prednisone Nursing Considerations & Management

 Drug Name

Generic Name : prednisone

Brand Name: Apo-Prednisone (CAN), Deltasone, Liquid Pred, Meticorten, Novo-Prednisone (CAN), Orasone, Panasol-S, Prednicen-M, Prednisone Intensol Concentrate, Sterapred DS, Sterapred (regular), Winpred (CAN)

Classification: Corticosteroid (intermediate acting), Glucocorticoid, Hormone

Pregnancy Category C 

Dosage & Route

Available forms : Tablets—1, 2.5, 5, 10, 20, 50 mg; oral solution—5 mg/5 mL, 5 mg/mL; syrup—5 mg/5 mL

ADULTS
  • Individualize dosage depending on severity of condition and patient’s response. Administer daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, consider alternate-day therapy. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. Initial dose, 5–60 mg/day PO. For maintenance therapy, reduce initial dose in small increments at intervals until lowest dose that maintains satisfactory clinical response is reached.
PEDIATRIC PATIENTS
  • Physiologic replacement: 0.05–2 mg/kg/day PO or 4–5 mg/m2/day PO in equal divided doses q 12 hr.
  • Other indications: Individualize dosage depending on severity of condition and patient’s response rather than by strict adherence to formulae that correct adult doses for age or body weight. Carefully observe growth and development in infants and children on prolonged therapy.
Therapeutic actions
  • Prednisone is biologically inert and converted to the predominantly prednisolone in the liver. It decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and vol of the lymphatic system; suppresses adrenal function at high doses. Indications and dosage are same as those for prednisolone.
Indications
  • Replacement therapy in adrenal cortical insufficiency
  • Hypercalcemia associated with cancer
  • Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders
  • Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia
  • Ulcerative colitis, acute exacerbations of MS and palliation in some leukemias and lymphomas
  • Trichinosis with neurologic or myocardial involvement
Adverse effects
  • Insomnia, nervousness, increased appetite, indigestion, dizziness/lightheadedness, headache, hirsutism, hypopigmentation, diabetes mellitus, glucose intolerance, hyperglycaemia, arthralgia, cataracts, glaucoma, epistaxis, diaphoresis, Cushing’s syndrome, edema, fractures, hallucinations, hypertension, muscle-wasting, osteoporosis, pancreatitis, pituitary-adrenal axis suppression, seizures.
Contraindications
  • Hypersensitivity, serious infections (except tuberculous meningitis), varicella, systemic fungal infections.
Nursing considerations
Assessment
  • History: Infections; renal or liver disease, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; hepatic disease; lactation
  • Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R, adventitious sounds, serum electrolytes, blood glucose
Interventions
  • Administer once-a-day doses before 9AM to mimic normal peak corticosteroid blood levels.
  • Increase dosage when patient is subject to stress.
  • WARNING: Taper doses when discontinuing high-dose or long-term therapy to avoid adrenal insufficiency.
  • Do not give live virus vaccines with immunosuppressive doses of corticosteroids.
Teaching points
  • Do not stop taking the drug without consulting your health care provider; take once-daily doses at about 9 AM.
  • Avoid exposure to infections.
  • Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of the disorder for which the drug is being taken.