Mosby's 2014 Nursing Drug Reference (204 page)

• Adult/adolescent:
PO
12.5-25 mg/day, may increase to 50 mg/day in 1-2 divided doses

• Child
>
6 mo:
PO
1-2 mg/kg/day in divided doses, max 37.5 mg for 6 mo-2 yr; max 100 mg/day for 2-12 yr

• Child
<
6 mo:
PO
up to 2-3.3 mg/kg/day in divided doses

Increase:
hyperglycemia, hyperuricemia, hypotension—diazoxide

Increase:
hypokalemia—glucocorticoids, amphotericin B

Increase:
toxicity—lithium, non-depolarizing skeletal muscle relaxants, cardiac glycosides

Increase:
renal failure risk—NSAIDs

Increase:
effects—loop diuretics

Decrease:
antidiabetics effects

Decrease:
thiazides absorption—cholestyramine, colestipol

Increase:
parathyroid test, uric acid, calcium, glucose, cholesterol, triglycerides

Decrease:
potassium, sodium, Hgb, WBC, platelets

• 
Weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily

• 
Rate, depth, rhythm of respiration, effect of exertion

• 
B/P lying, standing; postural hypotension may occur

• 
Blood studies: BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid, electrolytes

• 
Signs of metabolic alkalosis:
drowsiness, restlessness

• 
Signs of hypokalemia:
postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness, dehydration

• 
Confusion, especially in geriatric patients; take safety precautions if needed

• 
Therapeutic response: improvement in edema of feet, legs, sacral area daily, decreased B/P

• 
To increase fluid intake to 2-3 L/day unless contraindicated; to rise slowly from lying or sitting position

• 
To notify prescriber of muscle weakness, cramps, nausea, dizziness; hypokalemia is common

• 
That product may be taken with food or milk

• 
To use sunscreen for photosensitivity

• 
That blood glucose may be increased in diabetics

• 
To take early in day to avoid nocturia

• 
To avoid alcohol, OTC meds unless approved by prescriber

• 
To rise slowly to prevent dizziness

• Adult:
PO
2.5-10 mg q3-6hr prn, max 60 mg/day

• Adult:
PO
5 mg q4-6hr prn, max 30 mg/24 hr

• 
Do not break, crush, or chew tabs; only scored tabs can be broken

• 
With antiemetic after meals if nausea or vomiting occurs

• 
Do not exceed 4 g acetaminophen with combination product

• 
Give with food or milk to prevent gastric upset

Increase:
CNS depression—alcohol, opioids, sedative/hypnotics, phenothiazines, skeletal muscle relaxants, general anesthetics, tricyclics

Increase:
severe reactions—MAOIs

Increase:
CNS depression—lavender, valerian

Increase:
amylase, lipase

• 
Pain:
intensity, type, location, other characteristics before, 1 hr after giving product; titrate upward by 25% until pain reduced by half; need for pain medication, physical dependence, opioid is more effective before pain is severe

• 
CNS changes:
dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction

• 
B/P, pulse, respirations before, periodically; if respirations <10/min, dose may need to be reduced, oversedation may occur

• 
Bowel status: constipation; provide fluids, fiber in diet, may need stimulate laxatives

• 
Allergic reactions:
rash, urticaria

• 
Cough and respiratory dysfunction: respiratory depression, character, rate, rhythm

• 
History of ulcers if using ibuprofen combination product

• 
Storage in light-resistant area at room temp

• 
Safety measures: night-light, call bell within easy reach; assistance with ambulation

• 
Therapeutic response: decrease in pain or cough

• 
To report any symptoms of CNS changes, allergic reactions

• 
That physical dependency may result when used for extended periods

• 
That withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia

• 
To avoid driving, other hazardous activities because drowsiness occurs

• 
To avoid other CNS depressants; they will enhance sedating properties of this product

• 
To change positions slowly to reduce orthostatic hypotension

Anucort, Anusol, Cortifoam, Hemril, Proctocort, Rectasol

A-hydroCort, Solu-Cortef

Func. class.:
Corticosteroid

Chem. class.:
Short-acting glucocorticoid