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 ****bolic 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 05–10 mg daily;
by intramuscular injection or slow intravenous injection or infusion (as dexamethasone phosphate), initially 05–20 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 12 mg = dexamethasone sodium phosphate 13 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
******** baseline weight, BP, 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