Cortisone

INTRODUCTION

Indications

Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity. Replacement therapy in adrenal insufficiency.

Action

In pharmacologic doses, suppresses inflammation and the normal immune response. Numerous intense metabolic effects (see Adverse Reactions/Side Effects). Suppresses adrenal function at chronic doses of 20 mg/day. Replaces endogenous cortisol in deficiency states. Also has potent mineralocorticoid (sodium-retaining) activity. Therapeutic Effects: Suppression of inflammation and modification of the normal immune response. Replacement therapy in adrenal insufficiency.

Adverse Reactions/Side Effects

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

CNS: depression, euphoria, headache, increased intracranial pressure (children only), personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure. CV: hypertension. GI: PEPTIC ULCERATION, anorexia, nausea, vomiting. Derm: acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis. Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain, weight loss. MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: cushingoid appearance (moon face, buffalo hump), increased susceptibility to infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of thrombophlebitis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

• Monitor and report signs of peptic ulcer, including heartburn, nausea, vomiting blood, tarry stools, and loss of appetite.

• Assess any muscle or joint pain. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology (aseptic necrosis, fracture).

• Assess muscle strength periodically to determine degree of muscle wasting during long-term use.

• Measure blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor personality changes, including depression, euphoria, hallucinations, and psychosis. Notify physician if these changes become problematic.

• Be alert for signs of low potassium levels (hypokalemia) and metabolic acidosis, including hyperventilation, cardiac arrhythmias, dizziness, and confusion. Notify physician immediately if these signs occur.

• Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

• Monitor signs of hyperglycemia (confusion; drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing; polyuria; loss of appetite; unusual thirst). Insulin dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

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