokalemia, sodium retention, suppressed reaction to skin tests, weight gain
Nursing Considerations
- Expect prescriber to order baseline ophthalmologic examination before starting therapy because prolonged betamethasone use may lead to increased intraocular pressure, glaucoma, and optic nerve damage. Use betamethasone cautiously in patients with ocular herpes simplex because corneal perforation may occur.
- Determine if latent or active amebiasis has been ruled out in patients who have spent time in the tropics or who have unexplained diarrhea before betamethasone therapy starts because drug may worsen it
- Assess for signs of infection before administering betamethasone because drug may mask those signs. Because drug may cause immunosuppression, new infection may develop during therapy. If so, expect to administer appropriate antibiotic.
- Review serum electrolyte levels, as ordered, before starting therapy. Monitor these levels often during therapy to detect imbalances. Sodium and water retention and potassium and calcium depletion may occur with high-dose betamethasone therapy. If so, expect to restrict sodium intake and provide potassium and calcium supplements.
- Because betamethasone is linked to peptic ulcer formation, expect to administer it with an antacid or H2-receptor blocker.
- Watch for signs of steroid psychosis, such as delirium, clouded sensorium, euphoria, insomnia, mood swings, personality changes, and severe depression, which may develop 15 to 30 days after therapy begins. Expect to stop therapy. If this isn’t possible, expect to give psychotropic drugs.
- Rotate I.M. injection sites. To prevent muscle atrophy, avoid subcutaneous injection, injection in deltoid site, and repeated I.M. injections into same site.
- Administer oral betamethasone before 9 a.m., if appropriate, to mimic body’s natural release of corticosteroids
- After intra-articular injection, assess joint for marked increase in pain, local swelling, and more restricted movement. If patient also develops fever and malaise, suspect septic arthritis and notify prescriber immediately. Expect to assist with joint fluid aspiration to confirm septic arthritis.
- Monitor patient for cushingoid signs and symptoms, such as moon face, buffalo hump, central obesity, striae, acne, ecchymosis, and weight gain. Notify prescriber if you detect these symptoms.
- Expect to slowly taper oral betamethasone dosage to prevent adrenal insufficiency
PATIENT TEACHING
- Instruct patient to take betamethasone with food if GI upset occurs.
- Review signs of adrenal insufficiency and possible need for dosage increases during stress. Advise patient to notify prescriber immediately if signs of insufficiency occur or if she’s exposed to stress.
- Instruct patient to avoid exposure to infections because drug can cause immunosuppression. Also teach patient to recognize and immediately report signs of infection.
- After intra-articular use, advise patient not to overuse joint and to continue other treatments such as physical therapy.
| Hydrocortisone |
| 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 |
| Indication & Dosage 1. To treat severe inflammation or acute adrenal insufficiency ORAL SUSPENSION, TABLETS (HYDROCORTISONE, HYDROCORTISONE CYPIONATE) Adults. 20 to 240 mg daily as a single dose or in divided doses. I.V. INFUSION OR I.V., I.M., OR SUBCUTANEOUS INJECTION (HYDROCORTISONE SODIUM PHOSPHATE); I.M. INJECTION (HYDROCORTISONE) Adults. 15 to 240 mg daily as a single dose or in divided doses. Usual: One-half to one third the oral dose. DOSAGE ADJUSTMENT Dosage increased to more than 240 mg daily if needed to treat acute disease. I.V. INFUSION; I.V. OR I.M. INJECTION (HYDROCORTISONE SODIUM SUCCINATE) Adults. 100 to 500 mg every 2, 4, or 6 hr |
| 2. To treat joint and tissue inflammation INTRA-ARTICULAR INJECTION (HYDROCORTISONE ACETATE) Adults. 25 to 37.5 mg injected into large joints or bursae as a single dose, or 10 to 25 mg into small joints as a single dose. INTRALESIONAL INJECTION (HYDROCORTISONE ACETATE) Adults. 5 to 12.5 mg injected into tendon sheaths as a single dose, or 12.5 to 25 mg injected into ganglia as a single dose. SOFT-TISSUE INJECTION (HYDROCORTISONE ACETATE) Adults. 25 to 50 mg as a single dose. Sometimes a dose of up to 75 mg is needed |
