The generic or trade name of prednisolone is milipred, orapred, pediapred, prednisolone solution etc. The brand name of prednisolone is as follows – deltasone, orison, prednisane etc. Prednisolone is available in different formulations ranging from oral tablets to oral suspension and syrup. The other forms availablefor prednisolone is creams, gels, ointment, etc. Prednisolone is an artificial corticosteroid is used to treat immune system led inflammation. It is generally placed under glucocorticoid which is a cortisol derivative used in treatment of auto immune disease and inflammation. This essay will give a brief description on its class, different formulation types available for prednisolone, how it should be administered and what considerations should be made, what factors are involved in its metabolism, absorption and excretion, mode of actions, interactions with other drugs, do’s and don’t’s for nurses and what education is required for self-medication purpose. Therefore, the present article will give a brief idea about prednisolone and its administration guidelines essential for practicing nurses.
It belongs to the class of steroid and derivatives under drug taxonomy and in CAS schedule it is not a controlled drug as per the guidelines. It falls under the category of gluco/mineral corticoids. The structure of this medication is based upon hydroxylated prostane moiety. Different forms of this medication is available in the market i.e. tablet, syrup, capsule, cream, gel, ointment, injection and liquid. The dosage of prednisolone differs for different health condition taking into account patient health status , age and bvody weight. The usual dosage for inflammation in adults is 5-60 mg per day and dose is divided from 1-4 times a day. The pediatric dosage ranges from 0.1-2mg/kg/day which is divided 1-4 times per day. The same dosage is maintained for pediatric immunosuppression condition. In case of intravenous or intramuscular injection the dose vary from 4-60 mg per day. Prednisolone has a half life of 2-3 hours. The timing of dosage depends upon pharmacokinetics of delayed release drug and the disease for which it is given. In adults the usual dose is divided in q6-q12 hour, while in pediatric case it is divided in q12 hour per day(Buttgereit et al, 2005).
The medication must be taken with meal or snack. It is readily aborbed if orally administered. The concentration in body reaches max in 1-2 hours. It gets metabolized in liver to form active prednisolone, which then gets converted to inactive glucuronide and sulfates. These inactive metabolites and sulfates get released with the help of kidneys. The insignificant drug amounts are excreted by fecal matter also. The total half-life of prednisolone is 18-36 hours. While administering nurses and clinicians must note higher dose of glucocprticosteroids can lead to insomnia, so if immediate release formulation is given to patient it must be administered during morning in order to coincide with circadian rhythm. In case of delayed-release, it takes 4 hours to release active substances. Thus prior to administration the pharmacokinetics and the disease condition must be taken into account. For example in case of Rheumatoid arthritis it is better to give at ned time in order to prevent morning stiffness (Bennet, Tsang and Legler, 2013).
It interacts with a number of drug class , this section addresses some of the common drug interactions with necessary steps to be taken to counteract such interactions. With amphotericin B and other diuretics it leads to hypokalemia, which requires monitoring of sodium and potassium level at regular intervals. With antacids, colestipol and cholesteramine the absorption rate is disturbed, thus a different set of administration timing must be maintained. With cardiac glycosides class of drugs, the chances of hypokalemia and toxicity is more. Thus, potassium level and toxicity monitoring must be done. If patient is on estrogen therapy, the drug dosage must be adjusted as it affects the metabolism of prednisolone and the half-life of this corticosteroid is prolonged. In case of insulin therapy, the chances of hyperglycemia is more demanding dose adjustments (Hodgson and Kisior, 2013).
With respect to allergic reactions anaphylaxis and angioedema has been reported as adverse effects of prednisolone. The other adverse effects of this drug are- insomnia, headache, seizures in case of central nervous system, arrhythmias, thromboembolism and heart failure in cardio vascular section, pancreatitis in gastrointestinal tract, menstrual disorders in gynaecology, hypokalemia, carbohydrate intolerance and hyperglycemia may lead to metabolic disorders, osteoporosis, muscle weakness, growth shunting in children are issues in musculoskeletal section, Susceptibity to infection increases in case of adverse effects and acute adrenal insufficiency is observed(Tizani, 2010).
The mode of action of prednisolone is a diverse pathway based action. It stimulates enzymes which has anti-inflammatory action, it increases the production of T-lymphocytes which reduces the activity and volume of lymphatic system, complement system inhibition and immunoglobulin synthesis inhibition, decreasing the passage of immune complexes through basement membrane, etc.
It is used against severe inflammation or in case of compromised immune system as a result of disease. It plays an important role where inflammation is either self-immunity mediated or immune system plays an important role (Czock et al, 2005).
The effects which are usually monitored during prednisolone therapy are as follows –
The therapy may increase glucose and cholesterol level at the same time, the calcium and potassium levels may get decreased which requires time to time monitoring of lab results. Although overdose and toxicity has not been reported, it should not be taken lightly in case of overdose the necessary guidelines must be maintained. As far nurses are concerned, the patient must be tested for corticosteroid allergy and dose must be adjusted to be given in alternate days. Nurses must keep in mind most of the adverse effects are dose or duration dependent(Barber, Parkes and Blundell, 2012). The patient vital signs and other physical assessment must be done prior to administration and for less toxicity daily morning dose should be given. The two must point to be followed is not to withdraw therapy suddenly if the patient is on long term therapy as it leads to plethora of side effects such as rebound of inflammation, muscle weakness, depression, etc. Secondly it must not be confused with prednisone (Poeteker and Reh, 2010).
The drug must not be stopped abruptly; secondly it must be taken with food or milk. The patient must be taught on different side effects and adverse effects and how to adjust with them. In case of oral suspensions which must be made patient must be advised to visit to nearest health care center for help and in case of any overdose visit the nearest health care center (Clayton, 2012).
Barber, P., Parkes, J., & Blundell, D. (2012). Further essentials of pharmacology for nurses. McGraw-Hill Education (UK).
BENET, L., TSANG, S., & LEGLER, U. (2013, October). Immunotherapeutic Agents. In Advances in Immunopharmacology: Proceedings of the Second International Conference on Immunopharmacology, July 1982, Washington, USA (p. 17). Elsevier.
Buttgereit, F., Burmester, G. R., & Lipworth, B. J. (2005). Optimised glucocorticoid therapy: the sharpening of an old spear. The Lancet, 365(9461), 801-803.
Clayton, B. D. (2012). Basic Pharmacology for Nurses16: Basic Pharmacology for Nurses. Elsevier Health Sciences.
Czock, D., Keller, F., Rasche, F. M., & Häussler, U. (2005). Pharmacokinetics and pharmacodynamics of systemically administered glucocorticoids. Clinical pharmacokinetics, 44(1), 61-98.
Hodgson, B. B., & Kizior, R. J. (2013). Saunders Nursing Drug Handbook 2014. Elsevier Health Sciences.
Poetker, D. M., & Reh, D. D. (2010). A comprehensive review of the adverse effects of systemic corticosteroids. Otolaryngologic Clinics of North America,43(4), 753-768.
Tiziani, A. P. (2010). Havard's nursing guide to drugs. Elsevier Health Sciences.
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