Inhaled corticosteroids: Nursing Pharmacology

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Notes

Notes

INHALED CORTICOSTEROIDS
DRUG NAME
fluticasone (Flovent), beclomethasone (Qvar), budesonide (Pulmocort), mometasone (Asmanex)
CLASS
Inhaled corticosteroids
MECHANISM OF ACTION
Decrease airway inflammation by suppressing target genes involved in the inflammatory process, leading to:
  • decreased production and release of inflammatory mediators
  • reduced airway inflammation and edema
  • decreased mucus production, and 
  • improved air flow
INDICATIONS
  • Persistent asthma
  • COPD
ROUTE(S) OF ADMINISTRATION
INH
SIDE EFFECTS
  • Increased risk of respiratory tract infection
  • Oropharyngeal thrush
  • Sore throat
  • Hoarseness
  • Cough
  • Increased appetite
  • Weight gain
  • Osteoporosis
  • Bone fractures
  • Decreased bone growth rate in children
  • HPA axis suppression
  • Hypercortisolism
CONTRAINDICATIONS AND CAUTIONS
  • Active respiratory tract infection (e.g., pneumonia, tuberculosis)
  • Severe allergy to milk proteins or lactose
  • Cataracts
  • Glaucoma
NURSING CONSIDERATIONS: INHALED CORTICOSTEROIDS
ASSESSMENT AND MONITORING
  • Peak expiratory flow, symptom frequency and severity, nighttime awakenings, activity tolerance, use of short-acting bronchodilators
  • Side effects
CLIENT EDUCATION
  • Take medication on a fixed schedule; do not use inhaled corticosteroids for an acute attack
  • Use proper technique; use a spacer with MDI
  • Rinse and gargle after administration to reduce the risk of oropharyngeal thrush
  • If prescribed more than one puff, wait one minute between puffs
  • If prescribed short-acting bronchodilator, administer five minutes before inhaled corticosteroid
  • Promote bone health: dietary calcium, vitamin D; weight-bearing exercises
  • Due to increased risk of respiratory infections, take steps to avoid infection

Transcript

Inhaled corticosteroids are medications that improve breathing by decreasing lung inflammation. They are primarily used in clients with persistent asthma, meaning those who have asthmatic symptoms more than 2 days per week. Asthma is characterized by chronic inflammation in the lungs, as well as asthma exacerbations or attacks, where certain triggers, such as viruses, allergens, stress, aspirin or other NSAIDs and exercise, lead to reversible bronchial smooth muscle spasms and mucus production, both of which make it hard to breathe. As a result, clients experience symptoms like dyspnea, wheezing, chest tightness, and coughing. Inhaled corticosteroids help decrease the frequency of symptoms and prevent exacerbations. Inhaled corticosteroids can also be used in clients with chronic obstructive lung disease, or COPD, to prevent exacerbation and slow the progression of the disease.

Now, commonly used inhaled corticosteroids include fluticasone, beclomethasone, budesonide, and mometasone. These medications are typically used as maintenance therapy to help control the underlying lung inflammation, and are often combined with inhaled bronchodilators, such as long acting beta-2 agonists like salmeterol, which provide immediate relief of symptoms by inducing airway smooth muscle relaxation.

Sources

  1. "Inhaled Corticosteroids" StatPearls [Internet] (2021)
  2. "Molecular effects of inhaled glucocorticoid therapy in asthma" UpToDate (2021)
  3. "Inhaled Corticosteroid Medicines The Basics" UpToDate (undefined)
  4. "Major side effects of inhaled glucocorticoids" UpToDate (2021)
  5. "Pharmacology: A Patient-Centered Nursing Process Approach (8e)" Elsevier Health Sciences (2014)
  6. "When and How to Use an Inhaler" WebMD (2021)
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