Hydrocortisone

Drug Data Generic Name Hydrocortisone Trade Name Cortef, SoluCortef, Hydrocortone, Cortenema Content Hydrocortisone Dosage 20-240 mg/day in single dose or divided doses

Classification Pharmacologic Class Adrenal cortical steroid Corticosteroid Glucocorticoid Therapeutic Class Hormone

Mechanism of Action Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and saltretaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.

Indication -Replacement therapy in adrenal cortical insufficiency - Allergic states – severe or incapacitating allergic conditions - Hematologic disorders - Ulcerative colitis

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 592

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 592

Adverse Reaction

Nursing Responsibilities

CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis CV: Hypotension, shock, HPN and heart failure secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Dermatologic: Thin, fragile skin, petechiae, ecchymoses, purpura, striae, subcutaneous fat atrophy EENT: Cataracts, glaucoma, increased IOP Endocrine: Amenorrhea, irregular mens, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state, HPA suppression systemic , hyperglycemia GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures Other: Immunosuppression, aggravation or masking of infections, impaired wound healing

Before - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 593-594

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 594-595

Precaution - Kidney disease - Liver disease - Cirrhosis - Hypothyroidism - Ulcerative colitis with impending perforation - Diverticulitis - Recent GI surgery - Active or latent peptic ulcer - Inflammatory bowel disease - Hypertension - Heart failure - Thromboembolic tendencies - Osteoporosis - Convulsive disorders - Metastatic carcinoma - Diabetes mellitus - TB - Lactation

Pregnancy category C

Availability Tablets: 5, 10, 20 mg; Oral suspension: 10 mg/5 mL; Injection: 25, 50 mg/mL, 100, 200, 500, 1,000 mg/vial

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 592

Contraindications Concentrations - Allergy to any component of the drug - Fungal infections - Amebiasis - Hepatitis B - Vaccinia or varicella - Antibiotic-resistant infections - Immunosuppression

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 592

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 592

During - Give daily before 9am to mimic normal peak diurnal corticosteroid levels. - Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse effects. - Do not give IM injections if patient has thrombocytopenic purpura. - Taper doses when discontinuing high-dose or long-term therapy. After - Monitor client for at least 30 minutes. - Educate client on the side effects of the medication and what to expect. - Instruct client to report pain at injection site. - Instruct client to take drug exactly as prescribed. - Dispose of used materials properly. - Document that drug has been given.