Hydrocortisone

Hydrocortisone

Brand Name: hydrocortisone acetate

 

Pregnancy Category C

Drug classes: Corticosteroid, short acting, Glucocorticoid, Mineralocorticoid, Adrenal cortical hormone (hydrocortisone), Hormonal agent

 

 

Therapeutic actions

Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.

 

 

Indications

· Replacement therapy in adrenal cortical insufficiency

· Hypercalcemia associated with cancer

· Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders

· Hematologic disorders--thrombocytopenic purpura, erythroblastopenia

· Trichinosis with neurologic or myocardial involvement

· Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas

· Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques

· Retention enema: For ulcerative colitis, proctitis

· Dermatologic preparations: To relieve inflammatory and pruritic manifestations of dermatoses that are steroid responsive

· Anorectal cream, suppositories: To relieve discomfort of hemorrhoids and perianal itching or irritation

 

 

Contraindications

· Systemic administration: infections, especially tuberculosis, fungal infections, amebiasis, hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections; kidney disease (risk to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory bowel disease (risks exacerbations or bowel perforation); hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, diabetes mellitus; lactation.

· Retention enemas, intrarectal foam: systemic fungal infections, recent intestinal surgery, extensive fistulas.

· Topical dermatologic administration: fungal, tubercular, herpes simplex skin infections; vaccinia, varicella; ear application when eardrum is perforated; lactation.

 

 

Adverse effects

Vertigo, headache, paresthesias, insomnia, convulsions, psychosis

Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias secondary to electrolyte disturbances

Thin, fragile skin; petechiae; ecchymoses; purpura; striae; subcutaneous fat atrophy

Cataracts, glaucoma (long-term therapy), increased intraocular pressure

Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and diabetes mellitus, cushingoid state (long-term therapy), hypothalamic-pituitary-adrenal (HPA) suppression systemic with therapy longer than 5 days

Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain (long-term therapy)

Na+ and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased serum T1 and T4 levels

Anaphylactoid or hypersensitivity reactions

Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures (long-term therapy)

 

Drug Interactions:

· Increased steroid blood levels with hormonal contraceptives, troleandomycin

· Decreased steroid blood levels with phenytoin, phenobarbital, rifampin, cholestyramine

· Decreased serum level of salicylates

· Decreased effectiveness of anticholinesterases (ambenonium, edrophonium, neostigmine, pyridostigmine)

 

 

Nursing considerations

Systemic administration

· Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize HPA suppression.

· Space multiple doses evenly throughout the day.

· Do not give IM injections if patient has thrombocytopenic purpura.

· Rotate sites of IM repository injections to avoid local atrophy.

· Use minimal doses for minimal duration to minimize adverse effects.

· Taper doses when discontinuing high-dose or long-term therapy.

· Arrange for increased dosage when patient is subject to unusual stress.

· Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.

· Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.

· Provide antacids between meals to help avoid peptic ulcer.