PRED-ni-sone

Therapeutic Classification: corticosteroids (intermediate acting), immune modifiers

Pharmacologic Classification: corticosteroids

• Used systemically and locally in a wide variety of chronic diseases including:
  • Inflammatory,
  • Allergic,
  • Hematologic,
  • Neoplastic,
  • Autoimmune disorders.
• Suitable for alternate-day dosing in the management of chronic illness.

• In pharmacologic doses, suppresses inflammation and the normal immune response.
• Suppresses adrenal function at chronic doses of 5 mg/day.
• Replaces endogenous cortisol in deficiency states.
• Has minimal mineralocorticoid activity.

• Suppression of inflammation and modification of the normal immune response.

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed.

Metabolism/Excretion: Converted by the liver to prednisolone, which is then metabolized by the liver.

Half-life: 3.4–3.8 hr (plasma), 18–36 hr (tissue); adrenal suppression lasts 1.25–1.5 days.

(anti-inflammatory activity)

Contraindicated in:

• Active untreated infections (may be used in patients being treated for tuberculous meningitis)
• Some products contain alcohol and should be avoided in patients with known intolerance.

Use Cautiously in:

• Chronic treatment (leads to adrenal suppression; use lowest possible dose for shortest period of time)
• Stress (surgery, infections); supplemental doses may be needed
• Potential infections may mask signs (fever, inflammation)
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Chronic use in children will result in ↓ growth; use lowest possible dose for shortest period of time.

Adverse reactions/side effects are much more common with high-dose/long-term therapy

CV: hypertension.

Derm: acne, ↓wound healing, ecchymoses, hirsutism, petechiae.

EENT: cataracts, ↑ intraocular pressure.

Endo: adrenal suppression, cushingoid appearance (moon face, buffalo hump), hyperglycemia.

F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis.

GI: anorexia, nausea, PEPTIC ULCERATION, vomiting.

Hemat: THROMBOEMBOLISM, thrombophlebitis.

Metab: weight gain, weight loss.

MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain.

Neuro: depression, euphoria, headache, ↑ intracranial pressure (children only), personality changes, psychoses, restlessness.
Misc: ↑susceptibility to infection.

Drug-Drug:

• Additive hypokalemia with thiazide and loop diuretics, amphotericin B, or piperacillin/tazobactam.
• Hypokalemia may ↑ risk of digoxin toxicity.
• May ↑ requirement for insulins or oral hypoglycemic agents.
• Phenytoin,phenobarbital, and rifampin stimulate metabolism; may ↓ effectiveness.
• Oral contraceptives may ↓ metabolism.
• ↑risk of adverse GI effects with NSAIDs (including aspirin).
• At chronic doses that suppress adrenal function, may ↓ antibody response to and ↑ the risk of adverse reactions from live-virus vaccines.
• May ↑ risk of tendon rupture from fluoroquinolones.

• PO (Adults): Most uses: 5–60 mg/day as a single dose or in divided doses (delayed-release tablets should be administered once daily). Multiple sclerosis: 200 mg/day for 1 wk, then 80 mg every other day for 1 mo. Adjunctive therapy of Pneumocystis jiroveci pneumonia in patients with AIDS: 40 mg twice daily for 5 days, then 40 mg once daily for 5 days, then 20 mg once daily for 10 days.
• PO (Children): Nephrotic syndrome: 2 mg/kg/day initially given in 1–3 divided doses (maximum 80 mg/day; delayed-release tablets should be administered once daily) until urine is protein-free for 4–6 wk. Maintenance dose of 2 mg/kg/day every other day in the morning, gradually taper off after 4–6 wk. Asthma exacerbation: 1 mg/kg every 6 hr for 48 hr, then 1–2 mg/kg/day (maximum 60 mg/day) in divided doses twice daily.

(Generic available)

• Delayed-release tablets: 1 mg; 2 mg; 5 mg;
• Oral solution: 5 mg/5 mL; 5 mg/mL (concentrated);
• Tablets: 1 mg; 2.5 mg; 5 mg; 10 mg; 20 mg; 50 mg;

• Indicated for many conditions. Assess involved systems before and periodically during therapy.
• Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy.
• Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur.
• Pedi: Children should have periodic evaluations of growth.

• Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May decrease WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations.
  • Guaiac test stools. Promptly report presence of guaiac-positive stools.
  • May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I.
  • Suppress reactions to allergy skin tests.
  • Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy.

• Do not confuse prednisone with prednisolone.
• If dose is ordered daily or every other day, administer in the morning to coincide with the body's normal secretion of cortisol.
• Periods of stress, such as surgery, may require supplemental systemic corticosteroids.
• PO: Administer with meals to minimize GI irritation.
  • Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing.
  • Use calibrated measuring device to ensure accurate dosage of liquid forms.
  • DNC: Swallow delayed-release tablets whole; do not crush, break, or chew.

• Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening.
  • Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.
  • Caution patient to avoid vaccinations without first consulting health care professional.
  • Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Discuss possible effects on body image. Explore coping mechanisms.
  • Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.
  • Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate medical history.
  • Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams may be needed.
• Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see Appendix M). Alcohol should be avoided during therapy.

• Decrease in presenting symptoms with minimal systemic side effects.
• Suppression of the inflammatory and immune responses in autoimmune disorders, allergic reactions, and neoplasms.
• Management of symptoms in adrenal insufficiency.

Rayos

Winipred