Choose a disorder of the Immune System and a drug therapy to treat it. Detail the drug, side effects, drug-drug interactions, food-drug interactions, and any teaching needed for the patient.
PLEASE BE DESCRIPTIVE AND ANSWER EVERY QUESTION. PLEASE CITE YOUR SOURCE
DEXAMETHASONE FOR MYASTHENIA GRAVIS
DRUG DETAIL
1. It is used systematically and locally in a wide variety of chronic disease like inflammatory disorders, auto-immune disorders, allergic, hematologic and neoplastic disorders.
2. Action of dexamethasone- It suppresses the inflammatory and normal immune response; have minimal mineralocorticoid (sodium retaining) activity.
PHARMACOKINETICS
- Absorption: well-absorbed after oral administration and absorption from the local site is slow but complete.
- Distribution: widely distributed and also crosses placenta or probably enters breastmilk.
- Metabolic and excretion: metabolised by the liver to inactivate metabolites.
- Half-life: 3 - 4.5 hrs (plasma), 36 - 54 hr (tissue)
ROUTE AND DOSAGE
PO, IM, IV (adults) - anti-inflammatory: 0.75 - 9 mg
airway edema or exturbation: 0.5 - 2 mg/kg/day
cerebral edema: 10mg IV
PO, IM, IV (children) - airway edema or exturbation: 0.5 - 2 mg/kg/day
anti-inflammatory: 0.08-0.3 mg/kg/day
physiologic replacement: 0.03 - 0.15 mg/kg/day
SIDE-EFFECTS
CNS- depression, headache, elevated intracranial pressure (in children), personality changes, euphoria, psychosis, restlessness.
EENT- increased intraocular pressure, cataract
CV- hypertension
GI- peptic ulcer, anorexia, nausea, vomiting
Derm- acne, wound healing, hirsutism, petechiae, fragility
Fluid and Electrolyte- fluid retention
Metabolism- weight gain
Hemat- thromboembolism, thrombophlebitis
Endo- adrenal reabsorption, hyperglycemia
Misc- cushingoid appearance, susceptibility to infection
DRUG-TO-DRUG INTERACTION
-Increased risk of digoxin toxicity due to hypokalemia that is caused by dexamethasone with thiazide and loop diuretics.
-Phenytoin, phenobarbital and rifampin cause an increase in metabolism.
-Hormonal contraceptives can cause a decrease in metabolism.
-There is an increased risk of adverse effects in GI with NSAIDs.
-There is a high risk of adverse reactions from the live-virus vaccine.
DRUG TO FOOD INTERACTION
Grapefruit juice causes an elevated serum level and effects budesonide.
PATIENT/ FAMILY TEACHING
- Instruct patients for right way for the administration of medication as directed.
- Take missed dose ASAP unless almost time for next dose.
- Never double the dosage.
- Restriction of medication suddenly can cause severe side effects like adrenal insufficiency.
- Instruct to avoid people with the known contagious disease or infection strictly.
- Vaccination only after consultation of medical professionals
- Advice for the follow-up to assess side-effects and adverse reaction.
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