PCP Expansion - Respiratory (Dexamethasone) Flashcards
Describe Dexamethasone
Dexamethasone is a long-acting corticosteroid with anti-inflammatory and anti-emetic properties
What does Dexamethasone treat?
Dexamethasone treats respiratory diseases such as croup, bronchospasm in asthma, and chronic obstructive pulmonary disease (COPD)
True or false; Dexamethasone helps regulate sodium and water in the body
False, Dexamethasone has no mineralocorticoid activity
Why do we give Dexamethasone pre hospitaly?
Providing dexamethasone as a pre-hospital treatment can help decrease hospital admission rates and shorten hospital length of stay
When should Dexamethasone be used for Asthma?
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
When should Dexamethasone be used for Croup?
Dexamethasone should be used for significant stridor without marked improvement from inhaled EPINEPHrine
Epinephrine and corticosteroids are effective medications when managing croup
What are Dexamethasone two mechanisms of action?
- 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)
Why is systemic fungal infection a contraindication for Dexamethasone?
Steroids suppress the immune system which can worsen a systemic fungal infection
When should Dexamethasone be used for COPD?
Dexamethasone should be used for significant stridor without marked improvement from inhaled EPINEPHrine
List the contraindications of Dexamethasone
- Hypersensitivity to dexamethasone or other corticosteroids
- Systemic fungal infection
Why is CHF or HTN a precaution for Dexamethasone?
Dexamethasone has been associated with fluid retention and electrolyte disturbance
Monitor the patient’s blood pressure
List three precautions of Dexamethasone
- Patients with CHF or HTN
- Acute MI
- Pregnant patients (1st trimester)
Why is acute MI a precaution for Dexamethasone?
Corticosteroids have been associated with myocardial rupture
Use dexamethasone with caution following acute myocardial infarction
Why are pregnant patients a precaution for Dexamethasone?
Corticosteroids have been associated with myocardial rupture
Use dexamethasone with caution following acute myocardial infarction
What is the onset of Dexamethasone?
Minutes to hours (depending on route of administration)
What is the peak of Dexamethasone?
60-120 minutes (PO)
30-120 minutes (IM)
5-10 minutes (IV)
What is the duration of Dexamethasone?
Short (IV)
36-54 hours (PO)
What is the adult dosing for Dexamethasone?
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.
Why is oral administration of the injectable formulation the preferred route?
- The oral route of administration is less invasive, safer, and more convenient
- The injectable formulation is more flexible for dosing and can help us achieve weight-based pediatric dosing compared to the oral tablets
- The injectable formulation does not contain alcohol and is safe for pediatric patients compared to the commercially available dexamethasone oral syrup which contains alcohol
What are Dexamethasones adverse effects?
- Hyperglycemia
- Behavioral changes
- Hypertension
- Edema
Very few adverse effects have been reported from a single dose of dexamethasone
What is the pediatric dosing for Dexamethasone?
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
