DRUG STUDY: DIFFERENT AGENTS AFFECTING THE UPPER

RESPIRATORY AND LOWER RESPIRATORY SYSTEM

Submitted by: Kate Submitted to: Mr.

Roque Barcellus Belisario
 GENERIC NAME, CLASSIFICATION, PHARMACODYNAMICS, INDICATIONS, NURSING CONSIDERATIONS
I. DRUGS AFFECTING THE URT
CLASSIFICATIONS GENERIC NAME DRUGS INDICATIONS NURSING CONSIDERATION
1. Decongestants oxymetazoline Afrin Sinus , Dristan , Nasal congestion ➢ Monitor for S&S of
hydrochloride Duration Spray , Adults and children age 6 excess use. If noted,
(intranasal) Nasal Spray , Neo- and older: 2 to 3 sprays of discuss possibility of
Synephrine 12 Hour 0.05% solution in each rebound congestion.
Spray nostril b.i.d. Don’t use for ➢ Wash hands carefully
more than 3 days. after handling
oxymetazoline.
Anisocoria (inequality
of pupil size, blurred
vision) can develop if
eyes are rubbed with
contaminated
fingers.
➢ Do not to exceed
recommended
dosage. Rebound
congestion
(chemical rhinitis)
may occur with
prolonged or
excessive use.
➢ Systemic effects can
result from
 swallowing excessive
medication.
➢ Do not breast feed
while using this drug
without consulting
physician.
pseudoephedrine Children’s Silfedrine , ➢ Alert: Don’t use drug ➢ Monitor HR and BP,
hydrochloride Children’s Sudafed , with an MAO inhibitor or especially in those
Genaphed, Nexafed within 2 weeks of with a history of
,Sudafed , Sudafed stopping an MAO cardiac disease.
12 Hour , Sudafed 24 inhibitor. Report tachycardia
Hour , SudoGest , ➢ Nasal decongestant or hypertension.
Zephrex-D Adults and children age ➢ Avoid taking it
12 and older: 60 mg PO within 2 h of
every 4 to 6 hours; or bedtime because
120 mg extended- drug may act as a
release tablet PO every
stimulant.
12 hours; or 240 mg
➢ Discontinue
extended-release
tablet PO once daily. medication and
Maximum dosage, 240 consult physician if
mg daily. Children ages extreme
6 to 11 (immediate- restlessness or signs
release products only): of sensitivity occur.
30 mg PO every 4 ➢ Consult physician
to 6 hours. Maximum before
dosage, 120 mg daily. concomitant use of
Children ages 4 to 5 OTC medications;
(immediate-release
many contain
products only): 15 mg
ephedrine or other
PO every 4 to 6 hours or
1 mg/kg/dose every 6 sympathomimetic
hours. Maximum amines and might
dosage, 60 mg daily.
 intensify action of
pseudoephedrine.
➢ Do not breast feed
while taking this
drug without
consulting
physician.

