Clinician's Pocket Drug Reference 2008

Steroids, Systemic 191Stavudine (Zerit) WARNING: Lactic acidosis & severe hepatomegaly w/steatosis & pancreatitis reported Uses: *Advanced HIV* Action: Reverse transcriptaseinhibitor Dose: Adults. > 60 kg: 40 mg bid. < 60 kg: 30 mg bid. Peds.Birth–13 d: 0.5 mg/kg q12h. > 14 d & < 30 kg: 1 mg/kg q12h. = 30 kg: Adultdose; ↓ in renal insuff failure Caution: [C, +] Contra: Allergy Disp: Caps 15, 20,30, 40 mg; soln 1 mg/mL SE: Peripheral neuropathy, HA, chills, fever, malaise,rash, GI upset, anemias, lactic acidosis, ↑ LFTs, pancreatitis Notes: Take w/ plentyof H 2 OSteroids, Systemic (See also Table 3 ) The following relatesonly to the commonly used systemic glucocorticoids Uses:*Endocrine disorders* (adrenal insuff), *rheumatoid disorders, collagen–vascularDzs, derm Dzs, allergic states, cerebral edema,* nephritis, nephrotic synd, immunosuppressionfor transplantation, ↑ Ca 2+ , malignancies (breast, lymphomas),preop (in any pt who has been on steroids in the previous year, known hypoadrenalism,preop for adrenalectomy); inj into joints/tissue Action: Glucocorticoid Dose:Varies w/ use & institutional protocols.• Adrenal insuff, acute: Adults. Hydrocortisone: 100 mg IV; then 300 mg/d ÷ q6h;convert to 50 mg PO q8h × 6 doses, taper to 30–50 mg/d ÷ bid. Peds. Hydrocortisone:1–2 mg/kg IV, then 150–250 mg/d ÷ tid.• Adrenal insuff, chronic (physiologic replacement): May need mineralocorticoid suplsuch as Florinef. Adults. Hydrocortisone 20 mg PO qAM, 10 mg PO qPM; cortisone0.5–0.75 mg/kg/d ÷ bid; cortisone 0.25–0.35 mg/kg/d IM; dexamethasone0.03–0.15 mg/kg/d or 0.6–0.75 mg/m 2 /d ÷ q6–12h PO, IM, IV. Peds. Hydrocortisone:0.5–0.75 mg/kg/d PO tid; hydrocortisone succinate 0.25–0.35 mg/kg/d IM.• Asthma, acute: Adults. Methylprednisolone 60 mg PO/IV q6h or dexamethasone12 mg IV q6h. Peds. Prednisolone 1–2 mg/kg/d or prednisone 1–2 mg/kg/d ÷daily–bid for up to 5 d; methylprednisolone 2–4 mg/kg/d IV ÷ tid; dexamethasone0.1–0.3 mg/kg/d divided q6h.• Congenital adrenal hyperplasia: Peds. Initial hydrocortisone 30–36 mg/m 2 /d PO÷ 1/3 dose qAM, 2/3 dose qPM; maint 20–25 mg/m 2 /d ÷ bid.• Extubation/airway edema: Adults. Dexamethasone 0.5–1 mg/kg/d IM/IV ÷ q6h(start 24 h prior to extubation; continue × 4 more doses). Peds. Dexamethasone0.1–0.3 mg/kg/d ÷ q6h × 3 3–5 d (start 48–72 h before extubation)• Immunosuppressive/antiinflammatory: Adults & Older Peds. Hydrocortisone:15–240 mg PO, IM, IV q12h; methylprednisolone: 4–48 mg/d PO, taper to lowesteffective dose; methylprednisolone Na succinate: 10–80 mg/d IM. Adults. Prednisoneor prednisolone: 5–60 mg/d PO ÷ daily–qid. Infants & Younger Children.Hydrocortisone 2.5–10 mg/kg/d PO ÷ q6–8h; 1–5 mg/kg/d IM/IV ÷ bid.• Nephrotic synd: Peds. Prednisolone or prednisone 2 mg/kg/d PO tid–qid untilurine is protein-free for 5 d, use up to 28 d; for persistent proteinuria, 4mg/kg/dose PO qod max 120 mg/d for an additional 28 d; maint 2 mg/kg/doseqod for 28 d; taper over 4–6 wk (max 80 mg/d).