Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (183 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(floo-tic′a-sone)
Cutivate
Func. class.:
Corticosteroid, topical
Do not confuse:
fluticasone/
mometasone/fludrocortisone
Crosses cell membrane to attach to receptors to decrease inflammation, itching; inhibits multiple inflammatory cytokines
Inflammation/itching of corticosteroid-responsive dermatoses on the skin
Hypersensitivity, monotherapy in primary infections
Precautions:
Pregnancy (C), children, breastfeeding, skin infections, skin atrophy
Calculator
• Adult:
Apply to affected areas bid (cream/ointment) or daily (lotion)
Available forms:
Lotion, cream 0.05%, ointment 0.005%
Do not use with occlusive dressings
•
Cream/Ointment/Lotion:
Apply sparingly in a thin film and rub gently into the cleansed, affected area
•
Reassess treatment after 2 weeks
INTEG:
Burning, pruritus, dermatitis, hypertrichosis, hives
META:
Hyperglycemia, glycosuria
MISC:
HPA axis suppression, Cushing syndrome
Duration 10 hr, half life 7 hr
Increase:
Blood glucose
•
Skin reactions: burning, pruritus, dermatitis
•
Decreasing itching, inflammation on the skin
Not to use with occlusive dressings
•
Cream/Ointment/Lotion:
To apply sparingly in a thin film and rub gently into the cleansed, affected area
•
To reassess treatment after 2 weeks
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(floo-tic′a-sone) (sal-mee′ter-ol)
Advair Diskus, Advair HFA
Func. class.:
Corticosteroid, long-acting/β
2
-adrenergic agonist
Decreased inflammation in inhibiting mast cells, macrophages and leukotrienes; anti-inflammatory and vasoconstrictor properties relaxes bronchial smooth muscles
Maintenance of asthma (long term), COPD
Hypersensitivity, acute asthma/COPD episodes, severe hypersensitivity to milk proteins
Black Box Warning:
Asthma-related deaths
Precautions:
Pregnancy (C), breastfeeding, active infections, diabetes mellitus, glaucoma, immunosuppression
Calculator
• Adult/adolescent
≥
12 yr:
INH
1 inhalation of Advair diskus q12hr, or 2 inhalations of Advair HFA q12hr
• Child 4-11 yr:
INH
1 inhalation of fluticasone 100 mcg/salmeterol 50 mcg (Advair Diskus) q12hr
• Adult:
INH
1 inhalation of Advair diskus q12hr
Available forms:
Inhalation 100/50, 250/50, 500/50 mcg fluticasone/salmeterol; aerosol spray 45/21, 115/21, 230/21 mcg fluticasone/salmeterol
powder for oral inhalation (Diskus):
•
Most children <4 years of age do not generate sufficient inspiratory flow to activate dry powder inhalers
•
Give with the Diskus device: Have the patient to open and prepare mouthpiece, slide device lever to activate the first dose, do not advance the lever >1 time; holding the Diskus mouthpiece level to, but away from the mouth, exhale; then put the mouthpiece to the lips and breathe in the dose deeply and slowly; remove the Diskus from the mouth, hold breath for at least 10 sec, and then exhale slowly; close the Diskus, which also resets the dose lever for the next scheduled dose
•
Mouth should be rinsed
•
Discard device after 1 month or when counter reads 0 (whichever comes first)
•
Shake canister; prime the inhaler before first use with 4 test sprays away from face or with 2 test sprays (away from the face) if it has not been used for more than 4 wk, or after dropping
•
Rinse mouth with water after use; clean inhaler mouthpiece at least every day; discard inhaler after 120 sprays or when the counter reads 000
CNS:
Fever, headache, nervousness, dizziness, migraines, numbness to fingers
EENT:
Pharyngitis, sinusitis, rhinitis, laryngitis, hoarseness, dry eyes, cataracts, nasal discharge, epistaxis
GI:
Diarrhea, abdominal pain, nausea, vomiting, oral candidiasis, gastroenteritis
GU:
UTI
INTEG:
Urticaria, dermatitis
META:
Hyperglycemia, growth retardation in children, cushingoid features
MISC:
Influenza, eosinophilic conditions,
angioedema, Churg–Strauss syndrome, anaphylaxis, adrenal insufficiency (high doses),
reduced bone mineral density
MS:
Osteoporosis, muscle soreness, joint pain
RESP:
Upper respiratory infection, dyspnea, cough, bronchitis,
bronchospasm
Fluticasone: half-life 8 hr, peak 2 hr; Salmeterol: half-life 5.5 hr, peak 5 min
Increase:
Fluticasone levels—CYP3A4 inhibitors (ketoconazole, itraconazole), darunavir, nelfinavir, ritonavir, amprenavir, fosamprenavir, atazanavir, delavirdine, saquinavir
Increase:
Tendinitis, tendon rupture—quinolones
Increase:
Hypokalemia—loop diuretics, thiazides
Increase:
LFTs
Respiratory status:
Lung status, pulmonary function tests during, for several months after change from systemic to inhalation corticosteroid
•
Withdrawal symptoms from oral corticosteroids: depression, pain in joints, fatigue
Black Box Warning:
Adrenal Insufficiency:
nausea, weakness, fatigue, hypotension, hypoglycemia, anorexia; can occur when changing from systemic to inhalation corticosteroids; may be life threatening; adrenal function tests periodically: hypothalamic-pituitary-adrenal axis suppression in long-term treatment
•
Growth rate in children; blood glucose, serum potassium for all patients
•
Therapeutic response: decreased severity of asthma
•
To use bronchodilator first, before using inhalation, if taking both
•
Not to use for acute asthmatic attack; acute asthma might require oral corticosteroids
•
To avoid smoking, smoke-filled rooms, those with URIs, those not immunized against chickenpox or measles
•
To rinse mouth after inhaled product to reduce the risk of oral candidiasis