Flashcards in Methylprednisolone Deck (38):
What are the trade names of Methylprednisolone?
Medrol, Solu-medrol, Depo-medrol, A-methapred
What is the drug classification of methylprednisolone?
What are the general clinical uses of methylprednisolone?
-used as replacement therapy for deficiency states and to produce an intense glucocorticoid (anti-inflammatory) or immunosuppressant effect in disease states of hematologic, allergic, inflammatory, neoplastic, and autoimmune origins
What are the specific uses of methylprednisolone?
-secondary treatment in anaphylactic reactions when refractory bronchospasm or shock occurs
-Preop administration to asthmatic patients that have had frequent recent attacks
-peri-op replacement in patients with adrenal-cortical suppression
-Improvement of the outcome after non-penetrating spinal cord injuries
-Epidural steroid injections as an alternative to surgical treatment of lumbar disc disease
-Immunosuppression in organ transplantation
-treatment of aspiration pneumonitis (controversial!)
What is the MOA of methylprednisolone?
Interacts with intracellular glucocorticoid receptors that belong to the nuclear receptor superfamily. The glucocorticoids enter the cell and bind to specific receptors in the cytoplasm. The glucocorticoid-receptor enters the nucleus and causes some type of DNA change, bind to glucocorticoid response elements in the promotors of target genes and bring about corresponding changes (induction or repression) in transcription.
What are the physiologic effects of the MOA of methylprednisolone?
-physiologic effects exerted include the modulation of carbohydrate, lipid, and protein metabolism and maintenance of fluid and electrolyte homeostasis
-Cardiovascular, immunologic, musculoskeletal, endocrine, and neurologic physiology are also influenced by the drug
How does methylprednisolone decrease inflammation?
by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability
What is the DOA of methylprednisolone?
What is the e1/2 life of methylprednisolone?
3-3.5 hours and is reduce in obese patients
What is the e1/2 time of methylprednisolone?
Is methylprednisolone water soluble or lipid soluble? what about the formulation of methylprednisolone?
the drug itself is HIGHLY lipid soluble; however the formulation methylprednisolone succinate is highly soluble in water
How is methylprednisolone metabolized?
Metabolized by the hepatic system and eliminated in the renal system
What is the volume of distribution of methylprednisolone?
readily crosses the placenta?
Is methylprednisolone protein bound?
some synthetic glucocorticoids may bind to corticosteroid-binding globulin (CBG), but many do not bind to it at all; however they do tend to bind to albumin
****binding to both renders the drug biologically inactive
What are the fluid and electrolyte side effects of methylprednisolone?
What are the immunologic side effects of Methylprednisolone?
delayed wound healing
What are the metabolic effects of methylprednisolone?
negative nitrogen balance due to protein catabolism
What are the Neurological effects of methylprednisolone?
Increased ICP with papilledma
What are the musculoskeletal side effects of Methylprednisolone?
Loss of Muscle Mass
Pathologic fractures of long bones
What are the GI side effects of methylprednisolone?
Increased Liver enzymes
What are the dermatologic side effects of methylprednisolone?
fragile skin, petechiae, ecchymoses, facial erythema, increased sweating
What are the ophthalmic side effects of methylprednisolone?
posterior subscapular cataracts, increased IOP, glaucoma, exopthalmos
What are additional adverse reactions related to parenteral therapy of methylprednisolone?
include hper- hypo-pigmentation, urticaria, subq atrophy, abscess, N/V, cardiac arrhythmias, hypo/hypertension, cardiac arrest, and anaphylaxis
What are the contraindications to Methylprednisolone?
Systemic fungal infections and known hypersensitivity to the drug or its constituents
Which patients should you use caution with methyl prednisolone?
What happens when methylprednisolone is administered with Cyclosporin? What 2 other drugs can cause this too?
there is mutual inhibition of metabolism of both drugs
-Troleandomycin and Ketoconazole may also inhibit methylprednisolone's metabolism
What drugs if administered with Methylprednisolone may increase its clearance?
Drugs that induce hepatic enzymes, such as:
What drug can methylprednisolone increase the clearance time of?
chronic high dose aspirin
What can methylprednisolone do to the effects of anticoagulants?
either enhance or diminish effects when given concurrently
What drugs are a concern for potassium levels if given concurrently with methylprednisolone?
potassium-depleting diuretics due to the additive effects on lowering potassium
What happens when methylprednisolone and ethanol are taken together?
gastric mucosal irritation is increased
What OTC supplements may decrease methylprednisolone's levels?
St. John's wort, Cat's claw, and Echinacea
Cat's claw and Echinacea have immunostimulant properties
What drug is contraindicated with administration with Methylprednisolone due to the risk of decreased response and increased potential infections?
Live or live attenuated vaccines
What is the dosage for methylprednisolone?
Adults: 10-250mg IV q4-24 hours
How does the dosage of methylprednisolone compare to hydrocortisone?
Methylprednisolone is 5x the potency of hydrocortisone
What is the recommended IV dosing for acute spinal cord injury
30mg/kg given over 15 minutes; this would be followed in 45 minutes by a continuous infusion of 5.4mg/kg/hr for 23 hours
Why should you be cautious with infants born of mothers with substantial doses of corticosteroids?
monitor for Hypoadrenalism