Question

1. Please discuss ONE SPECIFIC hormonal or related medication in your assigned reading (Pituitary, Thyroid, Parathyroid, or Adrenal Disorders). Give class; actions and uses; side effects & adverse reactions; contraindications & toxicity; administration; any other pertinent information.

Answer 1

BETAMETHASONE

Classification: steroidal anti-inflammatory agents,

Pharmacologic: corticosteroids

Indications:

Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity. Used systemically and locally in a wide variety of chronic diseases including. Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders. Replacement therapy in adrenal insufficiency.

Unlabelled uses: Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn .

Action:In pharmacologic doses, suppresses inflammation and the normal immune response. Has numerous intense metabolic effects (see Adverse Reactions and Side Effects). Suppresses adrenal function at chronic doses of 0.6 mg/day. Has negligible mineralocorticoid activity.

Therapeutic Effects:Suppression of inflammation and modification of the normal immune response. Replacement therapy in adrenal insufficiency.

Adverse Reactions and Side Effects:

Adverse reactions/side effects are much more common with high-dose/long-term therapy

These include depression, euphoria, headache, increased intracranial pressure (children only), personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure, hypertension, peptic ulceration, anorexia, nausea, vomiting, acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, hyperglycemia, fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis, thromboembolism, thrombophlebitis, weight gain, weight loss, muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain, cushingoid appearance (moon face, buffalo hump), increased susceptibility to infection.

Contraindications and Precautions:

Contraindicated in:

• Active untreated infections (may be used in patients being treated for tuberculous meningitis). Traumatic brain injury (high doses may ↑ mortality).
• Lactation: Avoid chronic use. Some products contain bisulfites and should be avoided in patients with known hypersensitivity.

Use Cautiously in: Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time). Hypothyroidism. Cirrhosis. Ulcerative colitis. Stress (surgery, infections); supplemental doses may be needed. Potential infections may mask signs (fever, inflammation).

Also use cautiously in obstetric and pediatric patients.

Route and Dosage

Betamethasone is administered orally or as injections.

Endocrine Disorders

• 0.6-7.2 mg orally divided twice daily/four times daily or 0.6-9 mg/day intramuscularly each day divided twice daily

Inflammatory Conditions

Adult Dosage:

• 0.6-7.2 mg orally divided twice daily/four times daily or 0.6-9 mg/day intramuscularly each day divided twice daily

Pediatric Dosage:

• Children under 12 years old: 0.0175-0.25 mg/kg/day intramuscular/orally divided every 6-12 hours
• Children over 12 years old: As in adults

Rheumatoid Arthritis/Osteoarthritis

• Intrabursal, intra-articular, intradermal: 0.25-2 ml (6 mg/ml)
  • Intralesional (6 mg/ml)
  • Very large joints: 1-2 ml
  • Large joints: 1 ml
  • Medium joints: 0.5-1 ml
  • Small joints: 0.25-0.5 ml

Adrenal Insufficiency

Pediatric only

• Children under 12 years old: 0.0175-0.25 mg/kg/day divided every 6-12 hours intramuscularly/orally; use the lowest dose as initial dose
• Children over 12 years old: As in adults; use lowest dose as initial dose

Administration

• Base dosage on severity of disease and patient response

Nursing Implications

Assessment

• Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically throughout therapy
• Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur
• Pediatric: Children should have periodic growth evaluations
• Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum glucose evaluated. May ↓ WBC counts. May cause hyperglycemia, especially in persons with diabetes. May ↓ serum potassium and calcium and ↑ serum sodium concentrations
• Guaiac-test stools. Promptly report presence of guaiac-positive stools
• May ↑ serum cholesterol and lipid values. May decrease uptake of thyroid ¹²³I or ¹³¹I
• Suppress reactions to allergy skin tests
• Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal axis suppression in systemic and chronic topical therapy