| 3. As adjunct to treat ulcerative proctitis of the distal portion of the rectum in patients who can’t retain hydrocortisone or other corticosteroid enemas RECTAL AEROSOL (HYDROCORTISONE ACETATE) Adult men. Initial: 1 applicatorful once or twice daily for 2 to 3 wk; then every other day thereafter. Maintenance: Highly individualized. |
| To treat ulcerative colitis ENEMA (HYDROCORTISONE) Adults. 100 mg every night for 2 to 3 wk or until condition improves. |
| 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. |
| Metabolism and elimination Metabolized in tissues and liver Elimination Half life : plasma 1-2 hrs ,biologic 8-12 hrs Excreation :urine (mainly ) feces (minimally ) |
| Contra-indications : Hypersensitivity to hydrocortisone or its components, idiopathic thrombocytopenic purpura (I.M.), intestinal conditions prohibiting intrarectal steroids (P.R.), recent live-virus vaccination, systemic fungal infection |
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)
Interactions
Drug-drug. Amphotericin B, loop and thiazide diuretics, mezlocillin, piperacillin, ticarcillin: additive hypokalemia Fluoroquinolones: increased risk of tendon rupture
Hormonal contraceptives: prolonged half-life and increased effects of hydrocortisone
Insulin, oral hypoglycemics: increased requirements for these drugs
Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions
Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI reactions Phenobarbital, phenytoin, rifampin: decreased hydrocortisone efficacy Somatrem: inhibition of growthpromoting effect
Drug-diagnostic tests. Calcium, potassium, thyroxine, triiodothyronine: decreased levels Cholesterol, glucose: increased levels Digoxin assays: false elevation (with some test methods)
Nitroblue tetrazolium test: falsenegative result
Drug-herbs. Echinacea: increased immunostimulation
Ginseng: potentiation of immunomodulation
Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers
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.
- Caution 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
| Dexamethasone |
| Availability: Elixir: 0.5 mg/5 ml Intravitreal implant: 0.7 mg Oral solution: 0.5 mg/5 ml, 1 mg/ml Solution for injection (sodium phosphate): 4 mg/ml, 10 mg/ml, 20 mg/ml, 24 mg/ml Tablets: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg |
| Indication & dosage 1. Macular Edema following branch retinal vein occlusion or central retinal vein occlusion; non-infectious uveitis affecting posterior segment of eye Adults: 0.7 mg by intravitreal implant |
| 2. 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 |
| 3. 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. |
| 4. 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 : Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by: • inhibiting neutrophil and monocyte accumulation at inflammation site and suppressing phagocytic and bactericidal action • stabilizing lysosomal membranes • suppressing antigen response of macrophages and helper T cells • inhibiting synthesis of inflammatory response mediators, such as cytokines, interleukins, and prostaglandins |
| Administration : ● Give P.O. dose with food or milk. ● When giving I.M., inject deep into gluteal muscle; rotate sites as needed. ● 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. |
| Metabolism and Elimination Metabolized in liver Elimination Half-life: 1.8-3.5 hr (normal renal function) Excretion: Urine (mainly), feces (minimally) |
| Contra-indications : ● 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) |
| Precautions ● renal insufficiency, cirrhosis, diabetes mellitus, diverticulitis, GI disease, cardiovascular disease, hypoprothrombinemia, hypothyroidism, myasthenia gravis, glaucoma, osteoporosis, infections, underlying immunosuppression, psychotic tendencies ● pregnant or breastfeeding patients ● children. |
| Administration : ● Give P.O. dose with food or milk. ● When giving I.M., inject deep into gluteal muscle; rotate sites as needed. ● 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. |
