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1 TIME/ACTION PROFILE (anti-inflammatory activity)

ROUTE ONSET PEAK DURATION PDF Page #1
hydrocortisone (hye-droe-kor-ti-sone) PO unknown 1–2 hr 1.25–1.5 days
Cortef, Cortenema, Hycort, Solu-CORTEF IM rapid 1 hr variable
Classification IV rapid unknown unknown
Therapeutic: anti-inflammatories (steroidal)
Pharmacologic: corticosteroids Contraindications/Precautions
Contraindicated in: Active untreated infections (may be used in patients being
Pregnancy Category C treated for tuberculous meningitis or septic shock); Lactation: Avoid chronic use;
Known alcohol, bisulfite, or tartrazine hypersensitivity or intolerance (some products
contain these and should be avoided in susceptible patients).
Indications Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use low-
Management of adrenocortical insufficiency; chronic use in other situations is lim- est possible dose for shortest period of time); Pedi: Chronic use will result inp
ited because of mineralocorticoid activity. Used systemically and locally in a wide va- growth; use lowest possible dose for shortest period of time; Hypothyroidism; Cirrho-
riety of disorders including: Inflammatory, Allergic, Hematologic, Neoplastic, Auto- sis; Ulcerative colitis; Stress (surgery, infections); supplemental doses may be
immune disorders, Septic shock. needed; Potential infections may mask signs (fever, inflammation); OB: Safety not es-
tablished.
Action Adverse Reactions/Side Effects
In pharmacologic doses, suppresses inflammation and the normal immune re- Adverse reactions/side effects are much more common with high-dose/long-term
sponse. Has numerous intense metabolic effects (see Adverse Reactions and Side Ef- therapy CNS: depression, euphoria, headache,qintracranial pressure (children
fects). Suppresses adrenal function at chronic doses of 20 mg/day. Replaces endoge- only), personality changes, psychoses, restlessness. EENT: cataracts,qintraocular
nous cortisol in deficiency states. Also has potent mineralocorticoid pressure. CV: hypertension. GI: PEPTIC ULCERATION, anorexia, nausea, vomiting.
(sodium-retaining) activity. Therapeutic Effects: Replacement therapy in adre- Derm: acne,pwound healing, ecchymoses, fragility, hirsutism, petechiae. Endo:
nal insufficiency. Suppression of inflammation and modification of the normal im- adrenal suppression, hyperglycemia. F and E: fluid retention (long-term high
mune response. doses), hypokalemia, hypokalemic alkalosis. Hemat: THROMBOEMBOLISM, throm-
bophlebitis. Metab: weight gain, weight loss. MS: muscle wasting, osteoporosis,
Pharmacokinetics avascular necrosis of joints, muscle pain. Misc: hypersensitivity reactions including
ANAPHYLAXIS, cushingoid appearance (moon face, buffalo hump),qsusceptibility to
Absorption: Well absorbed following oral administration. Sodium succinate salt is
rapidly absorbed following IM administration. Absorption from local sites (intra-ar- infection.
ticular, intralesional) is slow but complete. Interactions
Distribution: Widely distributed, crosses the placenta, and probably enters breast Drug-Drug: Additive hypokalemia with thiazide and loop diuretics, or ampho-
milk. tericin B. Hypokalemia mayqthe risk of digoxin toxicity. Mayqrequirement for
Metabolism and Excretion: Metabolized mostly by the liver. insulin or oral hypoglycemic agents. Phenytoin, phenobarbital, and rifam-
Half-life: 1.5– 2 hr (plasma), 8– 12 hr (tissue); adrenal suppression lasts 1.25– pinqmetabolism; maypeffectiveness. Oral contraceptives maypmetabolism.q
1.5 days. risk of adverse GI effects with NSAIDs (includingaspirin). At chronic doses that
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/hydrocortisone 02/14/2014 02:24PM
2 ● Rect: Assess symptoms of ulcerative colitis (diarrhea, bleeding, weight loss, ano-
suppress adrenal function, maypantibody response to andqrisk of adverse reac-
tions from live-virus vaccines.
