Dexamethasone

dr.joan

Dexamethasone:
Trade name: dexacort
Class: adrenocorticosteroid –synthetic, glucocorticoid type
Pregnancy: (Category C/D if used in 1st trimester)

Action:

• They are a group of natural hormones produced by the adrenal cortex.
• They are used for a variety of therapeutic purposes.
• Many slightly modified synthetic variants are available today.
• Some patients respond better to one substance than to another.
• These hormones influence many metabolic pathways & all organ systems & are essential for survival.
• The release of corticosteroids is controlled by hormones such as corticotropin- releasing factor produced by the hypothalamus & ACTH produced by the anterior pituitary.

Uses:

• Replacement therapy: adrenal insufficiency (Addison’s disease) .
• Rheumatic disorders: rheumatoid arthritis & osteoarthritis.
• Collagen diseases: systemic lapus erythematosus, rheumatic cardiac.
• Allergic diseases: drug hypersensitivity, urticarial transfusion reaction.
• Respiratory diseases: bronchial asthma, rhinitis.
• Ocular diseases : allergic & inflammatory conjunctivitis, keratitis …
• Dermatological diseases: psoriasis, contact dermatitis, urticaria.
• Diseases of the GIT: ulcerative colitis.
• Nervous system: Myasthenia gravis.
• Malignancies: leukemia, lymphoma.
• Nephrotic syndrome.
• Hematologic diseases: hemolytic anemia, thrombocytopenic purpura.
• Miscellaneous: septic shock, liver cirrhosis, stimulation of surfactant
• Production, prevention of organ rejection.

Dose
By mouth, usual range 0.5–10 mg daily;
by intramuscular injection or slow intravenous injection or infusion (as dexamethasone phosphate), initially 0.5–20 mg; CHILD
200–500 micrograms/kg daily
Cerebral edema (as dexamethasone phosphate), by intravenous injection, 10 mg initially, then 4 mg by intramuscular injection every 6 hours as required for 2–10 days
Shock (as dexamethasone phosphate), by intravenous injection or infusion, 2–6 mg/kg, repeated if necessary after 2–6 hours
Note. Dexamethasone 1 mg = dexamethasone phosphate 1.2 mg = dexamethasone sodium phosphate 1.3 mg
Contraindications:

• If infection is suspected (Mask signs & symptoms).
• Peptic ulcer.
• Acute glomerulonephritis.
• Cushing’s syndrome.
• Congestive heart failure.
• Hypertension.
• Hyperlipidemia.

Side effects:

• Edema, alkalosis, hypokalemia, hypertension, CHF muscle wasting, weakness, osteoporosis, nausea & vomiting.
• Headache, hypercholesterolemia, hirsutism, amenorrhea, depression.
• Redistribution of body fats: thin extremities and fat trunk, moon-like face, buffalo hump.

Nursing considerations:
§ Administer oral forms with food to minimize ulcerogenic effect.
§ For chronic use, give the smallest dose possible.
§ Corticosteroids should be discontinued gradually if used chronically.
§ Document baseline weight, B.P., Pulse & temperature.
§ Frequently take BP, monitor body weight (signs of Na+ & H2O retention).
§ Periodic serum electrolytes, blood sugar monitoring.
§ Report signs & symptoms of side effects (Cushing-like syndrome).
§ Discuss with female client potentials of menstrual difficulties.
§ Instruct the client to take diet high in protein & potassium.

• Instruct the client to avoid falls & accidents (osteoporosis causes
• Pathological fracture).
• Remind the client to carry a card identifying the drug being used.
• Stress the need for regular medical supervision.
• Advice the client to delay any vaccination while taking these medications (Weakened immunity).

Explain the need to maintain general hygiene & cleanliness to prevent Infection.