prednisone

prednisone

(pred' ni sone)

Apo-Prednisone (CAN), Liquid Pred, Meticorten, Novo-Prednisone (CAN), Orasone, Panasol-S, Prednicen-M, Prednisone Intensol Concentrate, Sterapred DS, Sterapred (regular), Winpred (CAN)

Pregnancy Category C

Drug classes

Corticosteroid (intermediate acting)

Glucocorticoid

Hormone

Therapeutic actions

Enters target cells and binds to intracellular corticosteroid receptors, thereby initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects.

Indications

·        Replacement therapy in adrenal cortical insufficiency

·        Hypercalcemia associated with cancer

·        Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg,pemphigus), status asthmaticus, and autoimmune disorders

·        Hematologic disorders: thrombocytopenia purpura, erythroblastopenia

·        Ulcerative colitis, acute exacerbations of MS and palliation in some leukemias and lymphomas

·        Trichinosis with neurologic or myocardial involvement

Contraindications and cautions

·        Contraindicated with infections, especially TB, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation.

·        Use cautiously with renal or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; hepatic disease; pregnancy (monitor infants for adrenal insufficiency).

Available forms

Tablets—1, 2.5, 5, 10, 20, 50 mg; oral solution—5 mg/5 mL, 5 mg/mL; syrup—5 mg/5 mL

Dosages

ADULTS

Individualize dosage depending on severity of condition and patient's response. Administer daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, consider alternate-day therapy. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. Initial dose, 5–60 mg/day PO. For maintenance therapy, reduce initial dose in small increments at intervals until lowest dose that maintains satisfactory clinical response is reached.

PEDIATRIC PATIENTS

·        Physiologic replacement: 0.05–2 mg/kg/day PO or 4–5 mg/m²/day PO in equal divided doses q 12 hr.

·        Other indications: Individualize dosage depending on severity of condition and patient's response rather than by strict adherence to formulae that correct adult doses for age or body weight. Carefully observe growth and development in infants and children on prolonged therapy.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	Varies	1–2 hr	1–1.5 days

Metabolism: Hepatic; T_1/2: 3.5 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP, glaucoma (long-term therapy); euphoria, depression

·        CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias

·        Electrolyte imbalance: Na+ and fluid retention, hypokalemia, hypocalcemia

·        Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T₃ and T₄ levels, HPA suppression with systemic therapy longer than 5 days

·        GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain (long-term therapy)

·        Hypersensitivity: Hypersensitivity or anaphylactoid reactions

·        Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures (long-term therapy)

·        Other: Immunosuppression, aggravation or masking of infections; impaired wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae; subcutaneous fat atrophy

Interactions

Drug-drug

·        Increased therapeutic and toxic effects with troleandomycin, ketoconazole

·        Increased therapeutic and toxic effects of estrogens, including hormonal contraceptives

·        Risk of severe deterioration of muscle strength in myasthenia gravis patients who also are receiving ambenonium, edrophonium, neostigmine, pyridostigmine

·        Decreased steroid blood levels with barbiturates, phenytoin, rifampin

·        Decreased effectiveness of salicylates

Drug-lab test

·        False-negative nitroblue-tetrazolium test for bacterial infection

·        Suppression of skin test reactions

Nursing considerations

Assessment

·        History: Infections; renal or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; hepatic disease; lactation

·        Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R, adventitious sounds, serum electrolytes, blood glucose

Interventions

·        Administer once-a-day doses before 9 AM to mimic normal peak corticosteroid blood levels.

·        Increase dosage when patient is subject to stress.

·        WARNING: Taper doses when discontinuing high-dose or long-term therapy to avoid adrenal insufficiency.

·        Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Teaching points

·        Do not stop taking the drug without consulting your health care provider.

·        Avoid exposure to infections.

·        Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of the disorder for which the drug is being taken.

Adverse effects in Italic are most common; those in Bold are life-threatening.