Generic name (brand name) Dexamethasone

Indication

Dosage, Route, frequency Shock: 4 to 8 mg intravenously initially, repeat if necessary to a total dose of 24 mg. Autoimmune diseases and inflammations: longterm therapy with 0.5 to 1.5 mg oral per day. Avoid more than 1.5 mg daily, because serious side effects are more frequently encountered with higher doses. Adjuvant to or part of chemotherapy: individual schedule Diagnostic purposes: special schedule

Mechanism of action Dexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. It suppresses normal immune response. Onset: As acetate: Prompt. Duration: 72 hr. Absorption: Readily absorbed from the GI tract (Oral). Distribution: Readily crosses the placenta. Protein binding: About 77%. Metabolism: Hepatic. Excretion: Via urine (65% of the dose within 24 hr).

Side effects

Adverse reaction

contraindication

Nursing Responsibility

(decadron)

Classification: Glucocorticoid, Corticosteroid

Pregnancy category: C

Hypercalcemia associated with cancer Short-term management of various 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 leukemias and

- acne; - anxiety; - black or tarry stool; - cold or infection that lasts a long time; - depression; - dizziness; - easy bruising; - headache; - increased hair growth; - insomnia; - irregular or absent menstrual periods; - muscle weakness; - restlessness; - skin rash; - stomach irritation; - swollen face, lower legs, or ankles; - upset stomach; - vision problems; - vomiting;

If these signs and symptoms will be noted instruct the patient to call or notify the physician immediately. Skin rash Swollen face, legs or ankles (fluid retention) Vision problems ( Dexamethasone may cause cataracts and increased intraocular pressure) Cold or infection that last for a long time Muscle weakness Black or tarry stool (suggestive of peptic ulceration caused by Dexamethasone use)

Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibioticresistant infections, allergy to any component of the preparation used. Use cautiously with renal or hepatic 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; lactation.

1. Monitor intake and output of patient. 2. Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted. 3. For patients with cerebral edema, assess then for level of consciousness changes and headache during the therapy. 4. Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the physician immediately. 5. Administer with meals to minimize GI irritation. 6. For patients with difficulty swallowing, tablets can be crushed and administered with fluids or food. However, capsules should be swallowed whole. 7. Educate the patient to take

Potentially Fatal: Reduced efficacy in

lymphomas Cerebral edema associated with brain tumor, craniotomy, or head injury Testing adrenocortical hyperfunction Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of depression Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments

Half-life: About 190 min.

combination with ephedrine, cholestyramine, phenytoin, phenobarbital and rifampicin.

missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. 8. Instruct patient to avoid people with known infection and contagious illnesses as corticosteroids causes immunosuppression and may mask symptoms of infection. For systemic administration, do not give drug to nursing mothers; drug is secreted in breast milk.

Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels.

Increase dosage when patient is subject to stress.

Dermatologic preparations: Relief of inflammatory and pruritic manifestations of dermatoses that are steroid-responsive Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe

Taper doses when discontinuing high-dose or long-term therapy.

Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

For respiratory inhalant, intranasal preparation, do not use respiratory inhalant during an acute asthmatic attack or to manage status asthmaticus.

Do not use intranasal product with untreated local nasal infections, epistaxis, nasal trauma, septal ulcers, or recent nasal surgery.

Taper systemic steroids carefully during transfer to inhalational steroids; adrenal insufficiency deaths have occurred.

For topical dermatologic preparations, use caution when occlusive dressings, tight diapers cover affected area; these can increase systemic absorption.

Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases