Hydrocortisone

INTRODUCTION

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 disorders, including Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders.

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 20 mg/day. Replaces endogenous cortisol in deficiency states. Also has potent mineralocorticoid (sodium-retaining) activity. Therapeutic Effects: Replacement therapy in adrenal insufficiency. Suppression of inflammation and modification of the normal immune response.

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: PEPTI CULCERATION, 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: hypersensitivity reactions, INCLUDING ANAPHYLAXIS, 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 or nursing staff 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.

• Monitor signs of hypersensitivity reactions or anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

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

• Assess signs of increased intracranial pressure in children, including changes in mood and behavior, decreased consciousness, headache, lethargy, seizures, and vomiting. Notify physician immediately of these signs.

• 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, restlessness, hallucinations, ...