Steroids nasal sprays

Fluticasone, Nasal (Flonase) [Anti-inflammatory/Corticos-teiOld] Uses Seasonal allergic rhinids Action Topical steroid Dose Adults Peds >12 y. 2 sprays/nostril/d Peds 4-11 y. 1-2 sprays/nostril/d Caution [C, M] Contra Primary Rx of status asthmadcus Disp Nasal spray meg SE HA, dysphonia, oral candidiasis Interactions T Effects W/ ketoconazole EMS May... 

Combination therapy of topical and systemic drugs is also an important treatment consideration. When symptoms are isolated to the eye, topical treatment is rapid and most efficient. However, in cases of rhinoconjunctivitis, when nasal symptoms are also present, optimum management includes combining topical ophthalmic medications, olopatadine or ketotifen, for example, with a nasal spray or systemic treatment, such as the oral antihistamine desloratadine. For rhinitis, nasal steroids provide a good treatment option. The above approach targets particular areas of involvement by utilizing the most efficacious route of treatment. 

If a steroid spray is to be used for inflammation and the nasal passages are blocked, the use of a decongestant nasal spray prior to the first uses of the steroid spray can clear the nostrils, ensuring that the steroid spray is delivered to the nasal lining. 

Corticosteroids — Beclomethasone dipropionate (17) aerosol has been tested extensively clinically. It is used prophylactically (400 fig per day), not therapeutically, in the treatment of chronic asthma, particularly in children.52 An evaluation of the drug has been published.53 One of the most important clinical advantages is that 1 7 effectively can replace oral corticosteroids in steroid-dependent patients and avoid many of the adverse effects of adrenal suppression.52,54 Most patients with impaired adrenal function due to oral corticosteroids show recovery of adrenal function within 6 months.55 The combination of 17 and disodium cromoglycate (DSCG) showed no additive therapeutic effects.5 Flunisolide (18), when administered as a nasal spray for 4 weeks during the hay fever season in 51 patients, showed significant symptomatic improvement with no systemic steroid effects observed.57... 

The GnRH agonists also are used to suppress steroid-responsive conditions such as endometriosis, uterine leiomyomas, and acute intermittent porphyria. Nafarelin (SYNAREL) is administered by nasal spray for endometriosis. Depot preparations of goserelin (ZOLADEX), leuprolide (LUPRON DEPOT, elegard) Or triptorelin (trelstar la), which can be administered subcutaneously or intramuscularly monthly or every 3 months, can be used in these settings and may be particularly useful for pharmacological castration in disorders such as paraphilia, for which strict patient compliance is problematic. 

As with other dermatitides, topical steroids, antihistamines, and nasal sprays comprise the mainstay of treatment. Often, the worker must simply avoid that particular wood or chemical or, if this is not feasible, leave the industry. 

Patients prescribed intranasal steroids should be instructed to shake the product gently before each use and prime the pump before the first use or if not used for more than 1 week. Clear nasal passages before use, and avoid nose blowing for 10 to 15 minutes after use. Rare cases of septal perforation have been reported therefore, administration of the spray away from the septum should be stressed. Effects are not immediate, and regular use is... 

Uses Asthma in pts requiring chronic steroid therapy relieve seasonal/perennial allergic rhinitis Action Topical steroid Dose Adults. Met-dose inhal 2 inhal bid (max 8/d) Nasal 2 sprays/nostril bid (max 8/d) Peds >6y. Met-dose inhal 2 inhal bid (max 4/d) Nasal 1-2 sprays/nostril bid (max 4/d) Caution [C, ] w/ adrenal insuff Contra Status asdimaticus, viral, TB, fungal, bacterial Infxn Disp Inhaler SE Tach, bitter taste, local effects, oral candidiasis EMS Not for acute asthma, use inhaled [3-agonists OD Unlikely... 

The therapeutic benefits of topical steroids are not immediate. Patients need to understand this to ensure cooperation and continuation of therapy. Some patients notice improvement in a few days, but peak responses may not be observed for 2 to 3 weeks. Once a response is achieved the dosage may be reduced. Blocked nasal passages should be cleared with a decongestant before administration to ensure adequate penetration of the spray. Patients should be advised to avoid sneezing or blowing their noses for at least 10 minutes after administration. Topical steroids should not be used in patients with nasal septum ulcers or recent nasal surgery or trauma. 

Dexamethasone (100 mcg/metered spray) is indicated in control of bronchial asthma in patients with steroid-dependent asthma and for relief of symptoms of perennial or seasonal rhinitis and in prevention of recurrence of nasal polyps after surgical removal. 

The most common adverse effects of intranasal steroids are local irritation (e.g., a burning or stinging sensation) and nasal bleeding. Proper use has not been associated with mucosal atrophy. Long-term use has rarely been associated with nasal septal perforation. Nasal septal perforation may be the result of trauma from the spray velocity combined with vasoconstrictor activity of the steroid. Patients should be instructed to direct the spray away from the nasal septum, and physicians should periodically examine the septum for mucosal erosions, which may precede nasal septal perforation (54). 

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