Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

fludrocortisone Florinef Hormones, corticosteroids (mineralocorticoid) 0.05 mg PO qd
Peak Onset Duration Normal dosage range
unknown unknown 1-2 day 100mcg/day (range 100 mcg 3 times weekly – 200mcg daily). Doses
as small as 50 mcg daily may be required by some patients. Use with
10-37.5 mg cortisone daily or 10-30 mg hydrocortisone daily.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Sodium loss and hypotension associated with adenocortical N/A
insufficiency (given with hydrocortisone or cortisone).
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Fludrocortisone binds the mineralocorticoid receptor CHF; Addison’s disease (patients may have exaggerated response)
(aldosterone receptor). This binding (or activation of the
mineralocorticoid receptor by fludrocortisone) in turn causes
Common side effects
an increase in ion and water transport and thus raises
CHF
extracellular fluid volume and blood pressure and lowers
potassium levels.

Florinef (fludrocortisones)
Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) Monitor serum electrolytes periodically during therapy.
Levaquin: Concomitant administration of corticosteroids may Fludrocortisone causes decrease in serum potassium levels.
potentiate the risk of tendinitis and tendon rupture associated Be sure to teach the patient the following about this medication
with fluoroquinolone treatment. The mechanism is unknown. Instruct patient to take medication as directed. Take missed doses as
Tendinitis and tendon rupture have most frequently involved soon as remembered but not just before next dose is due. Explain that
the Achilles tendon, although cases involving the rotator cuff lifelong therapy may be necessary and that abrupt discontinuation may
(the shoulder), the hand, the biceps, and the thumb have also lead to addisonian crisis. Patient should keep an adequate supply
been reported. Some have required surgical repair or resulted available at all times. Advise patient to follow dietary modification
in prolonged disability. Tendon rupture can occur during or up prescribed by health care professional. Instruct patient to follow a diet
to several months after completion of fluoroquinolone therapy. high in potassium. Amount of sodium allowed in diet varies with
Miralax: The overuse or abuse of laxatives can cause pathophysiology. Instruct patient to inform health care provider if
significant loss of electrolytes and potentiate the risk of weight gain or edema, muscle weakness, cramps, nausea, anorexia, or
hypokalemia associated with corticosteroid therapy. dizziness occurs. Advise patient to carry identification at all times
Corticosteroids promote the retention of sodium and water and describing disease process and medication regimen.
the excretion of potassium. Although these effects are primarily
associated with mineralocorticoids like fludrocortisone, they
may also occur with higher dosages of glucocorticoids or
adrenocorticotropic agents, particularly if given systemically
for longer than brief periods.
Lanoxin: Systemically administered corticosteroids may
induce hypokalemia and possibly increase the risk of digoxin
toxicity. In addition, corticosteroid-induced sodium and water
retention can result in edema leading to heart failure. These
effects may be more common with the natural corticosteroids
(cortisone, hydrocortisone) which have greater
mineralocorticoid activity.
ASA: Coadministration with corticosteroids may decrease the
serum concentrations and therapeutic effects of salicylates.
Likewise, serum salicylate levels may increase following
withdrawal of corticosteroid therapy, potentially resulting in
salicylate toxicity. This interaction has been reported in
patients receiving intra-articular as well as oral corticosteroids.
One or more mechanisms may be involved, including an
increase in the renal clearance and/or an induction of hepatic
metabolism of salicylates caused by corticosteroids.
Pharmacologically, the potential for increased gastrointestinal
(GI) toxicity, including inflammation, bleeding, ulceration and
perforation, should be considered due to additive ulcerogenic
effects of these agents (especially aspirin) on the GI mucosa.
Grapefruit: Grapefruit juice may increase the plasma
concentrations of some orally administered drugs that are
substrates of the CYP450 3A4 isoenzyme. The proposed
mechanism is inhibition of CYP450 3A4-mediated first-pass
metabolism in the gut wall by certain compounds present in
grapefruits. The extent and clinical significance are unknown.
Moreover, pharmacokinetic alterations associated with
interactions involving grapefruit juice are often subject to a
high degree of interpatient variability.

Florinef (fludrocortisones)
Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this med? Check after giving
Monitor blood pressure periodically during Abrupt cessation of this medication may cause Normalization of fluid and
therapy. Report significant changes. Hypotension patient to have addisonian crisis. Consult with electrolyte balance without the
may indicate insufficient dose. Monitor for fluid health care provider before withholding dose. development of hypokalemia or
retention (weight daily, assess for edema, and hypertension.
auscultate lungs for rales/crackles). Monitor
patients with Addison’s disease closely and stop
treatment if a significant increase in weight or
blood pressure , edema, or cardiac enlargement
occurs. Patient with Addison’s disease are more
sensitive to the action of fludrocortisones and may
have an exaggerated response.

Florinef (fludrocortisones)