Solu-cortef (hydrocortisone)

Clinical Medications Worksheets Generic Name hydrocortisone

Trade Name Cortef/ Solu-Cortef

Peak 1-2 hr

Onset Unknown

Classification Short-acting corticosteroids Duration 1.25 – 1.5 days

Why is your patient getting this medication Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity (Addson’s Disease). Mechanism of action and indications (Why med ordered) Suppress inflammation and the normal immune response. Replace endogenous cortisol in deficiency states. Also have potent mineralocorticoid (sodium-retaining) activity.

Solu-Cortef (hydrocortisone)

Dose Route 20mg PO 10mg PO Normal dosage range 20-240 mg/day in 1-4 divided doses

Time/frequency Q am Q pm

For IV meds, compatibility with IV drips and/or solutions N/A Nursing Implications (what to focus on) Contraindications/warnings/interactions Active untreated infections (may be used in patients being treated for some forms of meningitis). Administration of live virus vaccines. Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time). Stress (surgery, infections); supplemental doses may be needed. Potential infections may mask signs (fever, inflammation). Common side effects Depression, euphoria, hypertension, PEPTIC ULCERATION, anorexia, nausea, acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, THROMBOEMBOLISM, muscle wasting, osteoporosis, cushingoid appearance (moon face, buffalo hump).

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Levaquin: Concomitant administration of corticosteroids may potentiate the risk of tendinitis and tendon rupture associated with fluoroquinolone treatment. The mechanism is unknown. Tendinitis and tendon rupture have most frequently involved the Achilles tendon, although cases involving the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Some have required surgical repair or resulted in prolonged disability. Tendon rupture can occur during or up to several months after completion of fluoroquinolone therapy. Lanoxin: Systemically administered corticosteroids may induce hypokalemia and possibly increase the risk of digoxin toxicity. In addition, corticosteroid-induced sodium and water retention can result in edema leading to heart failure. These effects may be more common with the natural corticosteroids (cortisone, hydrocortisone) which have greater mineralocorticoid activity. ASA: Coadministration with corticosteroids may decrease the serum concentrations and therapeutic effects of salicylates. Likewise, serum salicylate levels may increase following withdrawal of corticosteroid therapy, potentially resulting in salicylate toxicity. This interaction has been reported in patients receiving intra-articular as well as oral corticosteroids. One or more mechanisms may be involved, including an increase in the renal clearance and/or an induction of hepatic metabolism of salicylates caused by corticosteroids. Pharmacologically, the potential for increased gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration and perforation, should be considered due to additive ulcerogenic effects of these agents (especially aspirin) on the GI mucosa. Miralax: The overuse or abuse of laxatives can cause significant loss of electrolytes and potentiate the risk of hypokalemia associated with corticosteroid therapy. Corticosteroids promote the retention of sodium and water and the excretion of potassium. Although these effects are primarily associated with mineralocorticoids like fludrocortisone, they may also occur with higher dosages of glucocorticoids or adrenocorticotropic agents, particularly if given systemically for longer than brief periods. Lantus: The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and other diuretics, corticosteroids, estrogens, progestins, thyroid hormones, human growth hormone, phenothiazines, atypical antipsychotics, sympathomimetic amines, protease inhibitors, phenytoin, clozapine, megestrol, danazol, isoniazid, asparaginase, pegaspargase, diazoxide, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes. Coreg: Corticosteroids may antagonize the effects of antihypertensive medications by causing sodium and fluid retention. These effects may be more common with the natural corticosteroids (cortisone, hydrocortisone) because they have greater mineralocorticoid activity. In addition, some calcium

Solu-Cortef (hydrocortisone)

Lab value alterations caused by medicine Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May ↓ WBCs. May cause hyperglycemia, especially in persons with diabetes. 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 hypothalamicpituitary-adrenal axis suppression. Be sure to teach the patient the following about this medication 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. Corticosteroids 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. 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. Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates. Alcohol should be avoided during therapy.

Nursing Process- Assessment (Pre-administration assessment) 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 physician or other health care professional if these occur. Assess patient for changes in level of consciousness and headache during therapy.

Solu-Cortef (hydrocortisone)

Assessment Why would you hold or not give this med? Cerebral edema, undesirable side effects. Stopping the medication suddenly can be lifethreatening.

Evaluation Check after giving Decrease in presenting symptoms with minimal systemic side effects. Management of symptoms in adrenal insufficiency.