Corticosteroids inhaled

PATIENTS TAKING CORTICOSTEROID INHALANTS If the patient is receiving a sympathomimetic bronchodilator by inhalation and a corticosteroid such as triamcinolone by inhalation, die nurse administers the bronchodilator first, waits several minutes, then administers die corticosteroid inhalant. When administering two inhalations of die same drug, it is advisable to wait at least 1 minute between puffs. 

CORTICOSTEROID INHALANTS. The inhalers, particularly die corticosteroid or mast cell aerosols, may cause tiiroat irritation and infection with Candida albicans. The nurse instructs the patient to use strict oral hygiene, cleanse die inhaler as directed in die package directions, and use die proper technique when taking an inhalation. These interventions will decrease die incidence of candidiasis and help to soodie die throat. Occasionally an antifungal drug may be prescribed by die primary health care provider to manage the candidiasis. 

Bronchospasm may occur after administration of the inhaled corticosteroids If an immediate increase in wheezing indicating bronchospasm occurs after administration of a corticosteroid inhalant, the nurse immediately administers a shortacting inhaled bronchoditator. The inhaled corticosteroid is discontinued and an alternate treatment started. 

Corticosteroid Inhaled Powder—Hold the inhaler upright and twist off the cover. Twist the grip to the right as far as it will go, listen for the click, and then twist it back. Exhale and place the mouthpiece between lips slightly tilt head back and inhale deeply and forcefully. Remove inhaler from the mouth and hold breath for about 10 seconds. Rinse the mouth with water after each use to help reduce dry mouth and hoarseness. 

Assess the patient s adherence to long-term control therapy. If the patient is non-adherent, stress the importance of adherence to this therapy. Evaluate the complexity of the patient s treatment plan and simplify it as much as possible. Determine whether the patient would benefit from an inhaled corticosteroid/inhaled long-acting p2-agonist combination product. 

A major breakthrough in asthma therapy was the introduction in the 1970s of aerosol corticosteroids These agents (Table 39.3) maintain much of the impressive therapeutic efficacy of parenteral and oral corticosteroids, but by virtue of their local administration and markedly reduced systemic absorption, they are associated with a greatly reduced incidence and severity of side effects. The success of inhaled steroids has led to a substantial reduction in the use of systemic corticosteroids. Inhaled corticosteroids, along with 2-(tdreno-ceptor agonists, are front-line therapy of chronic asthma. 

Inhaled corticosteroids are minimally absorbed and have a local effect. However, depending on the dose and potency of the inhaled corticosteroid, inhaled forms can produce systemic side-effects. Oral prednisolone is rapidly absorbed and is metabolised by the liver. Some corticosteroids may be administered intravenously. 

Q12 Children who need more than occasional relief of bronchoconstriction are usually prescribed a standard corticosteroid inhaler as prophylaxis. 

Q12 It is recommended that a trial of a short-acting beta-2-agonist (/S)-agonist) inhaler be made for a few weeks as some COPD patients do benefit from bronchodilation. Although his doctor has prescribed a bronchodilator previously, it may be useful for Bill to try this again. There should also be a trial of a corticosteroid inhaler, as this diminishes the inflammatory component of COPD. If there is no appreciable benefit after four weeks, the steroid should be discontinued. 

Recent clinical guidelines suggest that a trial of a corticosteroid inhaler may be useful and should be made in bronchitic patients. Not all patients will benefit, but if the trial shows steroids to be effective they can be added to the patient s medication as maintenance therapy. 

HPI KG is a 39-year-old woman with asthma on fluticasone and albuterol complaining of SOB associated with exercise. Three months ago she started an aerobic exercise program that has been hampered by chest tightness and SOB shortly after she begins running. She admits to poor compliance with her corticosteroid inhaler and requests an oral medication to control her asthma symptoms. Her PMH is significant for mild, persistent asthma for 35 years and allergic rhinitis. Her medications include fluticasone and albuterol inhalers and fexofenadine. Pulmonary function tests (PFTs) reveal her forced expiratory volume in the first second (FEV,) = 89% of predicted. 

Replace the cap and if the inhaler is a corticosteroid inhaler, rinse the mouth out with water. 

If more than one type of inhaled medication is taken it is important to take them in the correct order. Bronchodilating inhalers are used first to help open the airways. These are followed by corticosteroid inhalers. This ensures that the airways are open when the corticosteroid is administered, allowing as much of the dose as possible to be absorbed. 

The spacer mask can be alarming to young babies and generally a positive smiling parent can cuddle the baby and allay fears. Stroke the baby s cheek with the mask prior to use so that the baby becomes familiar with the device. Often the spacer and mask can be used successfully when the baby is asleep. It is important that if a corticosteroid inhaler is used, the area of the child s face covered by the mask is wiped after use. 

Indications Allergic rhinitis, Asthma Category Corticosteroid, inhaled Half-life N/A... 

Trade names Aerobid (Roche) Nasalide (Ivax) Nasarel (Ivax) Indications Asthma, rhinitis Category Corticosteroid, inhaled Half-life N/A... 

Category Corticosteroid, inhaled Corticosteroid, topical Half-life 7 hours... 

The client with asthma asks the nurse, Why should I use the corticosteroid inhaler instead of prednisone Which statement by the nurse would be most appropriate ... 

Miller MR, Bright R Differences in output from corticosteroid inhalers used with a volumatic spacer. Eur Respir J 1995 8 1637-1638. 

Frost GD, Penrose A, HaU J, MacKenzie DI. Asthma-related prescribing patterns with four different corticosteroid inhaler devices. Respir Med 1998 92 1352-1358. 

Patients and physicians need to be aware that although antiasthma drugs inhaled from pMDIs do not usually produce adverse effects, they can make symptoms worse. Paradoxical bronchospasm has been associated with the use of betaj agonists and corticosteroids inhaled from MDIs (56-58). Decreases in FEVj, of more than 10% have been reported to occur in as many as 4.4% of subjects (59). Nick-las (58) reviewed adverse reaction reports submitted to the Center for Drug Evaluation and Research of the FDA between 1974 and 1988 of these, 126 reports associated with the use of these drugs by MDI, which were consistent with the diagnosis of paradoxical bronchospasm, were observed. More recently, Wilkinson et al. (60) reported paradoxical bronchoconstriction in asthmatic patients after inhaling salmeterol by a pMDI but not via a DPI. 

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