A Drug Study on Prednisone

A Drug Study Presented to

The Faculty of Nursing Department

Mrs. Josephine B. Magno, RN, MN

In Partial Fulfillment on the

Requirements in NCM 209

Pediatric Nursing Rotation

By:

Princess Alane Marie T. Moreno, St.N

BSN 2H

March 28, 2020

Generic Name: predniSONE
Brand Name: Apo-PredniSONE, PredniSONE Intensol
Classification: Pharmacotherapeutic: Adrenal corticosteroid
Clinical: Anti-inflammatory, immunosuppressant.
Mode of Action: Inhibits accumulation of inflammatory cells at inflammation
sites, phagocytosis, lysosomal enzyme release/synthesis, release of mediators of
inflammation.
Dose and Route: PO: ADULTS, ELDERLY: 5–60 mg/day in divided doses.
CHILDREN: 0.05–2 mg/kg/ day in 1–4 divided doses.
Indication: Dose dependent upon condition treated, patient response rather than rigid adherence to age,
weight, or body surface area.
Contraindication: Prednisone tablets are contraindicated in systemic fungal infections and known
hypersensitivity to components.
Side Effects: Frequent: Insomnia, heartburn, nervousness, abdominal distention, diaphoresis, acne, mood
swings, increased appetite, facial flushing, delayed wound healing, increased susceptibility to
infection, diarrhea, and constipation.
Occasional: Headache, edema, change in skin color, frequent urination.
Rare: Tachycardia, allergic reaction (rash, urticaria), psychological changes, hallucinations,
depression.
Adverse Effects: CNS: headache,nervousness,depression,euphoria,personality changes,
psychosis,vertigo,paresthesia,insomnia,restlessness,seizures,meningitis, increased
intracranial pressure
CV: hypotension, hypertension, vasculitis, heart failure, thrombophlebitis, thromboembolism,
fat embolism, arrhythmias, shock
 EENT: posterior subcapsular cataracts (especially in children), glaucoma, nasal irritation and
congestion, rebound congestion, sneezing, epistaxis, nasopharyngeal and oropharyngeal
fungal infections, perforated nasal septum, anosmia, dysphonia, hoarseness, throat irritation
(all with longterm use)
GI: nausea, vomiting, abdominal distention, rectal bleeding, esophageal candidiasis, dry
mouth, esophageal ulcer, pancreatitis, peptic ulcer
GU: amenorrhea, irregular menses
Hematologic: purpura
Metabolic: sodium and fluid retention, hypokalemia, hypocalcemia, hyperglycemia, decreased
carbohydrate tolerance, diabetes mellitus, growth retardation (in children), cushingoid effects
(with long-term use), hypothalamicpituitary-adrenal suppression (with systemic use longer than
5 days), adrenal suppression (with high-dose, longterm use)
Musculoskeletal: muscle weakness or atrophy, myalgia, myopathy, osteoporosis, aseptic joint
necrosis, spontaneous fractures (with long-term use), osteonecrosis, tendon rupture
Respiratory: cough, wheezing, bronchospasm
Skin: rash, pruritus, contact dermatitis, acne, striae, poor wound healing, hirsutism, thin fragile
skin, petechiae, bruising, subcutaneous fat atrophy, urticaria, angioedema
Other: bad taste, increased or decreased appetite, weight gain (with long-term use), facial
edema, aggravation or masking of infections, hypersensitivity reaction
Drug Interaction: Drug-drug. Amphotericin B, mezlocillin, piperacillin, thiazide and loop diuretics, ticarcillin:
additive hypokalemia
Aspirin, other nonsteroidal anti-inflammatory drugs: increased risk of GI discomfort and
bleeding Cardiac glycosides: increased risk of digitalis toxicity due to hypokalemia
Cyclosporine: therapeutic benefits in organ transplant recipients, but with increased risk of
toxicity Erythromycin, indinavir, itraconazole, ketoconazole,ritonavir,saquinavir: increased
prednisone blood level and effects
Hormonal contraceptives: impaired metabolism and increased effects of prednisone
Isoniazid: decreased isoniazid blood level
Live-virus vaccines: decreased antibody response to vaccine, increase risk of adverse effects
Oral anticoagulants: reduced anticoagulant requirements, opposition to anticoagulant action
Phenobarbital, phenytoin, rifampin: decreased prednisone efficacy
Salicylates: reduced salicylate blood level Somatrem: inhibition of somatrem’s growth-
promoting effects
Theophylline: altered pharmacologic effects of either drug
Drug-diagnostic tests. Calcium, potassium, thyroid 131I uptake, thyroxine, triiodothyronine:
decreased levels
Cholesterol, glucose: increased levels
Nitroblue tetrazolium test for bacterial infection: false-negative result
Drug-herbs. Alfalfa: activation of quiescent systemic lupus erythematosus
Echinacea: increased immune-stimulating effects
Ephedra (ma huang): decreased drug blood level
Ginseng: potentiation of immunomodulating effect
Licorice: prolonged drug activity
Drug-behaviors. Alcohol use: increased risk of gastric irritation and GI ulcers
Nursing Responsibility:

 Obtain baselines for height, weight, B/P, serum glucose, electrolytes.

 Check results of initial tests (tuberculosis [TB] skin test, X-rays, EKG).
 Monitor B/P,serum electrolytes, glucose, results of bone mineral density test, height, weight
in children.
 Be alert to infection (sore throat, fever, vague symptoms); assess oral cavity daily for
signs of Candida infection.
 Monitor for symptoms of adrenal insufficiency, or immunosuppression.
 Report if there is fever, sore throat, muscle aches, sudden weight gain, swelling, loss of
appetite, or fatigue.
 Avoidalcohol, minimize use of caffeine.
 Maintain fastidious oral hygiene.
 Do not abruptly discontinue without physician’s approval.
 Avoidexposure to chickenpox, measles.
 Long-term use may significantly increase risk of serious infections.
References:
Kizior, R.J., Hodgson, B.B., Hodgson, K.J, & Witmer, J.B. (2016). Saunders nursing drug
handbook 2019. St. Louis, MO: Elsevier
Kizior, R.J., & Hodgson, K.J. (2019). Saunders nursing drug handbook 2019. St. Louis,
MO: Elsevier
Prednisone (Prednisone Tablets, USP): Uses, Dosage, Side Effects, Interactions, Warning.
(2019, October 24). Retrieved from https://www.rxlist.com/prednisone-
drug.htm#clinpharm S