Patho Hogan Pharmacology Hesi Study Guide
Prednisone (Deltasone)
Action & Use:
o Corticosteroids: lyse lymphoid malignancies & have an indirect effect on malignant cells
Administration considerations:
o Oral forms should be administered with meals & may be crushed
o IV form should be given slowly by IV piggyback to prevent vaginal & anal bruising
Route & uses: PO; Inflammatory, allergic & debilitating conditions related to autoimmune disorders,
asthma, allergic reactions, & malignancies
Contradictions:
o Systemic infections
o Ulcerative colitis, diverticulitis, active or latent peptic ulcer disease
o Safe use in pregnancy (Category C) & nursing mothers has not been established
Significant Drug Interactions:
o Phenytoin (Dilantin) & Rifampin (Rifadin) increase steroid metabolism
o Increased doses may be required when given with amphotericin
o Diuretics increase potassium loss
o May inhibit antibody response to vaccines & toxoids
Significant Assessment Parameters:
o Establish baseline & continuing data on blood pressure, I&O, weight, & sleep patterns
o Measure 2-hour postprandial (occurring af ter a meal) blood glucose, serum potassium, & serum
calcium prior to therapy & at regular intervals thereafter
o Watch for changes in mood, emotional stability, & sleep patterns
Side Effects/Toxicity:
o Euphoria, headache, insomnia, psychosis
o Edema
, o Muscle weakness, delayed wound healing, osteoporosis, spontaneous fractures
o Hyperglycemia
Prednisone Use for Ophthalmic Disorder: Adverse Effects
o Crushing syndrome (hormonal disorder caused by prolonged exposure of the body's tissues to
high levels of the hormone cortisol), hyperglycemia, muscle weakness, nausea, vomiting,
dyspepsia (indigestion), increased appetite, delayed wound healing, superinfection, cataracts
glaucoma, thrombus formation
Glucocorticoids: an adrenocortical steroid hormone that increases glycogenesis, exerts an anti-
inflammatory effect, & influences many body functions. Its synthesis is regulated by the pituitary gland
via negative feedback loops; may regulate metabolism of skeletal & connective tissues
Route of administration for systemic use to treat inflammatory conditions include IV, IM, & PO
Route of administration for nonsystemic use include inhalation, nasal, ophthalmic, otic & topical
Drug Interactions:
o Antibiotics, cyclosporine, estrogen & ketoconazole slow metabolism or clearance of
glucocorticoids
o Antianxiety agents, antipsychotics, anticoagulants, vaccines, antihypertensives, hypoglycemics
Adverse Effects:
o Higher doses & prolonger therapy may alter metabolism of tissues & organs leading to muscle
wasting, & increased fay deposits in the central portion of the body & face; emotional lability or
changes in behavior & personality may occur
o Prolonged therapy may cause growth suppression in children & osteoporosis in adults; impaired
glucose tolerance & frank DM may also result
o Prolonged therapy can suppress the hypothalamic-pituitary-adrenal axis; adrenal crisis (an acute,
life threatening state of profound adrenocortical insufficiency) may result if drug is abruptly
withdrawn, so always taper does
Nursing Considerations:
o Check vital signs including BP, lung sounds, weight (including history of gain or loss), nausea &
vomiting, & signs of dependent edema
o Conduct mental status exam & assess for signs of depression, withdrawal, insomnia, & anorexia
o Check for skin for striae, thinning, bruising, change in color, change in hair growth & acne
o Check stool for occult blood periodically
, o With prolonger therapy, move & reposition immobilized clients carefully & limit use of adhesive
tape on skin because skin may become fragile & damaged for easily
Client Education:
o Take oral doses with meals & avoid use of alcohol
o Implement weight reduction diet, limit sodium intake, & increase potassium intake if excessive
weight gain occurs
o Avoid immunizations during therapy & for 3 months after, avoid contact with anyone with
measles or chicken pox or anyone receiving oral polio vaccine
Practice to Pass: A client taking glucocorticoid therapy asks the nurse about wearing some sort of
MedicAlert identification. How should the Nurse respond?
The nurse should encourage this action & should explain to the client the importance of wearing
MedicAlert identification. If the client should become ill or injured, the information about the
clients health contained on this identification will have an impact on treatment. The most
common side effects of glucocorticoid therapy are mental status changes, including effect, mood,
behavior, aggression, & depression.
