Endocrine case study r/t Cushing's syndrome

[bella14k]

Ok I am stuck on a question. A patient with COPD is on digoxin, decaDron (long term) and albuterol and beclovent inhalers. He has developed symptoms of Cushing's Syndrome. the question is:

"You inform the physician of J.S's assessment. The DR believes he has developed Cushing's Syndrome and decides to change his prescription from Decadron to Prednisone given on alternate days. Explain the rationale".

I'm thinking that both of these drugs are steroids and long term use of either one can lead to Cushing's Syndrome. I looked online and in my notes from class, and I can't figure it out. The only thing I'm thinking is that maybe it was given everyday before and maybe the DR switched it to be given QOD? And I know the reason for that: To allow the adrenals and pituitary to put out its own hormones on "rest" days, to avoid signs of dysfunction of both these glands when taken off the steroids. Now that I think about it, the doctor probably wants to wean the patient off the steroids so he can be taken off of them for good. I think I may have answered my own question, but I'm going to submit this anyway. Please help. I guess the question threw me off a little.

I just can't wait till the NCLEX!

[nurseprnRN, BSN, RN]

From: Difference Between Dexamethasone and Prednisone | Difference Between | Dexamethasone vs Prednisone

1.Prednisone and dexamethasone are both corticosteroids which have special purposes and actions.

2.Dexamethasone that is taken orally can lessen the need for supplemental medical intervention in comparison with oral prednisone.

3.Dexamethasone is the generic name of the drug, and its brand name is Decadron. Prednisone is also the generic name of the other drug, and its brand name is Predsol.

4.Dexamethasone is utilized for lessening the swelling in several diseases. Long-term inflammatory and allergic conditions of the iris, uvea, optic nerves, and conjunctiva are as well managed using this drug. On the other hand, prednisone is prominently effective for asthma patients.

[ckh23, BSN, RN]

Look up the the half life of each med and the glucocorticoid activity of each and that will give the answer.

[bella14k]

I appreciate both answers but the first one doesn't address the fact that the patient has developed Cushing's Syndrome which is why the M.D made the switch. This answer just tells me facts about these two drugs.

To ckh23, The half life for prednisone (1-2 days) is shorter than decadron (2.75 days) . Can you explain why this is pertinent to cushing's syndrome S/E AND to Cushing's withdrawal? Maybe this has something to do with the withdrawal..or prevention of? Idk. Please let me know!

[Esme12, ASN, BSN, RN]

If you read the article it will answer your question. If you have a drug that lasted longer and you could use a lower dosage less frequently how would that benefit a patient that is suffering side effects of a similar med?

[ckh23, BSN, RN]

I appreciate both answers but the first one doesn't address the fact that the patient has developed Cushing's Syndrome which is why the M.D made the switch. This answer just tells me facts about these two drugs.

To ckh23, The half life for prednisone (1-2 days) is shorter than decadron (2.75 days) . Can you explain why this is pertinent to cushing's syndrome S/E AND to Cushing's withdrawal? Maybe this has something to do with the withdrawal..or prevention of? Idk. Please let me know!

http://livertox.nih.gov/Corticosteroids.htm

This link has a chart under the background section that lists the glucocorticoid activity of decadron and prednisone. You will notice how powerful decadron is and combine that with the half life of these two drugs and this will give you the answer. Also keep in mind also that people on chronic steroids cannot have their mess stopped cold turkey.

[ckh23, BSN, RN]

Should say "meds" not mess.

[Esme12, ASN, BSN, RN]

meds can be a mess....Freudian slip....LOL