·
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®)
|
prednisolone
|
flunisolide ( AeroBid®)
|
prednisone
|
( I.V. corticosteroids)
|
|
methylprednisolone sodium
|
(DepMedalone®,Depojec®t)
|
hydrocortisone sodium succinate
|
(Cortef® ,Hydrocortone®)
|
Adverse Reactions:
·
Throat irritation
·
Hoarseness
·
Cough
·
Fungal infection
of the mouth and throat
·
Vertigo
·
Headache
·
Hyperglycemia
·
|
·
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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