Hydrocortisone

dr.joan

Hydrocortisone :

Trade names: hydrocortisone butyrate

Class:
· Corticosteroid, short acting
· Glucocorticoid
· Mineralocorticoid
· Adrenal cortical hormone (hydrocortisone)
· Hormonal agent
Pregnancy: (Category C/ D if used in 1st trimester)

Action: Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (Mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.

Indications

· Replacement therapy in adrenal cortical insufficiency
· Hypocalcaemia associated with cancer
· Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders
· Hematologic disorders--thrombocytopenic purpura, erythroblastopenia
· Trichinosis with neurologic or myocardial involvement
· Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemia and lymphomas
· Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques
· Retention enema: For ulcerative colitis, proctitis
· Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive
· Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation

Contraindications/cautions

· Systemic administration: infections, especially tuberculosis, fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections; kidney disease (risk to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (risks exacerbations or bowel perforation); hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, diabetes mellitus; lactation.
· Retention enemas, intrarectal foam: systemic fungal infections, recent intestinal surgery, extensive fistulas.
· Topical dermatologic administration: fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated; lactation.
Dose:
· by mouth, replacement therapy, 20–30 mg daily in divided doses , CHILD 10–30 mg
· By intramuscular injection or slow intravenous injection or infusion, 100–500 mg, 3–4 times in 24 hours or as required; CHILD by slow intravenous injection up to 1 year 25 mg, 1–5 years 50 mg, 6–12 years 100 mg

Adverse effects

Systemic

• CNS: Vertigo, headache, paresthesias, insomnia, convulsions, psychosis
• GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain (long-term therapy)
• CV: Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte disturbances
• Hematologic: Na+ and fluid retention, hypokalemia, hypocalcaemia, increased blood sugar, increased serum cholesterol, decreased serum T3 and T4 levels
• Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures (long-term therapy)
• EENT: Cataracts, glaucoma (long-term therapy), increased intraocular pressure
• Dermatologic: Thin, fragile skin; Petechiae; ecchymoses; purpura; striae; subcutaneous fat atrophy
• Hypersensitivity: Anaphylactoid or hypersensitivity reactions
• Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and diabetes mellitus, cushingoid state (long-term therapy), hypothalamic-pituitary-adrenal (HPA) suppression systemic with therapy longer than 5 d
• Other: Immunosuppression, aggravation or masking of infections, impaired wound healing

Adverse Effects Related to Specific Routes of Administration

• IM repository injections: Atrophy at injection site
• Retention enema: Local pain, burning; rectal bleeding; systemic absorption and adverse effects (above)
• Intra-articular: Osteonecrosis, tendon rupture, infection
• Intraspinal: Meningitis, adhesive arachnoiditis, conus medullaris syndrome
• Intralesional therapy, head and neck: Blindness (rare)
• Intrathecal administration: Arachnoiditis
• Topical dermatologic ointments, creams, sprays: Local burning, irritation, acneiform lesions, striae, skin atrophy

Nursing Considerations

Systemic Administration

· Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize HPA suppression.
· Space multiple doses evenly throughout the day.
· Do not give IM injections if patient has thrombocytopenic purpura.
· Rotate sites of IM repository injections to avoid local atrophy.
· Use minimal doses for minimal duration to minimize adverse effects.
· Taper doses when discontinuing high-dose or long-term therapy.
· Arrange for increased dosage when patient is subject to unusual stress.
· Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.
· Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
· Provide antacids between meals to help avoid peptic ulcer.

Topical Dermatologic Administration

· Use caution with occlusive dressings; tight or plastic diapers over affected area can increase systemic absorption.
· Avoid prolonged use, especially near eyes, in genital and rectal areas, on face, and in skin creases.