Prednisone
Trade names:
deltasone
Class: Corticosteroids "Glucocorticoid therapy ' , anti
inflammatory
Pregnancy: (Category C/ D if used in 1st
trimester ) Action:
They are a group of natural hormones produced by the adrenal
cortex.
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They are used for a variety
of therapeutic purposes.
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Many slightly modified
synthetic variants are available today.
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Some patients respond
better to one substance than to another.
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These hormones influence
many metabolic pathways & all organ systems & are essential for
survival.
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The release of
corticosteroids is controlled by hormones such as corticotropinreleasing factor
produced by the hypothalamus & ACTH produced by the anterior pituitary.
Uses:
§ Replacement therapy : adrenal
insufficiency (Addison’s disease) .
§ Rheumatic disorders : rheumatoid
arthritis & osteoarthritis.
§ Collagen diseases: systemic
lupus erythromatosus, rheumatic cardiac.
§ Allergic diseases: drug
hypersensitivity , urticarial transfusion reaction.
§ Respiratory diseases: bronchial
asthma , rhinitis.
§ Ocular diseases : allergic &
inflammatory conjunctivitis, keratitis § Dermatological diseases: psoriasis, contact
dermatitis, urticaria.
§ Diseases of the GIT: ulcerative
colitis.
§ Nervous system : Myasthenia
gravis.
§ Malignancies: leukemia,
lymphoma.
§ Nephrotic syndrome.
§ Hematologic diseases: hemolytic anemia,
thrombocytopenic purpura. § Miscellaneous:
septic shock, liver cirrhosis, stimulation of surfactant § production, prevention of organ rejection.
Dose:
by mouth, initially, up to 10–20 mg daily (severe disease, up
to 60 mg daily), preferably taken in the morning after breakfast; can often be
reduced within a few days but may need to be continued for several weeks or
months
Maintenance, usual range, 2.5–15 mg daily, but higher doses may be
needed; cushingoid sideeffects increasingly likely with doses above 7.5 mg
daily
By intramuscular injection, prednisolone acetate, 25–100
mg once or twice weekly Contraindications:
§ If infection is suspected (Mask signs & symptoms).
§ Peptic ulcer.
§ Acute glomerulonephritis.
§ Cushing’s syndrome .
§ Congestive heart failure.
§ Hypertension.
§ Hyperlipidemia.
Side effects:
Prolonged therapy may cause Cushing-like
syndrome & atrophy of the adrenal cortex & subsequent adrenocortical
insufficiency. N.B:
Steroid withdrawal syndrome may lead to :
anorexia, nausea, vomiting, weight loss , headache , myalgia & hypotension.
Side effects
include:
Edema, alkalosis, hypokalemia, hypertension,
CHF muscle wasting , weakness, osteoporosis, nausea & vomiting.
Headache , hypercholesterolemia , hirsutism, amenorrhea,
depression.
Redistribution of body fats: thin extremities and fat trunk,
moon-like face, buffalo hump.
Nursing
considerations:
§ Administer oral forms with food to minimize ulcerogenic effect.
§ For chronic use, give the smallest dose possible.
§ Corticosteroids
should be discontinued gradually if used chronically.
§ Document baseline weight , B.P. , Pulse & temperature.
§ Frequently take BP, monitor body weight (signs of Na+ & H2O
retention).
§ Periodic serum electrolytes, blood sugar monitoring.
§ Report signs & symptoms of side effects (cushing-like
syndrome).
§ Discuss with female client potentials of menstrual difficulties.
§ Instruct the client to take diet high in protein &
potassium. § Instruct the client to avoid falls
& accidents (osteoporosis causes § pathological
fracture).
§ Remind the client to carry a card identifying the drug being
used.
§ Stress the need for regular medical supervision.
§ Advise the client to delay any vaccination while taking these
medications (weakened immunity).
Explain the need to maintain general hygiene & cleanliness to
prevent infection.
