beclomethasone dipropionate Nursing Considerations & Management

 Drug Name

Generic Name: beclomethasone dipropionate

Brand Name:  Apo-Beclomethasone (CAN), Beconase AQ, Propaderm (CAN), QVAR

Classification: Corticosteroid, Glucocorticoid Hormone

Pregnancy Category C

Dosage & Route

Topical/Cutaneous

  • Skin disorders
  • Adult: Apply a 0.025% cream/ointment onto affected area.

Nasal

  • Prophylaxis and treatment of allergic and non allergic rhinitis
  • Adult: 100 mcg bid or 50 mcg 3-4 times daily in each nostril. Max: 400 mcg daily.

Inhalation

  • Prophylaxis of asthma
  • Adult: Initially, 600-800 mcg daily. Maintenance: 400 mcg daily in 2-4 divided doses.
  • Child: As dipropionate: 50 or 100 mcg bid-qid or 100 or 200 mcg bid.

Inhalation

  • Severe asthma
  • Adult: 250 mcg four times daily or 500 mcg bid. May be increased to 500 mcg 3-4 times daily if necessary. Max: 2 mg daily.
Therapeutic actions
  • Beclometasone controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability and lysosomal stabilisation at the cellular level to prevent or control inflammation.
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
Adverse effects
  • Loss of skin collagen and SC atrophy; local hypopigmentation of deeply pigmented skin; dryness, irritation, epistaxis, rarely ulceration or perforation of the nasal septum; smell and taste disturbances; hoarseness and candidiasis of the mouth or throat.
Contraindications
  • Hypersensitivity. Acute infections uncontrolled by antimicrobial chemotherapy.
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
  • BLACK BOX 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 or 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.