| Metabolism and Elimination Metabolized in liver Elimination Half-life: 1.8-3.5 hr (normal renal function) Excretion: Urine (mainly), feces (minimally) |
| Contra-indications : ● 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) |
| Precautions ● renal insufficiency, cirrhosis, diabetes mellitus, diverticulitis, GI disease, cardiovascular disease, hypoprothrombinemia, hypothyroidism, myasthenia gravis, glaucoma, osteoporosis, infections, underlying immunosuppression, psychotic tendencies ● pregnant or breastfeeding patients ● children. |
Adverse reactions
CNS: headache, malaise, vertigo, psychiatric disturbances, increased intracranial pressure, seizures
CV: hypotension, thrombophlebitis, myocardial rupture after recent myocardial infarction, thromboembolism
EENT: cataracts; elevated intraocular pressure (IOP), conjunctival hemorrhage (with intravitreal implant)
GI: nausea, vomiting, abdominal distention, dry mouth, anorexia, peptic ulcer, bowel perforation, pancreatitis, ulcerative esophagitis
Metabolic: decreased carbohydrate tolerance, hyperglycemia, cushingoid appearance (moon face, buffalo hump), decreased growth (in children), latent diabetes mellitus, sodium and fluid retention, negative nitrogen balance, adrenal suppression, hypokalemic alkalosis
Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis, tendon rupture, long bone fractures
Skin: diaphoresis, angioedema, erythema, rash, pruritus, urticaria, contact dermatitis, acne, decreased wound healing, bruising, skin fragility, petechiae
Other: facial edema, weight gain or loss, increased susceptibility to infection, hypersensitivity reactions
Patient monitoring
- Monitor blood glucose level closely in diabetic patients receiving drug orally.
- Monitor hemoglobin and potassium levels.
- Assess for occult blood loss.
- In long-term therapy, never discontinue drug abruptly. Dosage must be tapered gradually.
- Monitor patient for increased IOP after intravitreal injection.
Patient teaching
- Instruct patient to immediately report sudden weight gain, swelling off ace or limbs, excessive nervousness or sleep disturbances, excessive body hair growth, vision changes, difficulty breathing, muscle weakness, persistent abdominal pain, or change in stool color.
- Tell patient to take oral drug with or after meals.
- Advise patient to report vision changes and if eye becomes red, sensitive to light, or painful after intravitreal implant, to promptly report this to ophthalmologist.
- Inform patient that drug makes him more susceptible to infection. Advise him to avoid crowds and exposure to illness.
- Caution patient not to stop taking drug abruptly.
- 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.
| Triamcinolone |
| Availability: Cream: 0.025%, 0.1%, 0.5% Injectable suspension: 10 mg/ml, 40 mg/ml Lotion: 0.025%, 0.1% Ointment: 0.025%, 0.1%, 0.5% Suspension: 55 mcg/metered spray triamcinolone hexacetonide Injectable suspension: 5 mg/ml, 20 mg/ml |
| Indication & dosages 1. Allergic rhinitis Adults and children older than age 12: 220 mcg (two sprays of acetonide suspension) in each nostril daily. When maximum benefit has been achieved and symptoms have been controlled, reduce dosage to 110 mcg/day (one spray in each nostril daily). Children ages 6 to 12: Initially, 110 mcg (two sprays of acetonide suspension) as one spray in each nostril once daily. Use 220 mcg (two sprays in each nostril) daily in children not responding adequately to 110 mcg daily. Children ages 2 to 5: Recommended and maximum dosage is 110 mcg as one spray in each nostril once daily |
| 2. Severe inflammation; immunosuppression Adults and children older than age 12: 60 mg (acetonide) I.M. at 6-week intervals. For intralesional or sublesional use, 1 mg at each injection site, repeated one or more times weekly; for intra-articular, intrasynovial, or softtissue injection, 2.5 to 40 mg, repeated when symptoms recur. Or 0.5 mg/square inch of affected skin (hexacetonide) by intralesional or sublesional injection or 2 to 20 mg by intraarticular injection; may repeat at 3- to 4-week intervals. Children ages 6 to 12: 0.03 to 0.2 mg/kg or 1 to 6.25 mg/m2 I.M. at intervals of 1 to 7 days |
