Dexamethasone

INTRODUCTION

Indications

Used systemically and locally in a wide variety of chronic diseases, including Inflammatory, Allergic, Hematologic, Endocrine, Neoplastic, Dermatologic, and Autoimmune disorders, Management of cerebral edema, Diagnostic agent in adrenal disorders. Unlabeled Use: Short-term administration to high-risk mothers before delivery to prevent respiratory distress syndrome in the newborn. Adjunctive management of nausea and vomiting from chemotherapy. Treatment of airway edema prior to extubation. Used in neonates with bronchopulmonary dysplasia to facilitate ventilator weaning.

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 0.75 mg/day. Has negligible mineralocorticoid activity. Therapeutic Effects: 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, hallucinations, headache, increased intracranial pressure (children only), insomnia, personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure. CV: hypertension, edema. GI: PEPTIC ULCERATION, anorexia, nausea, increased appetite, vomiting. Derm: acne, decreased wound healing, ecchymoses, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: amenorrhea, hypokalemia, alkalosis. Hemat: THROMBOEMBOLISM, thrombophlebitis. Metab: weight gain. MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: ALLERGIC REACTIONS, 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 allergic reactions, 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 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, and psychosis. Notify physician if these changes become problematic.

• Be alert for signs of low potassium levels (hypokalemia) ...