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
Lippincotts Nursing
Drug Guide, p. 592

Source:
Karch, Amy: 2009 Lippincotts 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 Lippincotts Nursing
Drug Guide, p. 593-594

Source:
Karch, Amy: 2009 Lippincotts 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
Lippincotts 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 Lippincotts
Nursing Drug Guide, p. 592

Source:
Karch, Amy: 2009 Lippincotts
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.