Route/Dosage
PO (Adults and Children ⬎ 12 yr): 20– 240 mg/day in 1– 4 divided doses.
PO (Children): Physiologic replacement— 0.5– 0.75 mg/kg/day or 20– 25 mg/
m2/day divided q 6 hr. Anti-inflammatory or immunosuppressive— 2.5– 10 mg/
kg/day or 75– 300 mg/m2/dayin 3– 4 divided doses.
PO (Neonates): Congenital adrenal hyperplasia— 10– 20 mg/m2/day in 3 di-
vided doses.
PO, IV (Neonates): Refractory hypoglycemia— 5 mg/kg/day divided q 8– 12 hr
or 1– 2 mg/kg/dose q 6 hr.
Rect (Adults): Retention enema— 100 mg nightly for 21 days or until remission
occurs.
IM, IV (Adults): 100– 500 mg q 2– 6 hr (range 100– 8000 mg/day).
IM, IV (Children and Infants): Adrenocortical insufficiency— 1– 2 mg/kg/
dose bolus, then 25– 250 mg/day in divided doses q 6– 8 hr. Anti-inflammatory or
immunosuppressive— 1– 5 mg/kg/day or 30– 150 mg/m2/day divided q 12– 24
hr; Physiologic replacement— 0.25– 0.35 mg/kg/day or 12– 15 mg/m2/day once
daily; Shock— 50 mg/kg bolus then 50 mg/kg as a 24 hr infusion.
IV (Neonates): Bronchopulmonary dysplasia prevention in preterm neonates
with prenatal inflammatory exposure— 1 mg/kg/day divided q 12 hr during the
first 2 weeks of life; Refractory hypotension— 3 mg/kg/day divided q 8 hr x 5 days.
NURSING IMPLICATIONS
Assessment
● Indicated for many conditions. Assess involved systems prior to and periodically
during therapy.
● Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weak-
ness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) prior to 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 profes-
sional should these occur.
● Children should have periodic evaluations of growth.
Plate # 0-Composite pg 2 # 2
rexia, fever, leukocytosis) periodically during therapy.
● Lab Test Considerations: Systemic— Monitor serum electrolytes and glu- PDF Page #2
cose. May cause hyperglycemia, especially in persons with diabetes. May cause hy-
pokalemia. Monitor hematologic values, serum electrolytes, and serum and urine
glucose routinely in patients on prolonged therapy. May causepWBC counts. May
causepserum potassium and calcium andqserum sodium concentrations.
● Guaiac test stools. Promptly report presence of guaiac-positive stools.
● May cause elevated serum cholesterol and lipid values. May causepuptake of thy-
roid 123I or 131I.
● Suppresses 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.
Potential Nursing Diagnoses
Risk for infection (Side Effects)
Disturbed body image (Side Effects)
Implementation
● Do not confuse hydrocortisone with hydrocodone. Do not confuse Solu-
Cortef with Solu-Medrol (methylprednisolone).
● 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 corticoste-
roids.
● PO: Administer with meals to minimize GI irritation.
● Tablets may be crushed and administered with food or fluids for patients with diffi-
culty swallowing.
● IM: IM doses should not be administered when rapid effect is desirable. Do not
dilute with other solution or admix.
IV Administration
● pH: 7.0– 8.0.
● Direct IV: Reconstitute with provided solution (i.e., Act-O-Vials) or 2 mL of bac-
teriostatic water or saline for injection. Rate: Administer each 100 mg over at
least 30 sec. Doses ⱖ500 mg should be infused over at least 10 min.
● Intermittent Infusion: Diluent: May be added to 50– 1000 mL of D5W or
0.9% NaCl. Concentration: Usual 1– 5 mg/mL. Adults who are fluid restricted
may received up to 60 mg/mL. Rate: Administer over 20– 30 min.
