Sunday, April 15, 2012


·         Act as anti-inflammatory agents which inhibit the production of cytokines, leukotrines, and prostaglandins, the recruitment of eosinophils, and the release of other inflammatory mediators.
·         It works by decreasing the number and activity of inflammatory cells in the respiratory tract while inhibiting bronchoconstriction.
·         Indications:
o    Chronic asthma, chronic bronchitis, allergic rhinitis, and prophylactic treatment for exercise-induced asthma
·         Contraindications:   
o    Hypersensitivity, acute bronchospasm, status asthmaticus, acute episodes of asthma; cautiously used in patients with compromised immune systems, glaucoma, kidney disease, liver disease, convulsive disorders, and diabetes.

Example: (Inhaled corticosteroids)
beclomethasone dipropionate (Vabceril®, Beclovent®)
triamcinolone (Azmacort®)
(Oral corticosteroids)
fluticasone (Flonase®, Flovent®)
flunisolide ( AeroBid®)
                  ( I.V. corticosteroids)

methylprednisolone sodium
hydrocortisone sodium succinate
(Cortef® ,Hydrocortone®)

Adverse Reactions:

·         Throat irritation
·         Hoarseness
·         Cough
·         Fungal infection of the mouth and throat
·         Vertigo
·         Headache
·         Hyperglycemia

Oral/ IV
·         Immunosuppression

Nursing Considerations:

ü  Assess the respiratory condition regularly and assess peak flow readings before starting treatment
ü  Monitor the patient on signs & symptoms of oropharyngeal fungal infection.
ü  Instruct patient to rinse mouth with water after dose.
ü  Monitor the growth especially in children receiving systemic agents or higher doses of inhaled agents. Use the lowest effective dose to reduce the risk of adverse reactions.
ü  For elderly patients, suggest ways to prevent osteoporosis such as increased calcium intake and weight-bearing exercise.
ü  Instruct the patient to follow the prescribed administration and dosage of the drug.
ü  Give oral doses with food to prevent GI irritation.
ü  Teach the patient on how to administer the inhaled form properly via inhalation with the use of a spacer.
ü  Recognize early signs & symptoms of adrenal insufficiency such as fatigue, muscle weakness, fever, anorexia, dyspnea, and fainting; if these occur notify the physician.
ü  Do not stop the drug abruptly.

General Instructions for Metered-Dose Inhalers:

o    Shake the inhaler well, with the canister in place, for 5 to 10 seconds immediately after use.
o    Remove the cap and hold the inhaler system upright.
o    Tilt your head back slight and breathe out to the end of a normal breath.
o    Hold the inhaler on preferred method use:  holding the lips around the mouthpiece, holding the inhaler away from the mouth, and use spacer or extender (Spacers are useful for all patients, especially young children and older adults).
o    Position the mouthpiece 2 to 3 finger-widths from open mouth or use spacer.
o    Activate the inhaler, press down the inhaler to release the medicine, while taking a slow, deep breath for 3 to 5 seconds.
o    Hold the breath for about 10 seconds to allow the medicine goes deeply into the lungs and exhale slowly.
o    If more than one inhalation is required, wait about 1 minute between inhalations. Two minutes are allowed between inhalations for metaproterenol (see manufacturer’s directions for specific times).
o    Rinse or gargle the mouth after each dose to relieve dry mouth and throat irritation and prevent fungal infection.
o    If applicable, rinse the extender and mouthpiece daily in warm water and store them away from heat.
o    To monitor the amount of drug remaining in the canister, test the canister by placing it in a container of water (i.e. a full canister sinks; an empty canister floats).
o    Remember if two different inhaled medications are prescribed, and one of the medications contains glucocorticoids (corticosteroid), administer the bronchodilator first and the corticosteroids second, wait 5 minutes following the bronchodilator before inhaling the corticosteroids.

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