Gas Exchange
5.12 Corticosteriods
Corticosteroids
Corticosteroids can be prescribed in a variety of routes. Fluticasone is an example of a commonly used inhaled corticosteroid; prednisone is an example of a commonly used oral corticosteroid; and methylprednisolone is a commonly used IV corticosteroid. Additional information about corticosteroids and potential adrenal effects is located in the “Endocrine” chapter.
Mechanism of Action
Fluticasone is a locally-acting anti-inflammatory and immune modifier. The nasal spray is used for allergies, and the oral inhaler is used for long-term control of asthma. Fluticasone is also used in a combination product with salmeterol. It decreases the frequency and severity of asthma attacks and improves overall asthma symptoms. See Figures 5.12-5.12b[1],[2],[3] for images of different formulations of fluticasone.
Oral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.
Methylprednisolone IV prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Methylprednisolone requires reconstitution before administration. See Figure 5.12c[4] for an image of methylprednisolone.
Indications for Use
Fluticasone inhalers are used to prevent asthma attacks. In respiratory conditions, oral prednisone is used to control severe or incapacitating allergic conditions that are unresponsive to adequate trials of conventional treatment for seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, and drug hypersensitivity reactions. Methylprednisolone IV is used to rapidly control these same conditions.
Nursing Considerations Across the Lifespan
Fluticasone is safe for children aged 4 years and older. Prednisone and methylprednisolone are safe for all ages. Watch for potential mood changes such as irritability and possible hyperactivity in children. Short term use can also lead to increase in blood pressure and blood sugar levels.
Adverse/Side Effects
Fluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Clients should rinse their mouths after use to prevent candidiasis (thrush).
Prednisone and methylprednisolone: See more information about adverse effects of corticosteroids in the Endocrine chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as hypernatremia (↑Na), hypokalemia (↓ K+), and increased blood glucose with associated weight gain can occur. CNS symptoms include mood swings and euphoria. GI symptoms can include nausea, vomiting, and GI bleed. In long-term therapy, bone resorption occurs, which increases the risk for fractures; the skin may bruise easily and become paper thin; wound healing is delayed; infections can be masked; and the risk for infection increases. Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.[5]
Client Teaching & Education
Clients should be advised that corticosteroids are not used to treat an acute asthma attack. They can cause immunosuppression and suppress signs of infection. Corticosteroids can also cause an increase in blood glucose levels. Clients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes. These occurrences should be reported to one’s healthcare provider.[6]
Fluticasone Medication Card
Now let’s take a closer look at the medication card for fluticasone.[7][8][9]
Medication Card 5.12.1: Fluticasone
Class: Corticosteroids
Prototypes: Fluticasone (Flovent)
Mechanism: Fluticasone is a locally acting anti-inflammatory and immune modifier. The nasal spray is used for allergies, and the oral inhaler is used for long-term control of asthma. Fluticasone is also used in a combination product with salmeterol. It decreases the frequency and severity of asthma attacks and improves overall asthma symptoms. Note that there are other corticosteroids that are used for more generalized inflammation such as oral prednisone and Methylprednisolone IV. These drugs have more of a systemic effect and are used at times for respiratory needs but mostly as a last resort. Fluticasone and other inhalers are preferred.
Therapeutic Effects
- Used for management of the nasal symptoms of perennial non-allergic rhinitis
- Difficulty breathing
- Chest tightness
- Wheezing
- coughing
Administration
- Fluticasone aerosol oral inhaler is inhaled twice a day
- Fluticasone powder is inhaled once a day
- Use at the same time each day
- Follow directions exactly to get proper dose
- Rinse mouth before and after useage to prevent infection in oral cavity also called thrush
Indications
- Inhaler: Used to improve the control of asthma by reducing inflammation in the airways
- Respiratory conditions
- Seasonal or perennial allergic rhinitis
- Bronchial asthma
- When patients are not responding to fluticasone –Methylprednisolone IV may be used (not often but in special circumstances) for fast action in the hospital setting-the concern is that it also causes a suppression in the immune system so this is left for urgent needs after all other options exhausted.
Contraindications
- If allergic to milk products- pharmacist to advise
- Oral infections can be masked or caused by this drug especially fungal infections or use of antifungals or HIV protease inhibitors
Side Effects
- Hoarseness
- Dry mouth
- Cough
- Sore throat
- Oropharyngeal candidiasis
- Safety: This product is flammable do not use near open flames it may explode
Nursing Considerations
- Fluticasone will help prevent asthma attacks (shortness of breath, wheezing and coughing) but will not stop it once it is started so it is not really helpful during an attack
- It can take 24hrs to start feeling benefits of this medication up to two weeks. Do not stop taking it until discussed with prescribing doctor
- "Fluticasone Propionate Nasal Spray" by _BuBBy_ is licensed under CC BY 2.0 ↵
- "Fluticasone.JPG" by James Heilman, MD is licensed under CC BY-SA 4.0 ↵
- "Asthmatic Control" by David Camerer is licensed under CC BY-NC-ND 2.0 ↵
- "Methylprednisolone vial.jpg" by Intropin is licenced under CC BY 3.0 ↵
- Frandsen, G. & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer. ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of Pharmacology Notes: Nursing Implications for Clinical Practice by Gloria Velarde licensed under CC BY-NC-SA 4.0. ↵
- Frandsen, G. & Pennington, S. (2018). Abrams’ clinical drug: Rationales for nursing practice (11th ed.). Wolters Kluwer. ↵
- This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain. ↵