Below is the chart that shows the equivalent dose of the various agents All Rights Reserved. Oral. 1003. and 32 mg tablets. pkin2. The physiological disposition and metabolic fate of hydrocortisone in man. Following the initial emergency period, consideration should be given to employing a longer-acting injectable preparation or an oral preparation. Hydrocortisone may be administered by intravenous injection, by intravenous infusion or by intramuscular injection, the preferred method for initial emergency use being intravenous injection. Epidural steroids: a comprehensive, evidence-based review. (See Advanced Pulmonary and Extrapulmonary Tuberculosis under Uses. Peterson RE, Wyngaarden JB, Guerra SL et al. medication. Health and Public Policy Committee American College of Physicians. We comply with the HONcode standard for trustworthy health information - How can we manage her methylprednisolone dosing?One issue that comes up Micromedex. Suggest concurrent administration of antacids between meals to prevent peptic ulcer formation in patients receiving high dosages of corticosteroids.Various dermatologic effects (i.e., impaired wound healing, skin atrophy and thinning, acne, increased sweating, hirsutism, facial erythema, striae, petechiae, ecchymoses, easy bruising) are associated with systemic glucocorticoids.Kaposi’s sarcoma reported in patients receiving glucocorticoids; discontinuance may result in clinical remission.Glucocorticoids are distributed into milk and could suppress growth, interfere with endogenous glucocorticoid production, or cause other adverse effects in nursing infants.With long-term use, may delay growth and maturation in children and adolescents.Glucocorticoid-induced osteoporosis and associated fractures are common in children and adolescents receiving long-term systemic therapy. Rathmell JP. The a. IV. Accessed 2014 May 19. http://www.fda.gov/Drugs/DrugSafety/ucm394280.htm1002. frequently on the internal medicine service is the potency of different From FDA website. methylprednisolone the patient could either take ten 8 mg tablets per day or From FDA website. Bethesda, MD: American Society of Health-System Pharmacists; 2014. A patient is being treated with methylprednisolone 20 mg IV q6 hours for some inflammatory process and... A 55 year old business executive is being discharged from the hospital after a brief admission for cellulitis. take five a day.Using the chart, 80 mg i. Bello CE, Garrett SD. methylprednisolone 20 mg IV q6 hours for some inflammatory process and is (NIH publication No. 18th ed. A patient is being treated with methylprednisolone 20 mg IV q6 hours for some inflammatory process and... A 55 year old business executive is being discharged from the hospital after a brief admission for cellulitis. dosed more than once a dayThough the of hydrocortisone, methylprednisolone, prednisone, and dexamethasone is nearly j. So by staying with of action above – dexamethasone has a long half-life and doesn’t need to be )* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name1000. The dexamethasone suppression test for the detection, diagnosis, and managemnt of depression. Hydrocortisone systemic 20 mg (West-Ward 254) glucocorticoid potency generally parallels the anti-inflammatory potency of the Following the intravenous injection of hydrocortisone sodium succinate, demonstrable effects are evident within one hour and persist for a variable period. Is going to be back often in order to check up on new posts. immediate intravenous administration of high doses of hydrocortisone in a small volume of diluent and is particularly useful where high blood levels of hydrocortisone are required rapidly. LL, Chabner BA, Knollmann BC, eds. Hydrocortisone sodium succinate: 100 mg to 8 g daily. Cohen SP, Bicket MC, Jamison D et al. Powered by HughesMedicine - Pharmacotherapy Pearls from the Internal Medicine Clinical PharmacistA patient is being treated with Bethesda, MD: American Society of Health-System Pharmacists; 2003:2912-3.b. Longitudinal measurements may be repeated as often as every 6 months to detect possible bone loss. Bethesda, MD: American Society of Health-System Pharmacists; 2004:2886-98.h. transition to outpatient care. Manifestations of peritoneal irritation following GI perforation may be minimal or absent in patients receiving corticosteroids. might have to wait for the pharmacy to order the 16 mg tablets and then still In: Behrman RE, Kliegman RM, Jenson HB, eds. (See Cautions. I just couldn't depart your site before suggesting that I really enjoyed the standard information a person provide for your visitors? HID. The 2016 American Diabetes Association diabetes guidelines is a lengthy document outlining many aspects of diabetes care including eval... Let's start with a patient case. 2013-2016. Methods for monitoring bone mineralization (e.g., dual-energy x-ray absorptiometry [DXA]) in children and adolescents are similar to those in adults.Ensure children and adolescents consistently ingest adequate calcium and vitamin D either through diet or supplementation.Some commercially available injections contain benzyl alcohol as a preservative.Some manufacturers state that benzyl alcohol-containing injectable preparations are contraindicated in premature infants and use should be avoided whenever possible; AAP states that presence of small amounts in a commercially available injection should not proscribe its use when the medication is indicated in neonates and comparable benzyl alcohol-free preparations are not available.With prolonged therapy, muscle wasting, muscle pain or weakness, delayed wound healing, and atrophy of the protein matrix of the bone resulting in osteoporosis, vertebral compression fractures, aseptic necrosis of femoral or humeral heads, or pathologic fractures of long bones may occur.Before initiating glucocorticoid therapy in postmenopausal women, consider that such women are especially prone to osteoporosis.Patients with cirrhosis show an exaggerated response to glucocorticoids.Associated with long-term therapy: bone loss, cataracts, indigestion, muscle weakness, back pain, bruising, oral candidiasis.Inhibitors of CYP3A4: potential pharmacokinetic interaction (decreased hydrocortisone clearance).Inducers of CYP3A4: potential pharmacokinetic interaction (increased hydrocortisone clearance).Cases of cardiac enlargement and CHF reported with use of hydrocortisone to control adverse reactions to amphotericin BConflicting reports of alterations in the anticoagulant