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Prednisone Nursing Considerations & Implications | Bioavailable

Compound database
Corticosteroids
Prednisone

PrednisoneNursing considerations

Known brand names include Rayos and Deltasone.

A corticosteroid pill that calms inflammation and the immune system. It is used for flares of asthma, arthritis, lupus, allergies, skin and eye disease, and many other conditions, usually at the lowest dose for the shortest time.

Nursing implications

Hold parameters

Never stop abruptly after prolonged use; taper gradually
Increase the dose around surgery, trauma, or other major stress
Do not use with a systemic fungal infection
Do not give live vaccines at immunosuppressive doses
Avoid in active ocular herpes simplex and in cerebral malaria
Monitor for infection; reduce or withdraw if a serious infection develops

Sources: [1][2][3][4][5]

Administration

Give single daily doses in the morning, before 9 am, to match the body's cortisol rhythm

Take with food or milk to reduce stomach irritation

Space multiple daily doses evenly

Alternate-day therapy: twice the daily dose every other morning can limit adrenal suppression in long-term use

Salt restriction may help

Sources: [1]

Assess and report

Side effects by what to assess

Fluid and edema

Increased appetite and weight gain, fluid retention, moon face

Glucose

Hyperglycemia and higher insulin needs in diabetes

Labs

Hypokalemia and hypertension

Neuro and mental status

Euphoria, insomnia, mood swings, depression, psychosis

Skin and allergy

Thin fragile skin, bruising, impaired wound healing

Infection signs

Infection risk: new, worsened, disseminated, or reactivated (TB, hepatitis B), with masked signs (serious)

Vital signs

HPA axis suppression and adrenal insufficiency after withdrawal (serious)

Musculoskeletal

Osteoporosis, fractures, avascular necrosis, myopathy (serious)

GI

Peptic ulcer and GI perforation, with blunted signs (serious)

General

Cataracts and glaucoma (serious)
Slower growth in children (serious)

Sources: [1][2][3]

Labs and vitals

Blood glucose

Why: Steroid-induced hyperglycemia
When: Periodically, more often in diabetes
Act on: Adjust diabetes medicines
Normal: Fasting 70 to 99 mg/dL.

Sources: [1][2][3]

Blood pressure

Why: Hypertension from sodium and fluid retention
When: Periodically; frequently in children
Normal: Below 120/80 mm Hg.

Sources: [1][2][3]

Body weight

Why: Fluid retention, and growth in children
When: Frequently in children

Sources: [1]

INR (prothrombin time)

Why: Blunted warfarin response
When: Frequently during combined use
Act on: Adjust warfarin
Normal: INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Potassium

Why: Hypokalemia, especially with diuretics or amphotericin B
When: With potassium-depleting drugs
Act on: Potassium supplementation may be needed
Normal: 3.7 to 5.2 mEq/L.

Sources: [1][2][3]

Safety

High-alert status

Oral corticosteroids are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote, and this label has no overdose section. The urgent risk is adrenal insufficiency from stopping too fast after long use, managed by restarting steroids and tapering gradually, with extra steroid during stress.

Sources: [1][2]

Patient teaching

Do not stop suddenly or without medical supervision
Tell every clinician you take a steroid, and seek care quickly for fever or other signs of infection
Avoid exposure to chickenpox and measles, and call promptly if exposed
After stopping, aches, joint pain, and malaise can occur as withdrawal symptoms

Sources: [1]

Sound-alike and look-alike names

predniSONE and prednisoLONE

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

General: Initial 5 to 60 mg per day depending on the disease, then taper in small steps to the lowest dose that keeps control.
Acute multiple sclerosis exacerbation: 200 mg per day for a week, then 80 mg every other day for 1 month (prednisolone data; prednisone doses are the same).

Sources: [1]

Renal adjustment

The label gives no renal dose adjustment. Use with caution in renal insufficiency because of sodium retention, edema, and potassium loss.

Sources: [1]

Hepatic adjustment

The label gives no hepatic dose adjustment. Effects are stronger in cirrhosis because steroid metabolism is slower.

Sources: [1]

How it works

Mechanism

A synthetic glucocorticoid with strong anti-inflammatory action across many organ systems. It has wide metabolic effects and dampens the body's immune responses.

Sources: [1]