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Methylprednisolone

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VOL: 101, ISSUE: 41, PAGE NO: 31

GENERIC AND PROPRIETARY NAMES

- Methylprednisolone.

- Medrone.

- Solu-Medrone.

- Depo-Medrone.

ACTION

- Inhibits inflammation by suppressing the migration of polymorphonuclear leucocytes and fibroblasts.

CLASSIFICATION

- Corticosteroid.

INDICATIONS

- Suppression of inflammatory disorders, including rheumatoid arthritis, systemic lupus erythematosus, ulcerative colitis and Crohn’s disease.

- Severe allergic conditions: bronchial asthma; allergic rhinitis; and contact and atopic dermatitis.

- Chronic skin conditions including dermatitis herpetiformis, severe psoriasis and severe seborrhoeic dermatitis.

- Cerebral oedema linked to malignancy.

CONTRAINDICATIONS

- Systemic infection.

- Avoid live virus vaccines.

CAUTIONS

- Adrenal suppression and infection.

- Children and adolescents.

- History of tuberculosis.

- Hypertension.

- Recent myocardial infarction.

- Congestive heart failure.

- Liver failure.

- Renal impairment.

- Diabetes mellitus.

- Osteoporosis.

- Glaucoma.

- Corneal perforation.

- Severe affective disorder.

- Epilepsy.

- Peptic ulcer.

- Hypothyroidism.

- Steroid myopathy.

- Pregnancy.

- Breastfeeding.

COMMON SIDE-EFFECTS

- Side-effects can be reduced by using the minimum effective dose for the shortest time.

- Ophthalmic: papilloedema, glaucoma, posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of viral or fungal disease of eyes.

- Neuropsychiatric: depression, euphoria, insomnia, psychological dependence, psychosis, and aggravation of schizophrenia and epilepsy.

- Endocrine: adrenal suppression, menstrual problems and amenorrhoea, Cushing’s syndrome (in high doses), hirsutism, weight gain, increased appetite and increased susceptibility to infection.

- Musculoskeletal: proximal myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis and tendon rupture.

- Gastrointestinal: dyspepsia, peptic ulceration, abdominal distension, acute pancreatitis, oesophageal ulceration and candidiasis.

ADMINISTRATION

- Tablets.

- Injection.

- Intramuscular depot injection.

NURSING CONSIDERATIONS

- Assess for potassium depletion (fatigue, nausea, vomiting, depression, polyuria, dysrhythmia and weakness).

- Assess for hypertension, oedema and cardiac symptoms.

- Assess for mental status.

- Rotate sites in IM injection.

- Oral - take with food or milk to decrease GI symptoms.

PATIENT TEACHING

- Increase potassium, calcium and protein intake.

- Do not discontinue suddenly (can precipitate adrenal crisis).

- Avoid OTC products unless cleared with prescriber.

- Educate on symptoms of adrenal insufficiency (anorexia, dizziness, dyspnoea, fatigue, joint pain, nausea and weakness).

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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