䉷 2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/hydrocortisone 02/14/2014 02:24PM
3 ● Y-Site Incompatibility: amphotericin B colloidal, azathioprine, calcium chlo-
CONTINUED
hydrocortisone
● Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, allopurinol, amifos-
tine, amikacin, aminocaproic acid, aminophylline, amphotericin B cholesteryl,
amphotericin B lipid complex, amphotericin B liposome, amsacrine, anidulafun-
gin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine,
bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, carboplatin,
carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefote-
tan, cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol,
chlorpromazine, cisatracurium, cisplatin, cladribine, clindamycin, cyanocobala-
min, cytarabine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine,
cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, di-
goxin, docetaxel, dopamine, doripenem, doxacurium, doxorubicin hydrochlo-
ride, doxorubicin liposome, droperidol, edrophonium, enalaprilat, ephedrine,
epinephrine, epirubicin, epoetin alfa, eptifibitide, ertapenem, erythromycin, eto-
poside, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, flu-
orouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, grani-
setron, heparin, hetastarch, hydromorphone, ifosfamide, imiepnem/cilastatin,
indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, levofloxa-
cin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, me-
taraminol, methotrexate, methoxamine, methyldopate, methylergonovine, meto-
clopramide, metoprolol, metronidazole, milrinone, mitoxantrone, morphine,
multivitamins, nafcillin, naloxone, neostigmine, nesiritide, nicardipine, nitroglyc-
erin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxalipla-
tin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole,
pemetrexed, penicillin G, pentobarbital, phenobarbital, phentolamine, phenyl-
ephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium
chloride, procainamide, prochlorperazine, propofol, propranolol, pyridostig-
mine, ranitidine, remifentanil, rituximab, scopolamine, sodium acetate, sodium
bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin,
teniposide, theophylline, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban,
trastuzumab, trimetaphan, vasopressin, vecuronium, verapamil, vincristine, vi-
norelbine, voriconazole, zoledronic acid.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent.
Plate # 0-Composite pg 3 # 3
ride, ciprofloxacin, dacarbazine, dantrolene, diazepam, diazoxide, dobutamine,
PDF Page #3
doxycycline, ganciclovir, haloperidol, idarubicin, labetalol, mycophenolate, nal-
buphine, pentamidine, phenytoin, protamine, pyridoxime, quinapristin/dalfopris-
tin, rocuronium, sargramostim, thiamine, trimethoprim/sulfamethoxazole.
● Rect: Position patient on left side and administer nightly for 21 days. Enema
should be retained for at least 1 hr and preferrably all night. May use sedatives
and antidiarrheals to facilitate retention.
Patient/Family Teaching
● 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 sud-
denly may result in adrenal insufficiency (anorexia, nausea, weakness,
fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, no-
tify health care professional immediately. This can be life-threatening.
● Corticosteroids 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 profes-
sional.
● 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 medication regimen prior to
treatment or surgery.
● Discuss possible effects on body image. Explore coping mechanisms.
● Instruct patient to inform health care professional if symptoms of underlying dis-
ease return or worsen.
● 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. Alcohol should be avoided
during therapy.
Strikethrough ⫽ Discontinued.
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4
● If rectal dose used ⬎21 days, decrease to every other night for 2– 3 weeks to de- PDF Page #4
crease gradually.
Evaluation/Desired Outcomes
● Decrease in presenting symptoms with minimal systemic side effects.
● Suppression of the inflammatory and immune responses in autoimmune disor-
ders, allergic reactions, and neoplasms.
● Management of symptoms in adrenal insufficiency.
● Improvement in symptoms of ulcerative colitis. Clinical symptoms usually improve
in 3– 5 days. Mucosal appearance may require 2– 3 mo to improve.
Why was this drug prescribed for your patient?

䉷 2015 F.A. Davis Company