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Sunday, February 6, 2011

Beclomethasone dipropionate

Posted by Sampil 9:53 PM, under | 1 comment

beclomethasone dipropionate
(be kloe meth' a sone)
Apo-Beclomethasone (CAN), Beclodisk (CAN), Becloforte Inhaler (CAN), Beclovent Rotacaps (CAN), Beconase AQ, Propaderm (CAN), QVAR

Pregnancy Category C

Drug classes
Corticosteroid
Glucocorticoid
Hormone

Therapeutic actions
Anti-inflammatory effects; local administration into lower respiratory tract or nasal passages maximizes beneficial effects on these tissues while decreasing the likelihood of adverse corticosteroid effects from systemic absorption.

Indications
·        Respiratory inhalant use: Control of bronchial asthma that requires corticosteroids along with other therapy
·        Intranasal use: Relief of symptoms of seasonal or perennial rhinitis that respond poorly to other treatments; prevention of recurrence of nasal polyps following surgical removal

Contraindications and cautions
·        Respiratory inhalant therapy: Contraindicated with acute asthmatic attack, status asthmaticus. Use caution with systemic fungal infections (may cause excerbations), allergy to any ingredient, lactation
·        Intranasal therapy: Use caution with untreated local infections (may cause exacerbations); nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma (interferes with healing); lactation

Available forms
Aerosol—40 mcg/actuation, 80 mcg/actuation; nasal spray—0.042%

Dosages
Respiratory inhalant use
ADULTS AND CHILDREN > 11 YR
40–160 mcg bid. Do not exceed 320 mcg/bid.
PEDIATRIC PATIENTS 5–11 YR
40 mcg bid. Do not exceed 80 mcg bid.
PEDIATRIC PATIENTS < 5 YR
Do not use.
Intranasal therapy
Each actuation delivers 42 mcg. Discontinue therapy after 3 wk if no significant symptomatic improvement.
ADULTS AND CHILDREN > 11 YR
One to two inhalations (42–84 mcg) in each nostril bid (total dose 168–336 mcg/day).
PEDIATRIC PATIENTS 6–11 YR
One inhalation in each nostril bid. Total dose, 168 mcg. With more severe symptoms, may increase to two inhalation in each nostril bid (336 mcg).

Pharmacokinetics
Route
Onset
Peak
Inhalation
Rapid
1–2 wk

Metabolism: Lungs, GI, and liver; T1/2: 3–15 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Feces

Adverse effects
Respiratory inhalant use
·        Endocrine: Cushing's syndrome with overdose, suppression of hypothalamic-pituitary-adrenal (HPA) function due to systemic absorption
·        Local: Oral, laryngeal, pharyngeal irritation, fungal infections
Intranasal use
·        Local: Nasal irritation, fungal infections
·        Respiratory: Epistaxis, rebound congestion, perforation of the nasal septum, anosmia
·        Other: Headache, nausea, urticaria

Nursing considerations
Assessment
·        History: Acute asthmatic attack, status asthmaticus; systemic fungal infections; allergy to any ingredient; lactation; untreated local infections, nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma
·        Physical: Weight, T; P, BP, auscultation; R, adventitious sounds; chest radiograph before respiratory inhalant therapy; examination of nares before intranasal therapy

Interventions
·        WARNING: Taper systemic steroids carefully during transfer to inhalational steroids; deaths resulting from adrenal insufficiency have occurred during and after transfer from systemic to aerosol steroids.
·        Use decongestant nose drops to facilitate penetration of intranasal steroids if edema, excessive secretions are present.

Teaching points
·        This respiratory inhalant has been prescribed to prevent asthmatic attacks, not for use during an attack.
·        Allow at least 1 minute between puffs (respiratory inhalant); if you also are using an inhalational bronchodilator (isoproterenol, albuterol, metaproterenol, epinephrine), use it several minutes before using the steroid aerosol.
·        Rinse your mouth after using the respiratory inhalant aerosol.
·        Use a decongestant before the intranasal steroid, and clear your nose of all secretions if nasal passages are blocked; intranasal steroids may take several days to produce full benefit.
·        Use this product exactly as prescribed; do not take more than prescribed, and do not stop taking the drug without consulting your health care provider. The drug must not be stopped abruptly but must be slowly tapered.
·        You may experience these side effects: Local irritation (use the device correctly), headache (consult your health care provider for treatment).
·        Report sore throat or sore mouth.

Adverse effects in Italic are most common; those in Bold are life-threatening.

1 comments:

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Beclovent

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