Antibiotics:
Action & Use: Bactericidal- aminoglycosides kill bacteria cells by interfering with protein synthesis
Administration Considerations:
o Iv route preferred for optimal distribution to tissues
o May be used IM as well
o Topical Route: neomycin combined with other antibiotics provides broad spectrum coverage in
cream or ointment
Contraindications:
o Preexisting renal disease
o Concurrent order for renal toxic agents
Significant drug interactions:
o With oral anticoagulant therapy, bleeding may increase because aminoglycosides decrease
vitamin K synthesis in intestinal tract
Adverse Effects:
Prednisone (Deltasone)
Action & Use:
o Corticosteroids: lyse lymphoid malignancies & have an indirect effect on malignant cells
Administration considerations:
o Oral forms should be administered with meals & may be crushed
o IV form should be given slowly by IV piggyback to prevent vaginal & anal bruising
Route & uses: PO; Inflammatory, allergic & debilitating conditions related to autoimmune disorders,
asthma, allergic reactions, & malignancies
Contradictions:
o Systemic infections
o Ulcerative colitis, diverticulitis, active or latent peptic ulcer disease
o Safe use in pregnancy (Category C) & nursing mothers has not been established
Significant Drug Interactions:
o Phenytoin (Dilantin) & Rifampin (Rifadin) increase steroid metabolism
o Increased doses may be required when given with amphotericin
o Diuretics increase potassium loss
o May inhibit antibody response to vaccines & toxoids
Significant Assessment Parameters:
o Establish baseline & continuing data on blood pressure, I&O, weight, & sleep patterns
o Measure 2-hour postprandial (occurring af ter a meal) blood glucose, serum potassium, & serum
calcium prior to therapy & at regular intervals thereafter
o Watch for changes in mood, emotional stability, & sleep patterns
Side Effects/Toxicity:
o Euphoria, headache, insomnia, psychosis
o Edema
, o Muscle weakness, delayed wound healing, osteoporosis, spontaneous fractures
o Hyperglycemia
Prednisone Use for Ophthalmic Disorder: Adverse Effects
o Crushing syndrome (hormonal disorder caused by prolonged exposure of the body's tissues to
high levels of the hormone cortisol), hyperglycemia, muscle weakness, nausea, vomiting,
dyspepsia (indigestion), increased appetite, delayed wound healing, superinfection, cataracts
glaucoma, thrombus formation
Glucocorticoids: an adrenocortical steroid hormone that increases glycogenesis, exerts an anti-
inflammatory effect, & influences many body functions. Its synthesis is regulated by the pituitary gland
via negative feedback loops; may regulate metabolism of skeletal & connective tissues
Route of administration for systemic use to treat inflammatory conditions include IV, IM, & PO
Route of administration for nonsystemic use include inhalation, nasal, ophthalmic, otic & topical
Drug Interactions:
o Antibiotics, cyclosporine, estrogen & ketoconazole slow metabolism or clearance of
glucocorticoids
o Antianxiety agents, antipsychotics, anticoagulants, vaccines, antihypertensives, hypoglycemics
Adverse Effects:
o Higher doses & prolonger therapy may alter metabolism of tissues & organs leading to muscle
wasting, & increased fay deposits in the central portion of the body & face; emotional lability or
changes in behavior & personality may occur
o Prolonged therapy may cause growth suppression in children & osteoporosis in adults; impaired
glucose tolerance & frank DM may also result
o Prolonged therapy can suppress the hypothalamic-pituitary-adrenal axis; adrenal crisis (an acute,
life threatening state of profound adrenocortical insufficiency) may result if drug is abruptly
withdrawn, so always taper does
Nursing Considerations:
o Check vital signs including BP, lung sounds, weight (including history of gain or loss), nausea &
vomiting, & signs of dependent edema
o Conduct mental status exam & assess for signs of depression, withdrawal, insomnia, & anorexia
o Check for skin for striae, thinning, bruising, change in color, change in hair growth & acne
o Check stool for occult blood periodically
, o With prolonger therapy, move & reposition immobilized clients carefully & limit use of adhesive
tape on skin because skin may become fragile & damaged for easily
Client Education:
o Take oral doses with meals & avoid use of alcohol
o Implement weight reduction diet, limit sodium intake, & increase potassium intake if excessive
weight gain occurs
o Avoid immunizations during therapy & for 3 months after, avoid contact with anyone with
measles or chicken pox or anyone receiving oral polio vaccine
Practice to Pass: A client taking glucocorticoid therapy asks the nurse about wearing some sort of
MedicAlert identification. How should the Nurse respond?
The nurse should encourage this action & should explain to the client the importance of wearing
MedicAlert identification. If the client should become ill or injured, the information about the
clients health contained on this identification will have an impact on treatment. The most
common side effects of glucocorticoid therapy are mental status changes, including effect, mood,
behavior, aggression, & depression.
Antibiotics:
Action & Use: Bactericidal- aminoglycosides kill bacteria cells by interfering with protein synthesis
Administration Considerations:
o Iv route preferred for optimal distribution to tissues
o May be used IM as well
o Topical Route: neomycin combined with other antibiotics provides broad spectrum coverage in
cream or ointment
Contraindications:
o Preexisting renal disease
o Concurrent order for renal toxic agents
Significant drug interactions:
o With oral anticoagulant therapy, bleeding may increase because aminoglycosides decrease
vitamin K synthesis in intestinal tract
Adverse Effects:
