4/4/25, 6:05 NR 327 Medications List |
PM
NR 327 MEDICATIONS LIST EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATES UPDATE GRADED A++
✓Indications
-Administering the steroid as late as 37 weeks of gestation may be chosen if
fetal lung maturity studies demonstrate immature lungs later than 34 weeks.
✓ACTION:
all agents suppress inflammation and the normal immune response. All agents
have numerous intense metabolic effects
✓DOSAGE/ROUTE:
IM, (ADULT): 0.5-9 mg as betamethasone sodium phosphate/acetate suspension.
Prevention of respiratory distress syndrome in newborn—12 mg daily for 2-3 days
before delivery (unlabeled).
IM, (Children): Adrenocortical insufficiency—17.5 mcg/kg/day (500 mcg/m2/day) in 3
divided doses every 3rd day or 5.8-8.75 mcg/kg (166-250 mcg/m2)/day as a
single dose.
✓CONTRAINIDICATION:
Active untreated infections (may be used in patients being treated for some
forms of meningitis); Lactation: Avoid chronic use; Known alcohol, bisulfite, or
tartrazine hypersensitivity or intolerance (some products contain these and
should be avoided in susceptible patients); Administration of live virus vaccines.
Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest
possible dose for shortest period of time); Hypothyroidism; Immunosuppression.
Cirrhosis; Pedi: Children (chronic use will result in ↓ growth; use lowest possible
dose for shortest period of time); Stress (surgery, infections); supplemental doses
may be needed; Potential infections may mask signs (fever, inflammation);
Traumatic brain injury (high doses may be associated with ↑ mortality); OB:
Safety not established; Pedi: Neonates (avoid use of benzyl alcohol containing
injectable preparations; use preservative-free formulations).
✓SIDE EFFECTS:
Adverse reactions/side effects are much more common with high-dose/long-
term therapy.
CNS: depression, euphoria, headache, ↑ intracranial pressure (children only),
personality changes, psychoses, restlessness.
EENT: cataracts, ↑ intraocular pressure.
CV: HTN. GI: PEPTIC ULCERATION, anorexia, N/V.
Derm: acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae.
Endo: adrenal suppression, hyperglycemia.
fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis.
Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain.
MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain.
Misc: cushingoid appearance (moon face, buffalo hump), ↑ susceptibility
to infection.
✓ Interactions
Drug-Drug: ↑ risk of hypokalemia with thiazide and loop diuretics, or
amphotericin B.
Hypokalemia may ↑ risk of digoxin toxicity.
May increase requirement for insulin or oral hypoglycemic agents. Phenytoin,
phenobarbital, and rifampin ↑ metabolism; may ↓ effectiveness. Hormonal
contraceptives may ↓ metabolism. ↑ risk of adverse GI effects with NSAIDs
(including aspirin). At chronic doses that suppress adrenal function, may ↓
antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
May
↑ serum concentrations of cyclosporine and tacrolimus. May ↑ risk of tendon
1/31
,4/4/25, 6:05 NR 327 Medications List |
PM rupture from fluoroquinolones. Antacids ↓ absorption of prednisone and
Generic Name: Betamethasone dexamethasone. Known inhibitors of the CYP3A4 enzyme including ketoconazole,
Trade Name: Celestone itraconazole, ritonavir, indinavir, saquinavir, and erythromycin may ↑ blood
levels and effects of budesonide (↓ dose may be necessary). May ↓ isoniazid
long-acting corticosteroids levels and effectiveness. May antagonize the effects of anticholinergic agents in
myasthenia gravis.
Pregnancy Category C
Betamethasone are used to accelerate Drug-Food: Grapefruit juice ↑ serum levels and effects of budesonide (avoid
maturation of fetal lungs if preterm concurrent use).
delivery is likely.
✓ NURSING CONSIDERATIONS:
Risk category L2. Prednisone and Assessment
prednisolone compatible with
breastfeeding. Delay nursing 4 hr after • Assess for signs of adrenal insufficiency (hypotension, weight loss,
dose to reduce transfer to infant. Remove weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness)
from nipples before nursing if applied before and periodically during therapy.
topically. - Monitor I&Os, daily weight, fluid overload s/s. Observe patient for peripheral
edema, steady weight gain, rales/crackles, or dyspnea. Notify health care
professional if these occur.
• Cerebral Edema: Assess for changes in level of consciousness and
headache during therapy.
• Lab Test Considerations: Monitor serum electrolytes and glucose. May
cause hyperglycemia, especially in persons with diabetes. May cause
hypokalemia. Patients on prolonged therapy should routinely have CBC,
serum electrolytes, and serum and urine glucose evaluated. May ↓ WBCs. May ↓
serum potassium and calcium and ↑ serum sodium concentrations.
• Guaiac-test stools. Promptly report presence of guaiac-positive stools.
Implementation
• Do not confuse prednisone with prednisolone. Do not confuse Solu-Cortef
with Solu-Medrol.
• If dose is ordered daily or every other day, administer in the morning to
coincide with the body's normal secretion of cortisol.
• Periods of stress, such as surgery, may require supplemental
systemic corticosteroids.
• Patients with mild to moderate Crohn's disease may be switched from
oral prednisolone without adrenal insufficiency by gradually decreasing
prednisolone doses and adding budesonide.
• PO: Administer with meals to minimize GI irritation.
• For orally disintegrating tablets (ODT): place tablet on tongue; may
be swallowed whole or allowed to dissolve in mouth, with or without water.
Tablets are friable; do not cut, split, or break.
** IM, Subcut: Shake suspension well before drawing up. IM doses should not be
administered when rapid effect is desirable. Do not dilute with other solution or
admix. Do not administer suspensions IV.
✓ PT TEACHING:
• Take missed doses as soon as remembered unless almost time for next
dose. Do not double doses. Stopping the medication suddenly may result in
adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea,
hypotension, hypoglycemia). If these signs appear, notify health care professional
immediately. This can be life threatening.
• avoid grapefruit
• Corticosteroids cause immunosuppression and may mask symptoms of
infection. Instruct patient to avoid people with known contagious illnesses and
to report possible infections immediately.
• Prelone syrup should not be refrigerated, Pediapred solution
2/31
,4/4/25, 6:05 NR 327 Medications List |
PM
may be refrigerated, Orapred solution should be refrigerated.
3/31
, 4/4/25, 6:05 NR 327 Medications List |
PM ask MD about vaccines before getting.
report severe abdominal pain or tarry stools occur. unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or
behavior changes.
notify if exposed to chicken pox or measles.
Need to f/u & have routine labs.
Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see Appendix M). Alcohol
should be avoided during therapy; may ↑ risk of GI irritation.
If rectal dose used 21 days, decrease to every other night for 2-3 wk to decrease gradually.
4/31
PM
NR 327 MEDICATIONS LIST EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATES UPDATE GRADED A++
✓Indications
-Administering the steroid as late as 37 weeks of gestation may be chosen if
fetal lung maturity studies demonstrate immature lungs later than 34 weeks.
✓ACTION:
all agents suppress inflammation and the normal immune response. All agents
have numerous intense metabolic effects
✓DOSAGE/ROUTE:
IM, (ADULT): 0.5-9 mg as betamethasone sodium phosphate/acetate suspension.
Prevention of respiratory distress syndrome in newborn—12 mg daily for 2-3 days
before delivery (unlabeled).
IM, (Children): Adrenocortical insufficiency—17.5 mcg/kg/day (500 mcg/m2/day) in 3
divided doses every 3rd day or 5.8-8.75 mcg/kg (166-250 mcg/m2)/day as a
single dose.
✓CONTRAINIDICATION:
Active untreated infections (may be used in patients being treated for some
forms of meningitis); Lactation: Avoid chronic use; Known alcohol, bisulfite, or
tartrazine hypersensitivity or intolerance (some products contain these and
should be avoided in susceptible patients); Administration of live virus vaccines.
Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest
possible dose for shortest period of time); Hypothyroidism; Immunosuppression.
Cirrhosis; Pedi: Children (chronic use will result in ↓ growth; use lowest possible
dose for shortest period of time); Stress (surgery, infections); supplemental doses
may be needed; Potential infections may mask signs (fever, inflammation);
Traumatic brain injury (high doses may be associated with ↑ mortality); OB:
Safety not established; Pedi: Neonates (avoid use of benzyl alcohol containing
injectable preparations; use preservative-free formulations).
✓SIDE EFFECTS:
Adverse reactions/side effects are much more common with high-dose/long-
term therapy.
CNS: depression, euphoria, headache, ↑ intracranial pressure (children only),
personality changes, psychoses, restlessness.
EENT: cataracts, ↑ intraocular pressure.
CV: HTN. GI: PEPTIC ULCERATION, anorexia, N/V.
Derm: acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae.
Endo: adrenal suppression, hyperglycemia.
fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis.
Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain.
MS: muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain.
Misc: cushingoid appearance (moon face, buffalo hump), ↑ susceptibility
to infection.
✓ Interactions
Drug-Drug: ↑ risk of hypokalemia with thiazide and loop diuretics, or
amphotericin B.
Hypokalemia may ↑ risk of digoxin toxicity.
May increase requirement for insulin or oral hypoglycemic agents. Phenytoin,
phenobarbital, and rifampin ↑ metabolism; may ↓ effectiveness. Hormonal
contraceptives may ↓ metabolism. ↑ risk of adverse GI effects with NSAIDs
(including aspirin). At chronic doses that suppress adrenal function, may ↓
antibody response to and ↑ risk of adverse reactions from live-virus vaccines.
May
↑ serum concentrations of cyclosporine and tacrolimus. May ↑ risk of tendon
1/31
,4/4/25, 6:05 NR 327 Medications List |
PM rupture from fluoroquinolones. Antacids ↓ absorption of prednisone and
Generic Name: Betamethasone dexamethasone. Known inhibitors of the CYP3A4 enzyme including ketoconazole,
Trade Name: Celestone itraconazole, ritonavir, indinavir, saquinavir, and erythromycin may ↑ blood
levels and effects of budesonide (↓ dose may be necessary). May ↓ isoniazid
long-acting corticosteroids levels and effectiveness. May antagonize the effects of anticholinergic agents in
myasthenia gravis.
Pregnancy Category C
Betamethasone are used to accelerate Drug-Food: Grapefruit juice ↑ serum levels and effects of budesonide (avoid
maturation of fetal lungs if preterm concurrent use).
delivery is likely.
✓ NURSING CONSIDERATIONS:
Risk category L2. Prednisone and Assessment
prednisolone compatible with
breastfeeding. Delay nursing 4 hr after • Assess for signs of adrenal insufficiency (hypotension, weight loss,
dose to reduce transfer to infant. Remove weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness)
from nipples before nursing if applied before and periodically during therapy.
topically. - Monitor I&Os, daily weight, fluid overload s/s. Observe patient for peripheral
edema, steady weight gain, rales/crackles, or dyspnea. Notify health care
professional if these occur.
• Cerebral Edema: Assess for changes in level of consciousness and
headache during therapy.
• Lab Test Considerations: Monitor serum electrolytes and glucose. May
cause hyperglycemia, especially in persons with diabetes. May cause
hypokalemia. Patients on prolonged therapy should routinely have CBC,
serum electrolytes, and serum and urine glucose evaluated. May ↓ WBCs. May ↓
serum potassium and calcium and ↑ serum sodium concentrations.
• Guaiac-test stools. Promptly report presence of guaiac-positive stools.
Implementation
• Do not confuse prednisone with prednisolone. Do not confuse Solu-Cortef
with Solu-Medrol.
• If dose is ordered daily or every other day, administer in the morning to
coincide with the body's normal secretion of cortisol.
• Periods of stress, such as surgery, may require supplemental
systemic corticosteroids.
• Patients with mild to moderate Crohn's disease may be switched from
oral prednisolone without adrenal insufficiency by gradually decreasing
prednisolone doses and adding budesonide.
• PO: Administer with meals to minimize GI irritation.
• For orally disintegrating tablets (ODT): place tablet on tongue; may
be swallowed whole or allowed to dissolve in mouth, with or without water.
Tablets are friable; do not cut, split, or break.
** IM, Subcut: Shake suspension well before drawing up. IM doses should not be
administered when rapid effect is desirable. Do not dilute with other solution or
admix. Do not administer suspensions IV.
✓ PT TEACHING:
• Take missed doses as soon as remembered unless almost time for next
dose. Do not double doses. Stopping the medication suddenly may result in
adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea,
hypotension, hypoglycemia). If these signs appear, notify health care professional
immediately. This can be life threatening.
• avoid grapefruit
• Corticosteroids cause immunosuppression and may mask symptoms of
infection. Instruct patient to avoid people with known contagious illnesses and
to report possible infections immediately.
• Prelone syrup should not be refrigerated, Pediapred solution
2/31
,4/4/25, 6:05 NR 327 Medications List |
PM
may be refrigerated, Orapred solution should be refrigerated.
3/31
, 4/4/25, 6:05 NR 327 Medications List |
PM ask MD about vaccines before getting.
report severe abdominal pain or tarry stools occur. unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or
behavior changes.
notify if exposed to chicken pox or measles.
Need to f/u & have routine labs.
Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates (see Appendix M). Alcohol
should be avoided during therapy; may ↑ risk of GI irritation.
If rectal dose used 21 days, decrease to every other night for 2-3 wk to decrease gradually.
4/31
