PCP Expansion - Respiratory (Dexamethasone)

Question 1

Describe Dexamethasone

Answer 1

Dexamethasone is a long-acting corticosteroid with anti-inflammatory and anti-emetic properties

Question 2

What does Dexamethasone treat?

Answer 2

Dexamethasone treats respiratory diseases such as croup, bronchospasm in asthma, and chronic obstructive pulmonary disease (COPD)

Question 3

True or false; Dexamethasone helps regulate sodium and water in the body

Answer 3

False, Dexamethasone has no mineralocorticoid activity

Question 4

Why do we give Dexamethasone pre hospitaly?

Answer 4

Providing dexamethasone as a pre-hospital treatment can help decrease hospital admission rates and shorten hospital length of stay

Question 5

When should Dexamethasone be used for Asthma?

Answer 5

If the patient does not respond well to bronchodilator therapy, systemic corticosteroid therapy can help treat asthma exacerbation

Systemic corticosteroid therapy with dexamethasone can improve airflow obstruction due to airway inflammation and intraluminal mucus plugging

Question 6

When should Dexamethasone be used for Croup?

Answer 6

Dexamethasone should be used for significant stridor without marked improvement from inhaled EPINEPHrine

Epinephrine and corticosteroids are effective medications when managing croup

Question 7

What are Dexamethasone two mechanisms of action?

Answer 7

• Decreases inflammation by suppressing neutrophil migration
• Decreases production of inflammatory mediators

Both of which reverse increased capillary permeability to suppress normal immune response (i.e. immunosuppressant activity)

Question 8

Why is systemic fungal infection a contraindication for Dexamethasone?

Answer 8

Steroids suppress the immune system which can worsen a systemic fungal infection

Question 9

When should Dexamethasone be used for COPD?

Answer 9

Dexamethasone should be used for significant stridor without marked improvement from inhaled EPINEPHrine

Question 10

List the contraindications of Dexamethasone

Answer 10

• Hypersensitivity to dexamethasone or other corticosteroids
• Systemic fungal infection

Question 11

Why is CHF or HTN a precaution for Dexamethasone?

Answer 11

Dexamethasone has been associated with fluid retention and electrolyte disturbance

Monitor the patient’s blood pressure

Question 12

List three precautions of Dexamethasone

Answer 12

1. Patients with CHF or HTN
2. Acute MI
3. Pregnant patients (1st trimester)

Question 13

Why is acute MI a precaution for Dexamethasone?

Answer 13

Corticosteroids have been associated with myocardial rupture

Use dexamethasone with caution following acute myocardial infarction

Question 14

Why are pregnant patients a precaution for Dexamethasone?

Answer 14

Corticosteroids have been associated with myocardial rupture

Use dexamethasone with caution following acute myocardial infarction

Question 15

What is the onset of Dexamethasone?

Answer 15

Minutes to hours (depending on route of administration)

Question 16

What is the peak of Dexamethasone?

Answer 16

60-120 minutes (PO)

30-120 minutes (IM)

5-10 minutes (IV)

Question 17

What is the duration of Dexamethasone?

Answer 17

Short (IV)

36-54 hours (PO)

Question 18

What is the adult dosing for Dexamethasone?

Answer 18

Dosing: 8 mg PO, IV, IM

⚠️ Do not repeat dose

Oral administration route is preferred.

• The injectable formulation is administered orally and can be mixed with juice for palatability.
• Administer the injectable formulation orally via a non-sharp syringe to ensure you can measure how much the patient ingested.

Question 19

Why is oral administration of the injectable formulation the preferred route?

Answer 19

1. The oral route of administration is less invasive, safer, and more convenient
2. The injectable formulation is more flexible for dosing and can help us achieve weight-based pediatric dosing compared to the oral tablets
3. The injectable formulation does not contain alcohol and is safe for pediatric patients compared to the commercially available dexamethasone oral syrup which contains alcohol

Question 19

What are Dexamethasones adverse effects?

Answer 19

• Hyperglycemia
• Behavioral changes
• Hypertension
• Edema

Very few adverse effects have been reported from a single dose of dexamethasone

Question 20

What is the pediatric dosing for Dexamethasone?

Answer 20

Dosing:

• 0.5 mg/kg once (maximum 16 mg); PO (preferred); IM; IV
• Asthma (moderate-severe), croup:
  
  • PCP routes of administration: PO, IM
  • ACP routes of administration: PO, IM, IV

Oral administration route is preferred.

• The injectable formulation is administered orally and can be mixed with juice for palatability.
• Administer orally with a syringe

⚠️ Dexamethasone is rarely indicated for children under 6 months of age