Hydrocortisone

Question 1

Drug code for Hydrocortisone?

Answer 1

HYC

Question 2

Presentation and dosage of Hydrocortisone?

Answer 2

Solution for injection: Hydrocortisone phosphate 100mg/1ml solution for injection ampoules
Powder for solution for injection: Hydrocortisone (as Hydrocortisone sodium succinate) 100mg powder for reconstitution with up to 2ml of water.
An ampoule containing 100 milligrams hydrocortisone sodium succinate for reconstitution with up to 2 ml of water.

Question 3

What is an ampoule?

Answer 3

A small sealed vial which is used to contain and preserve a sample, usually a solid or liquid.
Ampoules are made of glass.
Most commonly used to contain pharmaceuticals and chemicals that must be protected from air and contaminants.

Question 4

Indications of Hydrocortisone?

Answer 4

Sever or life-threatening asthma
Anaphylaxis
Adrenal crisis, a time-critical medical emergency with an associated mortality

Question 5

In what patients may adrenal crisis occur?

Answer 5

patients on long-term steroid therapy, either:
as replacement therapy for adrenal insufficiency from any cause
in long-term therapy at doses of 5+mg prednisolone, e.g. for immune-suppression

Question 6

How would you administer hydrocortisone to patients in established adrenal crisis?

Answer 6

IV administration prefrable

Ensure parenteral hydrocortisone is given prior to transportation

Question 7

How and when would you administer hydrocortisone to patients with suspected adrenal insufficiency?

Answer 7

Adrenal insufficiency or long-time steroid therapy patients who have become unwell
To prevent them having an adrenal crisis
IM administration is usually sufficient

Question 8

Would you administer hydrocortisone to a patient where you have doubts about potential adrenal insufficiency?

Answer 8

Yes.

Question 9

Actions of hydrocortisone?

Answer 9

Glucocorticoid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume.
High levels are important to survive shock

Question 10

Therapeutic actions of hydrocortisone?

Answer 10

suppression of inflammation and immune response

Question 11

Contra-Indications of hydrocortisone?

Answer 11

Known allergy to the product/excipients

Question 12

Cautions of hydrocortisone?

Answer 12

None relevant to a single dose

Avoid intramuscular administration if the patient likely to require thrombolysis

Question 13

What is thrombolysis/thrombolytic therapy

Answer 13

A treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs.

Question 14

Side effects of hydrocortisone?

Answer 14

Both sodium phosphate and sodium succinate solutions contain significant amounts of phosphate preservative and may cause stinging or burning sensations

Question 15

Dosage of hydrocortisone for severe or life-threatening asthma and adrenal crisis?

Answer 15

If there is any doubt of previous steroid administration, it is better to administer further hydrocortisone
There is no toxic dose for hydrocortisone, but advanced hypercortisolemia may rapidly prove fatal

Question 16

What is hypercortisolemia

Answer 16

a condition involving a prolonged excess of serum levels of cortisol that can develop as a result of disregulatory abnormalities in the hypothalamic-pituitary-adrenal axis or from exogenous-source steroids

Question 17

What can hypercortisolemia also be known as?

Answer 17

Cushing syndrome

Question 18

Route of administration of hydrocortisone for severe or life-threatening asthma and adrenal crisis?

Answer 18

Preferably intravenous (SLOW injection over a minimum of 2 minutes to avoid side effects)
Otherwise: intramuscular (upper arm or thigh) where IV access is not possible 
Note that in patients with a larger BMI a longer IM needle will be required.

Question 19

Dosage and administration of hydrocortisone in adults for sever or life-threatening asthma and adrenal crisis where both IV and IM can be used?
Include initial dose, repeat dose, dose interval, volume and maximum dose.

Answer 19

Adult, 100 milligrams in 1ml
Initial dose: 100 milligrams
Repeat dose: none
Dose interval: N/A
Volume: 1ml
Maximum dose: 100 milligrams

Question 20

Dosage and administration of hydrocortisone in adults for sever or life-threatening asthma and adrenal crisis where only IV can be used?
Include initial dose, repeat dose, dose interval, volume and maximum dose.

Answer 20

Adult 100 milligrams in 2ml
Initial dose: 100 milligrams
Repeat dose: none
Dose interval: N/A
Volume: 2ml
Maximum dose: 100 milligrams

Question 21

Route of administration of hydrocortisone for anaphylaxis?

Answer 21

intravenous (SLOW injection over a minimum of 2 minutes to avoid side effects)/intraosseous
Intramuscular (when IV access is impossible)

Question 22

What is intraosseous infusion, why is it used?

Answer 22

The process of injecting directly into the marrow of a bone.
This provides a non-collapsible entry point into the systemic venous system.

Question 23

When would intraosseous infusion be used over intravenous?

Answer 23

When intravenous access is not available or not feasible.

Question 24

Dosage and administration of hydrocortisone in adults for anaphylaxis where IV, IM and IO can be used?
Include initial dose, repeat dose, dose interval, volume and maximum dose.

Answer 24

Adult, 100 milligrams in 1ml
Initial dose: 200 milligrams
Repeat dose: none
Dose interval: N/A
Volume: 2ml
Maximum dose: 200 milligrams

Adult 100 milligrams in 2ml
Initial dose: 200 milligrams
Repeat dose: none
Dose interval: N/A
Volume: 4ml
Maximum dose: 200 milligrams