DRUG CLASSIFICATIO MECHANISM OF DRUG-TO- DOSE, ROUTE, & SIDE NURSING CONSIDERATION

NAME N & INDICATION ACTION DRUG FREQUENCY EFFECTS

INTERACTIO &
N ADVERSE
EFFECTS
Generic Classification: Decreases inflammation by Increase: DECREASE LOCAL CNS: Assess:
Name: Corticosteroid suppression of migration of toxicity— INFLAMMATION (ORAL) Depression, Potassium, blood, urine glucose while receiving
Dexamethas Glucocorticoid polymorphonuclear cycloSPORINE Adults. Day 1: 4 to 8 mg I.M. Days 2 headache, long-term therapy; hypo/hyperglycemia, Weight
one Anti-inflammatory leukocytes, fibroblasts, and 3: 3 mg/day P.O. divided every 12 mood daily; notify prescriber of weekly gain >5 lb, B/P,
Immunosuppressant reversal of increased Increase: side hr. changes, pulse; notify prescriber of chest pain
Brand capillary permeability and effects—alcohol, Day 4: 1.5 mg/day P.O. divided every euphoria
Name: Indications: lysosomal stabilization, salicy- 12 hr. Days 5 and 6: 0.75 mg/day P.O. CV: I&O ratio; be alert for decreasing uri-
Dexasone Inflammation, allergies suppresses normal immune lates, as a Hypertension nary output, increasing edema
cerebral edema, response, no amphotericin B, single dose. EENT:
septic shock, mineralocorticoid effects digoxin, Increased Cerebral edema: LOC, and headache, baseline
dexamethasone cycloSPO- DECREASE CEREBRAL EDEMA intraocular and periodically
suppression test for Steroid substances secreted RINE, diuretics, (ORAL) pressure,
Cushing syndrome, by fetal adrenal glands NSAIDs Adults: 2 mg every 6 hr for 48 hr, cataracts Pregnancy/breastfeeding: no well-controlled
adrenocortical cause uterine contractions. followed by collection of 24-hr urine ENDO: HPA studies; use only if benefit outweighs fetal risk;
insufficiency The placenta may have a Increase: specimen to determine 17- suppression, discontinue breastfeeding or product
role by producing CRH dexamethasone hydroxycorticosteroid level. hyperglycemia
(Corticotropin releasing action—salic- , sodium, fluid Teach patient/family
DURING LABOR: hormone). During the last ylates, SEPTIC SHOCK: retention, To notify prescriber if therapeutic response
weeks of pregnancy, cortisol estrogens, (IV) pheochromo- decreases because dosage adjustment may be
improves the Bishop and DHEA-S hormonal Adult: 1.67-5 mg/kg slowly over cytoma needed
score of the cervix and (Dehydroepiandrosterone contracep- several minutes, may be repeated
thus causes softening sulfate), CRH in the fetus tives, within 2-6 hours until condition is GI: Nausea, To take with food or milk
of the cervix and increase, also maternal ketoconazole, stable and usually for up to 72 hours. peptic That bruising may occur easily
reduces the length of estrogens.Th. This results in macrolide Alternatively, initial dose may be ulceration, That if on long-term therapy, a high-protein diet may
time between labor modification of the antiinfec- followed by continuous infusion of 2.5 vomiting be needed
induction and the start contractility of the uterus. tives, NSAIDs mg/kg per 24 hours. INTEG: Acne,
of the active phase of Child: 167-333 mcg/kg daily. poor wound Not to discontinue abruptly because
childbirth. Decrease: healing, adrenal crisis can result
Studies have shown that potassium SCREENING TEST FOR CUSHING'S ecchymosis, About symptoms of adrenal insufficiency: nausea,
Pregnancy category: corticosteroids analogues as levels—thiazide/ SYNDROME (ORAL) petechiae, anorexia, fatigue, dizziness, dyspnea, weakness,
C dexamethasone could loop diuretics, Adult: 2 mg at 11 pm, followed by a hirsutism joint pain, hypertension
improve the Bishop score of amphotericin B blood test for plasma cortisol at 8 am
the cervix and thus causes the following morning. Alternatively, META: Corticosteroid injections are given intramuscularly
softening of the cervix and ACTIVITIES: 500 mcg 6 hourly for 48 hours, then Hypokalemia, at a 90-degree angle with a 22-25 gauge, 1-1.5 inch
reduces the length of time alcohol use: measure plasma cortisol at 8 am on fluid retention, long sterile needle into the upper arm, buttock, or
between labor induction and Increased risk of the 3rd morning (with 24-hour urine hypokalemic thigh. Be sure to document medication, dose, time,
delivery but further studies in GI bleeding collections for determination of 17- alkalosis and date, as well as the site of administration.
that field is still needed & no hydroxycorticosteroid excretion).
studies in prelabour rupture MS: Fractures, Administration of ACS is recommended to speed
of membranes were done. ADRENOCORTICAL osteoporosis, fetal lung maturity in all women who are preterm
INSUFFICIENCY (ORAL) weakness, and have an increased likelihood of giving birth
OTHER: Adults. Highly individualized dosage arthralgia, within 7 days, regardless of other complications of
based on severity of disorder. Usual: myopathy pregnancy. ACS should be initiated even if it is
Preterm babies do not have
0.75 believed that the full course may not be completed
enough surfactant in their
to 9 mg/day in divided doses. prior to delivery. Delivery should not be delayed in
lungs. Surfactant helps the
Children. Highly individualized, based order to complete the ACS course in cases where
lungs expand during
on severity of disorder. 0.02 to 0.3 delivery should be expedited, such as
breathing, and therefore
mg/kg/day in three or four divided chorioamnionitis or severe pre-
babies who lack surfactant
doses. eclampsia/eclampsia. In women with diabetes,
commonly develop RDS.
blood sugars should be closely monitored and
ACS increase the natural
additional insulin may be required. Women on
production of surfactant, and
thus reduce the risk that
newborns will develop
severe RDS if born early.
ACS have also been shown
to have a protective effect
on cerebral blood vessels,
thus reducing the risk of
intraventricular hemorrhage,
and on the intestines, thus
reducing the chance of
necrotizing enterocolitis.
DURING LABOR/ IMMINENT
PRETERM BIRTH: (IM)
Give dexamethasone (or
betamethasone) 24mg IM in divided
doses. A regimen of 12mg IM every 12
hours for two doses is recommended
for ease of administration, but other
regimens are also acceptable.
chronic steroids can receive ACS but may also
need a stress dose of their steroids at the time of
delivery. There are no absolute contraindications
for ACS.
Tocolysis: Medications to stop uterine contractions
(such as nifedipine or indomethacin) may be useful
to prolong pregnancy for a short time (up to 48
hours) to allow administration of ACS or transfer to
a higher level facility. Tocolysis has not been shown
to reduce rates of preterm birth.vii iii Transfer to a
higher level facility: A woman with an increased
likelihood of a preterm birth should be cared for in a
facility where both the mother and baby can receive
appropriate care
Antibiotics: There is strong evidence supporting
antibiotic use for preterm prelabor rupture of
membranes (PPROM) because it delays labor and
reduces neonatal infection rates.ii Antibiotics
should be given to women with PPROM. Give
ampicillin 2gms IV twice daily and erythromycin
250mg orally three times daily for two days,
followed by amoxicillin 500mg orally and
erythromycin 250mg orally three times daily to
complete 7 days of therapy. Multiple studies have
shown no improvement in outcomes from the use of
antibiotics in women with intact membranes and
preterm labor.