Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (179 page)
(floo-droe-kor′ti-sone)
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Mineralocorticoid
Promotes increased reabsorption of sodium and loss of potassium, water, hydrogen from distal renal tubules
Adrenal insufficiency, salt-losing adrenogenital syndrome, Addison’s disease
Unlabeled uses:
Renal tubular acidosis (type IV), idiopathic orthostatic hypotension
Children <2 yr, hypersensitivity, acute glomerulonephritis, amebiasis, psychoses, Cushing’s syndrome, fungal infections
Precautions:
Pregnancy (C), breastfeeding, children >2 yr, osteoporosis, CHF, hypertension, diabetes
Calculator
• Adult:
PO
100-200 mcg/day
• Child:
PO
50-100 mcg/day
• Adult:
PO
50-200 mcg/day
Available forms:
Tabs 100 mcg (0.1 mg)
CNS:
Flushing, sweating
, headache, paralysis, dizziness,
seizures
CV:
Hypertension
,
circulatory collapse, thrombophlebitis, embolism,
tachycardia,
CHF,
edema
ENDO:
Weight gain, adrenal suppression, hyperglycemia
META:
Hypokalemia
MISC:
Hypersensitivity, cataracts, GI ulcers,
anaphylaxis
MS:
Fractures, osteoporosis, weakness
Peak 1.5 hr, half-life 18-36 hr, metabolized by liver, excreted in urine
Increase:
B/P—sodium-containing food or medication
Decrease:
fludrocortisone action—barbiturates, rifampin, phenytoin
Decrease:
potassium levels—thiazides, potassium-wasting products, loop diuretics, amphotericin B, piperacillin, mezlocillin
Increase:
hypokalemia—aloe, buckthorn, cascara sagrada, Chinese rhubarb, senna
Increase:
corticosteroid effect—aloe, licorice, perilla
Increase:
potassium, sodium
Decrease:
Hct
•
Weight daily; notify prescriber of weekly gain >5 lb
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
B/P q4hr, pulse; notify prescriber if chest pain occurs
•
Potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
Electrolytes: sodium, potassium, chloride, hypokalemia is common
•
Titrated dose; use lowest effective dose
•
With food or milk to decrease GI symptoms
•
Assistance with ambulation in patient with bone tissue disease to prevent fractures
•
Therapeutic response: correction of adrenal insufficiency
•
That emergency ID as steroid user should be carried
•
Not to discontinue this medication abruptly
•
To notify health care provider of muscle cramps, weight gain, edema, nausea, infection, trauma, stress
•
Not to breastfeed while taking this medication
•
Avoid exposure to disease, trauma
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(flu-maz′e-nill)
Anexate
, Romazicon
Func. class.:
Antidote: benzodiazepine receptor antagonist
Chem. class.:
Imidazobenzodiazepine derivative
Antagonizes actions of benzodiazepines on CNS, competitively inhibits activity at benzodiazepine recognition site on GABA/benzodiazepine receptor complex
Reversal of sedative effects of benzodiazepines
Hypersensitivity to this product or benzodiazepines, serious cyclic antidepressant overdose, patients given benzodiazepine for control of life-threatening conditions
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, status epilepticus, head injury, labor/delivery, renal/hepatic disease, hypoventilation, panic disorder, drug and alcohol dependency, ambulatory patients
Black Box Warning:
Benzodiazepine dependence, seizures
Calculator
• Adult:
IV
0.2 mg given over 15 sec; wait 45 sec then give 0.2 mg if consciousness does not occur; may be repeated at 60-sec intervals prn (max 3 mg/hr) or 1 mg/5 min
• Child:
IV
10 mcg (0.01 mg)/kg; cumulative dose of 1 mg or less
• Adult:
IV
0.2 mg given over 30 sec; wait 30 sec then give 0.3 mg over 30 sec if consciousness does not occur; further doses of 0.5 mg can be given over 30 sec at intervals of 1 min up to cumulative dose of 3 mg
• Child:
IV
10 mcg (0.01 mg/kg), cumulative dose of <1 mg
Available forms:
Inj 0.1 mg/ml
•
Check airway and IV access before administration
•
Use large vein
•
Give undiluted or diluted with 0.9% NaCl, D
5
W, LR; give over 15-30 sec into running IV
•
Stable for 24 hr if drawn into a syringe or mixed with other solutions
CNS:
Dizziness, agitation, emotional lability, confusion,
seizures,
somnolence, panic attacks
CV:
Hypertension, palpitations, cutaneous vasodilation,
dysrhythmias,
bradycardia, tachycardia, chest pain
EENT:
Abnormal vision, blurred vision, tinnitus
GI:
Nausea, vomiting, hiccups
SYST:
Headache, inj site pain, increased sweating, fatigue, rigors
Terminal half-life 41-79 min, metabolized in liver, onset 1-2 min
•
Toxicity: mixed product overdosage
•
Antagonize action of benzodiazepines, zaleplon, zolpidem
•
Cardiac status using continuous monitoring
Black Box Warning:
For seizures; protect patient from injury; most likely among those who are withdrawing from benzodiazepines; flumazenil can precipitate benzodiazepine withdrawal and onset of seizures, seizures are increased in head trauma
•
GI symptoms: nausea, vomiting; place patient in side-lying position to prevent aspiration
•
Allergic reactions:
flushing, rash, urticaria, pruritus
Black Box Warning:
Seizures/benzodiazepine dependence:
do not use in those who have used these products for IIP or status epilepticus; use in intensive care setting cautiously, there may be unrecognized benzodiazepine dependence
•
Therapeutic response: decreased sedation, respiratory depression, toxicity
•
That amnesia may continue
•
Not to engage in hazardous activities for 18-24 hr after discharge
•
Not to take any alcohol or nonprescription products for 18-24 hr
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B