Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

hydrocortisone Cortef/ Solu-Cortef Short-acting corticosteroids 20mg PO Q am
10mg PO Q pm
Peak Onset Duration Normal dosage range
1-2 hr Unknown 1.25 – 1.5 days 20-240 mg/day in 1-4 divided doses
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Management of adrenocortical insufficiency; chronic use in N/A
other situations is limited because of mineralocorticoid activity
(Addson’s Disease).
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Suppress inflammation and the normal immune response. Active untreated infections (may be used in patients being treated for
Replace endogenous cortisol in deficiency states. Also have some forms of meningitis). Administration of live virus vaccines.
potent mineralocorticoid (sodium-retaining) activity. Chronic treatment (will lead 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).
Common side effects
Depression, euphoria, hypertension, PEPTIC ULCERATION,
anorexia, nausea, acne, decreased wound healing, ecchymoses,
fragility, hirsutism, petechiae, adrenal suppression,
THROMBOEMBOLISM, muscle wasting, osteoporosis, cushingoid
appearance (moon face, buffalo hump).

Solu-Cortef (hydrocortisone)
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
Levaquin: Concomitant administration of corticosteroids may
potentiate the risk of tendinitis and tendon rupture associated
with fluoroquinolone treatment. The mechanism is unknown.
Tendinitis and tendon rupture have most frequently involved
the Achilles tendon, although cases involving the rotator cuff
(the shoulder), the hand, the biceps, and the thumb have also
been reported. Some have required surgical repair or resulted
in prolonged disability. Tendon rupture can occur during or up
to several months after completion of fluoroquinolone therapy.
Lanoxin: Systemically administered corticosteroids may
induce hypokalemia and possibly increase the risk of digoxin
toxicity. In addition, corticosteroid-induced sodium and water
retention can result in edema leading to heart failure. These
effects may be more common with the natural corticosteroids
(cortisone, hydrocortisone) which have greater
mineralocorticoid activity.
ASA: Coadministration with corticosteroids may decrease the
serum concentrations and therapeutic effects of salicylates.
Likewise, serum salicylate levels may increase following
withdrawal of corticosteroid therapy, potentially resulting in
salicylate toxicity. This interaction has been reported in
patients receiving intra-articular as well as oral corticosteroids.
One or more mechanisms may be involved, including an
increase in the renal clearance and/or an induction of hepatic
metabolism of salicylates caused by corticosteroids.
Pharmacologically, the potential for increased gastrointestinal
(GI) toxicity, including inflammation, bleeding, ulceration and
perforation, should be considered due to additive ulcerogenic
effects of these agents (especially aspirin) on the GI mucosa.
Miralax: The overuse or abuse of laxatives can cause
significant loss of electrolytes and potentiate the risk of
hypokalemia associated with corticosteroid therapy.
Corticosteroids promote the retention of sodium and water and
the excretion of potassium. Although these effects are primarily
associated with mineralocorticoids like fludrocortisone, they
may also occur with higher dosages of glucocorticoids or
adrenocorticotropic agents, particularly if given systemically
for longer than brief periods.
Lantus: The efficacy of oral hypoglycemic agents and insulin
may be diminished by certain drugs, including thiazides and
other diuretics, corticosteroids, estrogens, progestins, thyroid
hormones, human growth hormone, phenothiazines, atypical
antipsychotics, sympathomimetic amines, protease inhibitors,
phenytoin, clozapine, megestrol, danazol, isoniazid,
asparaginase, pegaspargase, diazoxide, temsirolimus, as well as
pharmacologic dosages of nicotinic acid and
adrenocorticotropic agents. These drugs may interfere with
blood glucose control because they can cause hyperglycemia,
glucose intolerance, new-onset diabetes mellitus, and/or
exacerbation of preexisting diabetes.
Coreg: Corticosteroids may antagonize the effects of
antihypertensive medications by causing sodium and fluid
retention. These effects may be more common with the natural
corticosteroids (cortisone, hydrocortisone) because they have
greater mineralocorticoid activity. In addition, some calcium
Solu-Cortef (hydrocortisone)
Lab value alterations caused by medicine
Monitor serum electrolytes and glucose. May cause hyperglycemia,
especially in persons with diabetes. May cause hypokalemia. Patients
on prolonged therapy should routinely have hematologic values, serum
electrolytes, and serum and urine glucose evaluated. May ↓ WBCs.
May cause hyperglycemia, especially in persons with diabetes. 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.
Be sure to teach the patient the following about this medication
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. 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 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
medication regimen before treatment or surgery. Instruct patient to
inform health care professional if symptoms of underlying disease
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.
Encourage patient to eat a diet high in protein, calcium, and potassium,
and low in sodium and carbohydrates. Alcohol should be avoided
during therapy.
Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this med? Check after giving
Assess involved systems before and periodically Cerebral edema, undesirable side effects. Decrease in presenting symptoms
during therapy. Assess patient for signs of adrenal Stopping the medication suddenly can be life- with minimal systemic side
insufficiency (hypotension, weight loss, weakness, threatening. effects. Management of
nausea, vomiting, anorexia, lethargy, confusion, symptoms in adrenal
restlessness) before and periodically during insufficiency.
therapy. Monitor intake and output ratios and daily
weights. Observe patient for peripheral edema,
steady weight gain, rales/crackles, or dyspnea.
Notify physician or other health care professional
if these occur. Assess patient for changes in level
of consciousness and headache during therapy.

Solu-Cortef (hydrocortisone)