Mosby's 2014 Nursing Drug Reference (264 page)

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methylPREDNISolone (Rx)

(meth-il-pred-niss′oh-lone)

A-Methapred, Depo-Medrol, Medrol, Solu-Medrol

Func. class.:
Corticosteroid, synthetic

Chem. class.:
Glucocorticoid, immediate acting

Do not confuse:
methylPREDNISolone
/predniSONE/medroxyPROGESTERone/methylTESTOSTERone

ACTION:

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization

USES:

Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis

Unlabeled uses:
Multiple myeloma, bronchospasm prophylaxis, airway-obstructing hemangioma, noncardiogenic pulmonary edema, idiopathic pulmonary fibrosis, carpal tunnel syndrome, temporal arteritis, Churg-Strauss syndrome, mixed connective-tissue disease, polyarteritis nodosa, relapsing polychondritis, polymyalgia rheumatica, vasculitis, Weg-ener’s granulomatosis,
Pneumocystis jiroveci
pneumonia in AIDS patients, acute spinal cord injury, severe acute res-piratory syndrome (SARS), acute interstitial nephritis

CONTRAINDICATIONS:

Hypersensitivity, intrathecal use, neonates

Precautions:
Pregnancy (C), breastfeeding, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, tartrazine, benzyl alcohol, corticosteroid hypersensitivity, viral infection, TB, traumatic brain injury, Cushing’s syndrome, measles, varicella, fungal infections

DOSAGE AND ROUTES
Calculator
Adrenal insufficiency/inflammation

• Adult:
PO
4-48 mg in 4 divided doses;
IM
10-80 mg (acetate);
IM/IV
10-250 mg (succinate);
INTRAARTICULAR
4-80 mg (acetate)

• Child:
IV
0.5-1.7 mg/kg in 3-4 divided doses (succinate)

Multiple sclerosis

• Adult:
PO
160 mg/day × 1 wk then 64 mg every other day × 30 days

Multiple myeloma/temporal arteritis/Churg-Strauss syndrome/mixed connective-tissue disease/polyarteritis nodosa/relapsing polychondritis/polymyalgia rheumatica/vasculitis/wegener’s granulomatosis (unlabeled)

• Adult:
PO
4-48 mg/day in 4 divided doses;
IM
10-120 mg (acetate);
IV
10-40 mg over several min (sodium succinate)

• Child:
PO/IM
0.5-1.7 mg/kg or 5-25 mg/m
2
/day in divided doses q6-12hr

Bronchospasm prophylaxis (unlabeled)

• Adult and adolescent:
PO/IV
40-80 mg/day in 1-2 divided doses

• Child:
PO/IV
1 mg/kg in 2 divided doses (max 60 mg)

Airway-obstructing hemangioma (unlabeled)

• Child:
PO
0.5-1.7 mg/kg or 5-25 mg/m
2
/day in divided doses q6-12hr

Idiopathic pulmonary fibrosis (unlabeled)

• Adult:
IV
1-2 g/wk or every other week

Carpal tunnel syndrome (unlabeled)

• Adult:
INJ
(local) 40-80 mg as a single inj

Available forms:
Tabs 2, 4, 8, 16, 24, 32 mg; inj 20, 40, 80 mg/ml acetate; inj 40, 125, 500, 1000, 2000 mg/vial succinate

Administer:

• 
Titrated dose; use lowest effective dose

PO route

• 
With food or milk to decrease GI symptoms (PO)

• 
Once-a-day dose should be given in
AM
to coincide with body’s normal cortisol secretion

IM route

• 
IM inj deep in large muscle mass; rotate sites; avoid deltoid; use 21G needle; after shaking suspension (parenteral); inj site reaction may occur (induration, pain at site, atrophy)

• 
In one dose in
AM
to prevent adrenal suppression; avoid SUBCUT administration; may damage tissue

 
Do not give Solu-Medrol intrathecally

IV route

• 
Use only Solu-Medrol, never use acetate product

Direct IV route

• 
Use only methylPREDNISolone sodium succinate (Solu-Medrol) IV, never use methylPREDNISolone acetate suspension IV

