It is very slightly soluble in water and in ether; sparingly soluble in acetone and in alcohol; slightly soluble in chloroform. Its molecular weight is Hydrocortisone tablets, USP are available for oral administration in three strengths: each tablet contains either 5 mg, 10 mg, or 20 mg of hydrocortisone. Inactive ingredients: colloidal silicon dioxide, lactose monohydrate, magnesium stearate and microcrystalline cellulose. Naturally occurring glucocorticoids hydrocortisone and cortisone , which also have salt-retaining properties, are used as replacement therapy in adrenocortical deficiency states.
Their synthetic analogs are primarily used for their potent anti-inflammatory effects in disorders of many organ systems. Glucocorticoids cause profound and varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli. Hydrocortisone tablets are indicated in the following conditions. Primary or secondary adrenocortical insufficiency hydrocortisone or cortisone is the first choice; synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy mineralocorticoid supplementation is of particular importance.
As adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation in:. During an exacerbation or as maintenance therapy in selected cases of:. Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment:. Severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa such as:. To induce a diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus.
Tuberculous meningitis with subarachnoid block or impending block when used concurrently with appropriate antituberculous chemotherapy. Systemic fungal infections and known hypersensitivity to components. In patients on corticosteroid therapy subjected to unusual stress, increased dosage of rapidly acting corticosteroids before, during, and after the stressful situation is indicated. Corticosteroids may mask some signs of infection, and new infections may appear during their use.
Infections with any pathogen including viral, bacterial, fungal, protozoan or helminthic infections, in any location of the body, may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents that affect cellular immunity, humoral immunity, or neutrophil function.
These infections may be mild, but can be severe and at times fatal. With increasing doses of corticosteroids, the rate of occurrence of infectious complications increases. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerves, and may enhance the establishment of secondary ocular infections due to fungi or viruses.
Usage in pregnancy: Since adequate human reproduction studies have not been done with corticosteroids, the use of these drugs in pregnancy, nursing mothers or women of childbearing potential requires that the possible benefits of the drug be weighed against the potential hazards to the mother and embryo or fetus.
Infants born of mothers who have received substantial doses of corticosteroids during pregnancy, should be carefully observed for signs of hypoadrenalism. Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. These effects are less likely to occur with the synthetic derivatives except when used in large doses. Dietary salt restriction and potassium supplementation may be necessary.
All corticosteroids increase calcium excretion. Administration of live or live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of corticosteroids. Killed or inactivated vaccines may be administered to patients receiving immunosuppressive doses of corticosteroids; however, the response to such vaccines may be diminished. Indicated immunization procedures may be undertaken in patients receiving nonimmunosuppressive doses of corticosteroids.
The use of hydrocortisone tablets in active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary as reactivation of the disease may occur. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis.
Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chicken pox and measles, for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases, particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known.
If exposed to chicken pox, prophylaxis with varicella zoster immune globulin VZIG may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin IG may be indicated. If chicken pox develops, treatment with antiviral agents may be considered. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides threadworm infestation.
In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia. Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage.
This type of relative insufficiency may persist for months after discontinuation of therapy; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted. There is an enhanced effect of corticosteroids on patients with hypothyroidism and in those with cirrhosis. Corticosteroids should be used cautiously in patients with ocular herpes simplex because of possible corneal perforation.
The lowest possible dose of corticosteroid should be used to control the condition under treatment, and when reduction in dosage is possible, the reduction should be gradual. Psychic derangements may appear when corticosteroids are used, ranging from euphoria, insomnia, mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated by corticosteroids.
Steroids should be used with caution in nonspecific ulcerative colitis, if there is a probability of impending perforation, abscess or other pyogenic infection; diverticulitis; fresh intestinal anastomoses; active or latent peptic ulcer; renal insufficiency; hypertension; osteoporosis; and myasthenia gravis. Growth and development of infants and children on prolonged corticosteroid therapy should be carefully observed. Kaposi's sarcoma has been reported to occur in patients receiving corticosteroid therapy.
Discontinuation of corticosteroids may result in clinical remission. Pheochromocytoma crisis, which can be fatal, has been reported after administration of systemic corticosteroids. In patients with suspected pheochromocytoma, consider the risk of pheochromocytoma crisis prior to administering corticosteroids.
The pharmacokinetic interactions listed below are potentially clinically important. Drugs that induce hepatic enzymes such as phenobarbital, phenytoin and rifampin may increase the clearance of corticosteroids and may require increases in corticosteroid dose to achieve the desired response.
Drugs such as troleandomycin and ketoconazole may inhibit the metabolism of corticosteroids and thus decrease their clearance. Therefore, the dose of corticosteroid should be titrated to avoid steroid toxicity. Administer drug daily at 8 to 9 AM to mimic normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis HPA.
Which of the following patient complaint s will alert the nurse for possible aldosterone toxicity? Signs of toxicity include hypokalemia, weight gain, edema, and hypertension. Muscle weakness and abdominal fullness can be signs and symptoms of hypokalemia. Hypothalamic agents can inhibit or stimulate the release of hormones from the anterior pituitary using hormones or factors.
However, not all of these hormones are available for pharmacological use. Factors that inhibit antagonists include somatostatin growth hormone-inhibiting factor and prolactin-inhibiting factor. Other drugs acting on the endocrine system include the following: pituitary agents, adrenocortical agents, thyroid and parathyroid agents , and agents to control blood glucose levels.
Here is a table of commonly encountered endocrine system drugs, their generic names, and brand names:. Here are some important aspects to remember for indication of hypothalamic agents in different age groups:. Here are the characteristic interactions of hypothalamic agents and the body in terms of absorption, distribution, metabolism, and excretion:.
Drug interactions of hypothalamic agents are related to the specific hormones that the drug is affecting. They will be discussed in detail as each agents for specific hormones will be covered in this study guide. The specific nursing care of patient who is receiving hypothalamic releasing factor is related to the hormone s that the drug is affecting. This will be discussed further as each drugs affecting certain hormones will be covered in this study guide.
Options A, B, and D are all hypothalamic agonists and can, therefore, decrease the production of sex hormones. Agonists inhibit pituitary gonadotropin secretion, with a resultant drop in the production of sex hormones. Which of the following health history data will alert the nurse to question the use of hypothalamic agents in a short-term therapy?
Hypothalamic agents should be cautioned in lactating mothers because of potential adverse effects to the neonate. All other options are not contraindicated. Agonists can decrease the production of sex hormones. Medical conditions like endometriosis and precocious puberty are characterized by increased sex hormones. Infertility will best benefit from hypothalamic antagonists.
This drug decreases the abdominal fat in HIV -infected patients with lipodystrophy. Which of the following should be monitored closely in patients receiving hypothalamic agents? In patients receiving hypothalamic agents, the nurse should monitor closely for adverse effects associated with changes in overall endocrine function, particularly growth and development and metabolism.
Other aspects to be monitored include periodic radiograph of long bones, hydration, and nutrition.