Mosby's 2014 Nursing Drug Reference (58 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(be-kloe-meth′a-sone)
QVAR
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Glucocorticoid
Do not confuse:
beclomethasone
/betamethasone
Prevents inflammation by suppression of the migration of polymorphonuclear leukocytes, fibroblasts and the reversal of increased capillary permeability and lysosomal stabilization; does not suppress hypothalamus and pituitary function
Chronic asthma, allergic/vasomotor rhinitis, nasal polyps
Hypersensitivity, status asthmaticus (primary treatment)
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, nasal disease/surgery, nonasthmatic bronchial disease; bacterial, fungal, viral infections of mouth, throat, lungs; HPA suppression, osteoporosis, Cushing’s syndrome, diabetes mellitus, measles, cataracts, corticosteroid hypersensitivity, glaucoma, herpes infection
Calculator
• Adult and child >12 yr: ORAL INH
40-80 mcg bid (alone) or 40-160 mcg bid (previous inhaled corticosteroids); max 320 mcg bid
• Child 5-11 yr: ORAL INH
40 mcg bid; max 80 mcg bid
Available forms:
Oral inh 40, 80, 250mcg/metered spray
•
Bronchodilator spray; if used, should be used 1st, then wait a few minutes, then use beclomethasone
•
Prime before 1st use or if not used for 7-10 days; prime by spraying 2 actuations into the air, away from the face; do not share inhaler
•
Oral inhalation
(metered-dose non-CFC aerosol) (QVAR); shake well, use spacer; after using, rinse mouth, gargle if possible; clean weekly with dry cloth/tissue, do not wash inhaler
•
Titrated dose, use lowest effective dose
CNS:
Headache
EENT:
Hoarseness, candidal infection of oral cavity, sore throat
, loss of taste/smell, dysgeusia
ENDO:
HPA suppression
GI:
Dry mouth, dyspepsia
MISC:
Angioedema, adrenal insufficiency,
facial edema, Churg-Strauss syndrome (rare)
RESP:
Bronchospasm,
wheezing, cough
INH:
Onset 1-4 wk; excreted in feces, urine (metabolites); half-life 2.8 hr; crosses placenta; metabolized in lungs, liver (by CYP3A)
•
For fungal infection in mucous membranes
•
Adrenal function periodically for HPA axis suppression during prolonged therapy, monitor growth/development
•
Gum, rinsing of mouth for dry mouth
•
Therapeutic response: decreased dyspnea, wheezing, dry crackles
•
To gargle/rinse mouth after each use to prevent oral fungal infections
•
That during times of stress, systemic corticosteroids may be needed to prevent adrenal insufficiency; not to discontinue oral product abruptly, to taper slowly
•
To notify prescriber if therapeutic response decreases; dosage adjustment may be needed
•
Proper administration technique and cleaning technique
•
About all aspects of product usage, including cushingoid symptoms
•
About
adrenal insufficiency symptoms:
nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain, depression
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(be-kloe-meth′a-sone)
Beconase AQ, Qnasal
Func. class.:
Nasal corticosteroid
Readily crosses cell membranes and binds with high affinity to specific cytoplasmic receptors; inhibition of leukocyte infiltration at the site of inflammation, interference in the function of mediators of inflammatory response, and suppression of humoral immune responses
To relieve symptoms of seasonal/perennial rhinitis
Hypersensitivity
Precautions:
Child <6 yr, untreated fungal infections, glaucoma and/or cataracts, nasal septum ulcers/surgery/trauma
Calculator
• Adult/child ≥12 yr:
Nasal 1-2 sprays in each nostril bid (42 mcg/spray); 2 sprays in each nostril every day (80 mcg/actuation)
• Child 6-12 yr:
Nasal 1 spray in each nostril bid
Available forms:
nasal spray 42 mcg/metered spray; nasal aerosol 80 mcg/actuation
•
Products are not always interchangeable owing to differences in route of administration and in the amount of active drug released per spray
•
To avoid the spread of infection, do not use the container for more than one person
•
Product’s effectiveness depends on regular use
•
Instruct patient to shake the canister well before administering
•
Before first use, instruct the patient to prime the pump by actuating 4 times. After the initial priming, the dose-counter should read 120
•
If the canister is not used for 7 consecutive days, instruct the patient to prime by actuating 2 times
•
Instruct patient on proper administration technique
•
Instruct patient to shake the nasal sprayer well before use
•
Before first use, instruct the patient to prime the pump by actuating 6 times
•
If the pump is not used for 7 days, prime until a fine spray appears
•
Instruct patient on proper administration technique
•
After use, rinse the tip of the bottle with hot water, taking care not to suck water into the bottle, and dry with a clean tissue; replace the cap
CNS:
Headache, dizziness
EENT:
Nasal burning, epistaxis, nasal fungal infections, nasal congestion, sneezing
GI:
Nausea
Onset 7 days, peak 21 days, half-life 15 hr
•
Nasal symptoms: Assess for sneezing, running of nose before and after use, avoid use longer than 3 wk, check for fungal infections, changes in vision
•
Decrease nasal running, sneezing, other symptoms of seasonal/perennial rhinitis
•
That products are not always interchangeable owing to differences in route of administration and in the amount of active drug released per spray
•
To avoid the spread of infection, do not use the container for more than one person
•
That product effectiveness depends on regular use
•
Instruct patient to shake the canister well before administering
•
Before first use, instruct the patient to prime the pump by actuating 4 times. After the initial priming, the dose-counter should read 120
•
If the canister is not used for 7 consecutive days, instruct the patient to prime by actuating 2 times
•
Instruct patient on proper administration technique
•
Instruct patient to shake the nasal sprayer well before use
•
Before first use, instruct the patient to prime the pump by actuating 6 times
•
If the pump is not used for 7 days, prime until a fine spray appears
•
Instruct patient on proper administration technique
•
After use, rinse the tip of the bottle with hot water, taking care not to suck water into the bottle, and dry with a clean tissue; replace the cap