• 
After diluting with diluent provided; agitate slowly; give ≤500 mg/≥1 min directly over 3-15 min; doses ≥2 mg/kg or 250 mg should be given by intermittent IV infusion unless potential benefits outweigh risks

Intermittent/continuous INF route

• 
Dilute further in D5W, NS, D5NS; haze may form, give over 15-60 min; large dose (≥500 mg) should be given over 30-60 min

Syringe compatibilities:
Granisetron, metoclopramide

Y-site compatibilities:
Acyclovir, amifostine, amphotericin B cholesteryl, amrinone, aztreonam, cefepime, CISplatin, cladribine, cyclophosphamide, cytarabine, DOPamine, DOXOrubicin, enalaprilat, famotidine, fludarabine, grani-setron, heparin, melphalan, meperidine, methotrexate, metroNIDAZOLE, midazolam, morphine, piperacillin/tazobactam, remifentanil, sodium bicarbonate, tacrolimus, teniposide, theophylline, thiotepa

SIDE EFFECTS

CNS:
Depression, flushing, sweating, headache, mood changes

CV:
Hypertension,
circulatory collapse, thrombophlebitis, embolism,
tachycardia

EENT:
Fungal infections, increased intraocular pressure, blurred vision, cataracts

GI:
Diarrhea, nausea, abdominal distention,
GI hemorrhage,
increased appetite, pancreatitis

HEMA:
Thrombocytopenia

INTEG:
Acne, poor wound healing, ecchymosis, petechiae

MS:
Fractures, osteoporosis, weakness

PHARMACOKINETICS

Half-life >3½ hr (plasma), 18-36 hr (tissue); crosses placenta, enters breast milk in small amounts; metabolized in liver; excreted by kidneys (unchanged)

PO:
Peak 1-2 hr, duration 1½ days, well absorbed

IM:
Peak 4-8 days, duration 1-4 wk, well absorbed

Intraarticular:
Peak 1 wk

INTERACTIONS

Increase:
side effects—amphotericin B, diuretics

Increase:
methylPREDNISolone action—oral contraceptives, estrogens

Increase:
adrenal suppression—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)

Decrease:
methylPREDNISolone effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)

Decrease:
effects of antidiabetics, vaccines, somatrem

Drug/Herb

• 
Avoid use with St. John’s wort

Drug/Food

• 
Do not use with grapefruit juice; level of methylPREDNISolone will be increased

Drug/Lab Test

Increase:
cholesterol, blood glucose

Decrease:
Calcium, potassium, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS

False negative:
skin allergy tests

NURSING CONSIDERATIONS
Assess:

• 
Potassium depletion:
parethesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness

• 
Edema, hypertension, cardiac symptoms

• 
Mental status: affect, mood, behavioral changes, aggression

• 
Potassium, blood glucose, urine glucose while receiving long-term therapy; hypokalemia and hyperglycemia

• 
Joint mobility, pain, edema if product given intraarticularly

• 
B/P q4hr, pulse; notify prescriber of chest pain, crackles

• 
I&O ratio; be alert for decreasing urinary output, increasing edema; weight daily; notify prescriber of weekly gain >5 lb

 
Adrenal insufficiency:
weight loss, nausea, vomiting, confusion, anxiety, hypotension, weakness; plasma cortisol levels during long-term therapy (normal level: 138-635 nmol/L SI units when drawn at 8
AM
)

• 
Growth in children receiving long-term treatment

• 
Infection:
increased temp, WBC, even after withdrawal of product; product masks infection

Evaluate:

• 
Therapeutic response: ease of respirations, decreased inflammation; decreased symptoms of adrenal insufficiency

Teach patient/family:

• 
To increase intake of potassium, calcium, protein

• 
To carry emergency ID as corticosteroid user

• 
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed

 
Not to discontinue abruptly because adrenal crisis can result

• 
To take PO with food, milk to decrease GI symptoms

• 
To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber; to avoid vaccinations because immunosuppression occurs

• 
Adrenal insufficiency:
nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain

• 
Cushingoid symptoms:
buffalo hump, moon face, rapid weight gain, excess sweating

• 
Infection:
to avoid persons with known infections; corticosteroids can mask symptoms of infection

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

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