responseIncreased blood glucose concentrations in diabetes mellitusMay require dosage adjustment of concurrent insulin and/or oral hypoglycemic agentsPossible increase in metabolic clearance of hydrocortisoneEnhance the potassium-wasting effects of glucocorticoidsPossible increase in metabolic clearance of hydrocortisoneDosage adjustment of hydrocortisone may be required if estrogens are added to or withdrawn from a stable dosage regimenPossible decrease in metabolic clearance of hydrocortisoneInhibits adrenal corticosteroid synthesis, causing adrenal insufficiency during corticosteroid withdrawalMay need a reduction in dosage of hydrocortisone to avoid potential adverse effectsPossible decrease in metabolic clearance of hydrocortisoneMay need a reduction in dosage of hydrocortisone to avoid potential adverse effectsObserve patients receiving both drugs closely for adverse effects of either drugMay be necessary to increase salicylate dosage when corticosteroids are administered concurrently or decrease salicylate dosage when corticosteroids are discontinuedUse aspirin and corticosteroids with caution in hypoprothrombinemiaPossible increase in metabolic clearance of hydrocortisoneIncreased dosage of hydrocortisone may be necessaryPossible increase in metabolic clearance of hydrocortisoneIncreased dosage of hydrocortisone may be necessaryMay cause a diminished response to toxoids and live or inactivated vaccinesMay potentiate replication of some organisms contained in live, attenuated vaccinesCan aggravate neurologic reactions to some vaccines (supraphysiologic dosages) Live virus vaccines contraindicated in individuals receiving immunosuppressive hydrocortisone dosesDefer routine administration of vaccines or toxoids until corticosteroid therapy is discontinuedMay need serologic testing to ensure adequate antibody response for immunization;May undertake immunization procedures in patients receiving nonimmunosuppressive doses of glucocorticoids or in patients receiving glucocorticoids as replacement therapy (e.g., Addison’s disease)The duration of anti-inflammatory activity of hydrocortisone approximately equals the duration of HPA-axis suppression, about 1.25–1.5 days for a single 250-mg oral dose.Most glucocorticoids are removed rapidly from the blood and distributed to muscle, liver, skin, intestines, and kidneys.Extensively bound to corticosteroid-binding globulin (transcortin) and albumin.Patients with low serum albumin concentrations may be more susceptible to effects of glucocorticoids than those with normal serum albumin concentrations.Metabolized in most tissues, but primarily in the liver, to inactive compounds.Inactive metabolites are excreted by the kidneys, primarily as glucuronides and sulfates, but also as unconjugated products.Following oral or IV administration of hydrocortisone, 1.5–3.5 hours.Metabolic clearance may be decreased in patients with hypothyroidism and increased in those with hyperthyroidism.Hydrocortisone sodium succinate: Store unreconstituted at 20–25°C.Store reconstituted solution at 20–25°C; protect from light.For information on systemic interactions resulting from concomitant use, see Interactions.Injections of hydrocortisone and its esters have been reported to be incompatible with various drugs, but the compatibility depends on several factors (e.g., concentration of the drugs, resulting pH, temperatures).Dextrose–Ringer’s injection, lactated, combinationsAntithymocyte globulin (rabbit) with heparin sodiumHetastarch in lactated electrolyte injection (Hextend)Principally an anti-inflammatory or immunosuppressant agent.Exhibits potent anti-inflammatory activity and some mineralocorticoid properties.Decreases inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; or reducing leukocyte adhesion to capillary endothelium.Inhibits macrophage accumulation in inflamed areas.Reduces capillary wall permeability and edema formation.Antagonizes histamine activity and release of kinin from substrates.Reduces fibroblast proliferation, collagen deposition, and subsequent scar tissue formation.Stimulates erythroid cells of bone marrow, prolongs survival time of erythrocytes and platelets, and produces neutrophilia and eosinopenia.Promotes gluconeogenesis, redistribution of fat from peripheral to central areas of the body, and protein catabolism, which results in negative nitrogen balance.Reduces intestinal absorption and increases renal excretion of calcium.Suppresses the immune response by reducing activity and volume of the lymphatic system, producing lymphocytopenia.Decreases immunoglobulin and complement concentrations and passage of immune complexes through basement membranes.Depresses reactivity of tissue to antigen-antibody interactions.In pharmacologic doses, suppresses release of corticotropin (ACTH) from the pituitary, thus, the adrenal cortex ceases secretion of endogenous corticosteroids (secondary adrenalcortical insufficiency); degree and duration of HPA axis suppression depends on dose, frequency, and time of administration, and duration of therapy.In patients receiving long-term therapy, importance of not discontinuing the drug abruptly.Importance of notifying a clinician of any infections, signs of infections (e.g., fever, sore throat, pain during urination, muscle aches), or injuries that develop during therapy or within 12 months after therapy is discontinued.When surgery is required, importance of informing the attending physician, dentist, or anesthesiologist of recent (within 12 months) glucocorticoid therapy.Advise patients receiving orally inhaled glucocorticoid therapy who are currently being withdrawn or who have been withdrawn from systemic therapy to immediately resume full therapeutic dosages of systemic glucocorticoids and to contact their clinician for further instructions during stressful periods (e.g., severe infection, severe asthmatic attack).In immunosuppressed patients, importance of avoiding exposure to certain infections (e.g., chickenpox, measles) and of obtaining medical advice if such exposure occurs.When considering epidural glucocorticoid injections for pain relief, importance of understanding potential benefits and risks of epidural injections and alternative treatments.Patients should carry identification cards listing the diseases for which they are being treated, the glucocorticoid they are receiving and its dosage, and the name and telephone number of their clinician. ’ s pharmacy might have to order them ; 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