A Drug Study on

Dexamethasone

In Partial Fulfillment of the

Requirement in 4th Rotation – NCM 212 RLE

IMMUNOLOGY/CANCER NURSING ROTATION

Submitted to:
Lovely Erediano, RN
Clinical Instructor

Submitted by:
Gwyneth S. Bermudez, St. N.
BSN – 3B Group 3

November 29, 2021

GENERIC NAME Dexamethasone

BRAND NAME Decadron, Dexamethasone Intensol, DexPak,

Maxidex
CLASSIFICATION Glucocorticoid, Anti-inflammatory, Antiemetic
MODE OF ACTION Decreases inflammation by suppression of
neutrophil migration, decreases production of
inflammatory mediators. Reverses increased
capillary permeability. Suppresses normal immune
response.
SUGGESTED DOSE/ROUTE Anti-Inflammatory
IV: ADULTS, ELDERLY: 0.5-9 mg/day in divided
doses q6-12h
CHILDREN: 0.02-0.3 mg/kg/day in divided doses q6-
12h
Cerebral Edema
IV: ADULTS, ELDERLY: Initially, 10 mg, then 4 mg
q6h
CHILDREN: Loading dose of 1-2 mg/kg, then 1-1.5
mg/kg/day in divided doses q4-6h
Nausea/Vomiting in Chemotherapy Patients
IV: ADULTS, ELDERLY: 8-20 mg 15-30 min before
treatment
CHILDREN: 2 mg q12h up to 6 mg/m2/dose q6h
INDICATION • Hyperkalemia associated with cancer
• Short-term management of various inflammatory
and allergic disorders, such as rheumatoid
arthritis, collagen diseases, dermatologic
diseases, status asthmaticus, and autoimmune
disorders
• Hematologic disorders: thrombocytopenic
purpura, erythroblastopenia
• Trichinosis with neurologic or myocardial
involvement
• Ulcerative colitis, acute exacerbations of multiple
sclerosis, and palliation in some leukemias and
lymphomas
• Cerebral edema associated with brain tumor,
craniotomy, or head injury
CONTRAINDICATION • Hypersensitivity to dexamethasone. Systemic
fungal infections.
• Cautions: Thyroid disease, renal/hepatic
impairment, cardiovascular disease, diabetes,
glaucoma, cataracts, myasthenia gravis, patients
at risk for seizures, osteoporosis, post-MI, elderly.
SIDE EFFECTS Frequent:
• Inhalation: Cough, dry mouth, hoarseness, throat
irritation
• Intranasal: Burning, mucosal dryness
• Ophthalmic: Blurred vision
• Systemic: Insomnia, facial edema, moderate
abdominal distention, indigestion, increased
appetite, nervousness, facial flushing,
diaphoresis
 Occasional:
• Inhalation: Localized fungal infection
• Intranasal: Crusting inside nose, epistaxis, sore
throat, ulceration of nasal mucosa
• Ophthalmic: Decreased vision; lacrimation; eye
pain; burning, stinging, redness of eyes; nausea;
vomiting
• Systemic: Dizziness, decreased/blurred vision
Rare:
• Inhalation: Increased bronchospasm, esophageal
candidiasis
• Intranasal: Nasal/pharyngeal candidiasis, eye
pain
• Systemic: Generalized allergic reaction; pain,
redness, swelling at injection site; psychological
changes; false sense of well-being;
hallucinations; depression
ADVERSE EFFECTS Long-term therapy: Muscle wasting, osteoporosis,
spontaneous fractures, amenorrhea, cataracts,
glaucoma, peptic ulcer disease, HF.
Ophthalmic: Glaucoma, ocular hypertension,
cataracts.
Abrupt withdrawal following long-term therapy:
Severe joint pain, severe headache, anorexia,
nausea, fever, rebound inflammation, fatigue,
weakness, lethargy, dizziness, orthostatic
hypotension.
DRUG INTERACTIONS DRUG: Amphotericin may hypokalemia. CYP3A4
may decrease concentration. CYP3A4 inhibitors,
macrolide antibiotics may increase concentration.
 May decrease therapeutic effect of aldesleukin. May
increase hyponatremic effect of desmopressin. Live
virus vaccines may decrease patient’s antibody
response to vaccine, increase vaccine side effects,
potentiate virus replication.
HERBAL: Echinacea may increase
immunosuppressant effect. St. John’s wort may
decrease concentration/effect.
FOOD: Interferes with calcium absorption.
LAB VALUES: May increase serum glucose, lipids,
sodium levels. May decrease serum calcium,
potassium, thyroxine, WBC.
NURSING INTERVENTIONS 1. Provide patient education about drug effects and
warning signs.
R: To report enhance patient knowledge and
promote compliance.
2. Assess for contraindications or cautions, such as
history of allergy, pregnancy, acute infections,
etc.
R: To avoid adverse effects.
3. Obtain baselines for weight, temperature, B/P,
pulse, respiration, glucose tolerance, serum
electrolytes, etc.
R: To determine baseline status before beginning
therapy and for any potential adverse effects.
4. Monitor results of hematology studies and blood
glucose, serum electrolyte, cholesterol, and lipid
levels.
R: Dexamethasone may cause hyperglycemia,
hypernatremia, hypokalemia, hypocalcemia, or
leukopenia. It may also increase serum cholesterol
 and lipid levels and may decrease iodine uptake by
the thyroid.
5. Use dexamethasone cautiously in patients with
congestive heart failure, hypertension, or renal
insufficiency.
R: Dexamethasone can cause sodium retention,
which may lead to edema and hypokalemia.
6. Space multiple doses evenly throughout the day.
R: To try to achieve homeostasis.
7. Taper doses when discontinuing.
R: To give the adrenal glands a chance to recover
and produce adrenocorticoids.
8. Provide comfort measures
R: To help patient cope with drug effects.
9. Protect patient from unnecessary exposure to
infection and invasive procedures.
R: Steroids suppresses the immune system, and the
patient is at increased risk for infection.
10. Monitor fluid intake and output and daily weight,
watch for crackles, dyspnea, peripheral edema,
and steady weight gain.
R: To identify the negative or positive responses to
the medication.
11. Advise patient to follow a low-sodium, high-
potassium, high-protein diet, if prescribed.
R: To help minimize weight gain, which is common
with dexamethasone therapy.

References:
Kizior, R., & Hodgson, K. (2021). Saunders Nursing Drug Handbook 2021. Missouri,
USA: Elsevier.
MIMS (2021). Dexamethasone. Retrieved November 25, 2021, from
https://www.mims.com/philippines/drug/info/dexamethasone?mtype=generic
Kizior, R., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019. Missouri,
USA: Elsevier.