Dexamethasone

Brand Name: Cortastat, Dalalone, Decadrol, Decaject, Deronil, Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol, Primethasone, Solurex

Classification: Long- acting corticosteroid

Indications

1. Management of cerebral edema
2. Diagnostic agent in adrenal disorders
3. Relieves inflammation
4. Allergic disorders
5. Asthma
6. Arthritis

Mechanism of Action

Dexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation.

Contraindications

1. Hypersensitivity
2. Active untreated infection
3. Lactation
4. Systemic fungal infection

Use Cautiously in:

1. Children (chronic use may result in decreased growth)
2. Stress (surgery or infections)
3. Potential infections as dexamethasone may mask the signs of infection such as fever and inflammation.
4. Pregnancy (safety is not established with the sue of the drug during pregnancy)

Side Effects

1. Acne
2. Decreased wound healing
3. Depression
4. Vomiting
5. Easy bruising
6. Headache
7. Increased hair growth
8. Insomnia
9. Restlessness
10. Stomach irritation
11. Irregular or absent menstruation
12. Dizziness

Adverse reactions

If these signs and symptoms will be noted instruct the patient to call or notify the physician immediately.

1. Skin rash
2. Swollen face, legs or ankles (fluid retention)
3. Vision problems ( Dexamethasone may cause cataracts and increased intraocular pressure)
4. Cold or infection that last for a long time
5. Muscle weakness
6. Black or tarry stool (suggestive of peptic ulceration caused by Dexamethasone use)

Route and Dosage

Cerebral Edema

PO (Adults): 2 mg q 8-12 hours

IM, IV (adults): 10 mg initially IV, 4 mg q 6 hr, may be decreased to 2 mg q 8-12 hr, then change PO.

Adrenocortical Insufficiency/Anti-inflammatory

PO (Adults): 0.5-9 mg daily in single or divided doses

PO (children): 23.3 mcg/kg in 3 divided doses.

IV (Adults): 0.5-24 gm/day

IM (Adults): 8-16 mg q 1-3 wk

Nursing Interventions

1. Monitor intake and output of patient.
2. Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted.
3. Periodic growth evaluation for children should be done time to time.
4. For patients with cerebral edema, assess then for level of consciousness changes and headache during the therapy.
5. Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the physician immediately.
6. Administer with meals to minimize GI irritation.
7. For patients with difficulty swallowing, tablets can be crushed and administered with fluids or food. However, capsules should be swallowed whole.
8. Educate the patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
9. Instruct patient to avoid people with known infection and contagious illnesses as corticosteroids causes immunosuppression and may mask symptoms of infection.