Corticosteroid

• Management of croup in pediatrics over the age of 6 months
• Adjunctive treatment for exacerbation of asthma or chronic obstructive pulmonary in patients with a known diagnosis of these conditions
  • Diagnosis can be established by
    • Patient identification of condition
    • Availability of an action plan
    • Regular inhaler use
  • Adjunctive treatment should be considered when there is a lack of improvement in symptoms despite use of ipratropium and salbutamol

• Hypersensitivity to dexamethasone or other corticosteroids
• Active systemic fungal infection

Onset Based on Clinical Effect:
IV: up to 2 hours
Oral: 2-6 hours

Peak:
6-12 hours

Duration of Action: 
36-72 hours

This list includes the side effects most likely to impact the patient with short term use of systemic corticosteroids and does not consider side effects associated with long term use.

• Cardiac: Worsening heart failure and edema (including pulmonary), hypertension
• Central Nervous System: Emotional lability, personality or mood changes, insomnia, dizziness, headache
• Derm: Injection site reaction
• GI: Nausea, stomach upset, increased appetite, reflux
• Endo: Increased blood sugars
• Hypersensitivity: rare
• Infection: immunosuppression with long term use, impaired wound healing

• Dexamethasone is not effective for management of adrenal insufficiency as it does not provide any mineralocorticoid activity
• Use with caution if decompensated heart failure or significantly uncontrolled hypertension
• Pregnancy in the first trimester – weigh the risks and benefits
• Corticosteroids have been associated with myocardial rupture when used in acute myocardial infarction

If there are concerns related to the adverse effects of steroids with the following drug interactions, the risk of administering steroids likely outweighs the benefit.

• NSAIDs: May enhance the risk of gastrointestinal ulceration
• Phenytoin: may decrease serum concentrations of phenytoin
• Warfarin: increases the INR and bleeding risk