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.