| 3. Corticosteroid-responsive dermatoses Adults and children older than age 12: Apply cream, ointment, or lotion sparingly to affected area two to four times daily |
| Mechanism of Action : Inhibits the release of prostaglandins and leukotrienes, thus reducing immediate and late-phase allergic responses in chronic asthma. Triamcinolone also: • decreases peribronchial edema and mucus secretion by inhibiting the binding of allergens to immunoglobulin E antibodies on the surface of mast cells, thereby inactivating the release of chemotactic substances • decreases inflammation by interfering with leukocyte adhesion to capillary walls • inhibits the release of leukocytic acid hydrolases, preventing macrophage accumulation at the infection site • inhibits histamine and kinin release, preventing the formation of scar tissue. |
| Administration : 1. Don’t withdraw systemic corticosteroids abruptly when patient begins inhalation steroid therapy. 2. Know that patient will need additional steroids during times of stress or trauma. 3. Apply cream, lotion, or ointment sparingly. Know that triamcinolone is a high-potency steroid; it can be absorbed systemically and should not be withdrawn abruptly. 4. Avoid intralesional injection to face or head (may cause blindness). 5. Don’t apply topical form near eyes. 6. Know that occlusive dressing may be used with topical form when treating psoriasis or other recalcitrant conditions, but should be removed if infection |
| Metabolism & Elimination Absorption Peak plasma time : 7 hrs Peak plasma concentration :1143.7pg/mL Half life :633.9 hrs |
| Contra-indications : ● Hypersensitivity to drug, tartrazine, chlorofluorocarbon propellants, alcohol, propylene glycol, or polyethylene glycol ● Systemic fungal infections (parenteral use) ● Idiopathic thrombocytopenic purpura (I.M. use) ● Administration of live-virus vaccines (with immunosuppressant doses of triamcinolone) |
| Precautions 1. active untreated infection, systemic infection, immunosuppression, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomoses, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability 2. pregnant or breastfeeding patients 3. Children younger than age 2 (safety not established). |
Adverse Reactions
CNS: Dizziness, emotional lability, exacerbated psychosis, fatigue, headache, insomnia, restlessness, seizures, vertigo
CV: Edema, heart failure, hypertension
EENT: Altered sense of smell or taste, cataracts, dry mouth, epistaxis (nasal form), glaucoma, hoarseness, nasal congestion, nasal irritation (inhalation form), nasal septal perforation (nasal form), oropharyngeal candidiasis, pharyngitis, posterior subcapsular cataracts, rhinorrhea, secondary ocular infection, sinusitis, sneezing
ENDO: Cushing’s syndrome, diabetes mellitus, growth retardation (children)
GI: Abdominal pain, constipation, diarrhea, dyspepsia, esophageal ulceration, gastritis, nausea, vomiting
GU: Cystitis, renal disease, UTI, vaginitis
MS: Bone mineral density loss, bursitis, muscle wasting or weakness, myalgia, osteoporosis, tenosynovitis
RESP: Asthma, bronchitis, bronchospasm (inhalation form), chest congestion, dyspnea, increased cough
SKIN: Ecchymosis, petechiae (parenteral form), photosensitivity, pruritus, rash, striae, urticaria
Other: Anaphylaxis; angioedema; facial edema; flu syndrome; herpes infection; impaired wound healing; injection site atrophy, induration, pain, soreness, and sterile abscess; weight gain
Patient monitoring
- Monitor respiratory status. Watch for worsening signs and symptoms.
- With long-term use, assess for adverse endocrine and musculoskeletal reactions.
- Monitor carefully for signs and symptoms of infection, which drug may mask.
Patient teaching
- Teach patient correct use of drug. Make sure he has received manufacturer’s patient information sheet.
- Inform patient that drug can affect many body systems. Urge him to report serious adverse effects promptly.
- Tell parents drug may make child more vulnerable to childhood infections, such as chicken pox and measles.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
RFERENCES
- 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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