Sterapred

predniSONE

Rayos

Sterapred

Winipred

Indications

Action

Pharmacokinetics

Time/action profile (anti-inflammatory activity)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• depression (most frequent)
• euphoria (most frequent)
• headache
• ↑ intracranial pressure (children only)
• personality changes
• psychoses
• restlessness

Ear, Eye, Nose, Throat

• cataracts
• ↑ intraocular pressure

Cardiovascular

• hypertension (most frequent)

Gastrointestinal

• peptic ulceration (life-threatening)
• anorexia (most frequent)
• nausea (most frequent)
• vomiting

Dermatologic

• acne (most frequent)
• ↓ wound healing (most frequent)
• ecchymoses (most frequent)
• fragility (most frequent)
• hirsutism (most frequent)
• petechiae (most frequent)

Endocrinologic

• adrenal suppression (most frequent)
• hyperglycemia

Fluid and Electrolyte

• fluid retention (long-term high doses)
• hypokalemia
• hypokalemic alkalosis

Hematologic

• thromboembolism (life-threatening)
• thrombophlebitis

Metabolic

• weight gain
• weight loss

Musculoskeletal

• muscle wasting (most frequent)
• osteoporosis (most frequent)
• avascular necrosis of joints
• muscle pain

Miscellaneous

• cushingoid appearance (moon face, buffalo hump) (most frequent)
• ↑ susceptibility to infection

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Indicated for many conditions. Assess involved systems before and periodically during therapy.
• Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy.
• Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur.
• Pediatric: Children should have periodic evaluations of growth.
• Lab Test Considerations: Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May decrease WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations.
  • Guaiac-test stools. Promptly report presence of guaiac-positive stools.
  • May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I.
  • Suppress reactions to allergy skin tests.
  • Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.

Potential Nursing Diagnoses

Implementation

• If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
• Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
• Oral: Administer with meals to minimize GI irritation.
  • Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing.
  • Use calibrated measuring device to ensure accurate dosage of liquid forms.
  • Swallow delayed-release tablets whole; do not crush, break, or chew.

Patient/Family Teaching

• Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
  • Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
  • Caution patient to avoid vaccinations without first consulting health care professional.
  • Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Discuss possible effects on body image. Explore coping mechanisms.
  • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
  • Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history.
  • Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
• Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see ). Alcohol should be avoided during therapy.

Evaluation/Desired Outcomes

• Decrease in presenting symptoms with minimal systemic side effects.
• Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
• Management of symptoms in adrenal insufficiency.