2. Mucolytics acetylcysteine Acetadote, Cetylev ➢ Adjunctive therapy for ➢ During IV infusion,

abnormal viscid or carefully monitor for
thickened mucous fluid overload and
signs of
secretions in patients
hyponatremia (i.e.,
with pneumonia, changes in mental
bronchitis, status).
bronchiectasis, primary ➢ Monitor for S&S of
amyloidosis of the lung, aspiration of excess
TB, cystic fibrosis, secretions, and for
emphysema, bronchospasm
(unpredictable);
atelectasis, pulmonary
withhold drug and
complications of notify physician
thoracic surgery, or CV immediately if either
surgery occurs.
➢ Diagnostic bronchial ➢ Lab tests: Monitor
studies ABGs, pulmonary
➢ Routine tracheostomy functions and pulse
oximetry as
care
indicated.
➢ Acetaminophen toxicity ➢ Have suction
➢ PO apparatus
 IV Adjust-a-dose: Refer to immediately
manufacturer's instruction available. Increased
for dosing in patients volume of respiratory
weighing less than 40 kg tract fluid may be
and requiring fluid liberated; suction or
restriction. endotracheal
aspiration may be
necessary to
establish and
maintain an open
airway. Older adults
and debilitated
patients are
particularly at risk.
➢ Nausea and vomiting
may occur,
particularly when
face mask is used,
due to unpleasant
odor of drug and
excess volume of
liquefied bronchial
secretions.
➢
3. Expectorants guaiFENesin Altarussin , Balminil , ➢ Expectorant ➢ Monitor reaction to
(glyceryl Children’s Mucinex Adults and children age drug; persistent cough
guaiacolate) Chest Congestion 12 and older: 200 to 400 for more than 1 wk,
Mini- mg PO every 4 hours, or fever, rash, or persistent
Melts , Diabetic Tussin 600 to 1,200 mg headache may indicate
, Fenesin IR , Geri- (extended-release a more serious
Tussin , Liquibid , tablets) PO every 12 condition.
Mucinex , Mucinex hours. Maximum,
Maximum Strength , 2,400 mg daily.
Mucosa , Mucus
 Relief , Organ-I NR , Children ages 6 to 11:
Q-Tussin , Refenesen , 100 to 200 mg PO every
Robafen , Robitussin 4 hours. Maximum,
Chest Congestion , 1,200
Tussin mg daily.
Children ages 4 to 5: 50
to 100 mg granules,
syrup, or liquid every 4
hours as
needed. Maximum, 600
mg daily.
4. Antihistamines cetirizine Antihistamines ➢ Allergic rhinitis, urticaria, ➢ Evaluation of a
hydrochloride, pruritus, vertigo, motion patient using
chlorpheniramine sickness, nausea and antihistamines
maleate, vomiting, sedation, include: Monitor
desloratadine, dyskinesia, parkinsonism patient response to
diphenhydrAMINE the drug (relief of the
hydrochloride, symptoms of allergic
fexofenadine rhinitis). Monitor for
hydrochloride, adverse effects (skin
levocetirizine dryness, GI upset,
dihydrochloride, sedation and
loratadine, drowsiness, urinary
promethazine retention, thickened
hydrochloride secretions,
glaucoma)
azelastine Astelin, Astepro ➢ Pruritus from allergic ➢ Monitor level of
hydrochloride conjunctivitis alertness especially
➢ Adults and children in older adults and
age 3 and older: with concurrent use
Instill 1 drop into
of other CNS
affected eye b.i.d.
depressants.
➢ Perennial allergic
rhinitis (Astepro only)
➢ Adults and children ➢ Follow
age 12 and older: manufacturer's
Instill 2 sprays (0.15%) directions for
per nostril b.i.d. priming the
➢ Children ages 6 to
metered dose
11: Instill 1 spray
spray unit before
(0.1% or 0.15%) per
nostril b.i.d. first use and after
➢ Children age 6 storage of >3 d.
months to 5 years: ➢ Tilt head forward
Instill 1 spray (0.1%) while instilling spray.
per nostril b.i.d. Avoid getting spray
➢ Seasonal allergic in eyes.
rhinitis ➢ Do not drive or
➢ Adults and children engage in
age 12 and older: potentially
Instill 1 to 2 sprays
hazardous activities
(0.1% or 0.15%)
until response to
➢ per nostril b.i.d. or 2
sprays (0.15%) per drug is known.
nostril once daily. ➢ Avoid concurrent
➢ Children ages 6 to use of CNS
11 (Astepro): Instill 1 depressants, such
spray (0.1% or 0.15%) as alcohol, while
per nostril taking this drug.
b.i.d. ➢ Discard spray unit
➢ Children ages 5 to and dispensing
11 (Astelin): Instill 1 package bottle
spray (0.1%) per
after 3 mo.
nostril b.i.d.
➢ Do not breast feed
➢ Children ages 2 to 5
(Astepro only): Instill while using this
1 spray (0.1%) per drug.
nostril b.i.d.
 ➢ Vasomotor rhinitis
(Astelin only)
➢ Adults and
adolescents age 12
and older: Instill 2
sprays (0.1%) per
nostril b.i.d.

azelastine Dymista ➢ Symptoms of seasonal ➢ Follow

hydrochloride– allergic rhinitis manufacturer's
fluticasone directions for
propionate priming the
metered dose
spray unit before
first use and after
storage of >3 d.
➢ Tilt head forward
while instilling spray.
Avoid getting spray
in eyes.
➢ Do not drive or
engage in
potentially
hazardous activities
until response to
drug is known.
➢ Avoid concurrent
use of CNS
depressants, such
as alcohol, while
taking this drug.
 ➢ Discard spray unit
and dispensing
package bottle
after 3 mo.
➢ Do not breast feed
while using this
drug.

diphenhydrAMINE Banophen , Benadryl ➢ Rhinitis, allergy ➢ Report a sustained or

hydrochloride , Children's Benadryl symptoms, motion symptomatic
Allergy , Sominex , sickness, Parkinson decrease in blood
Unisom SleepMelts disease pressure
➢ Nighttime sleep aid (hypotension) or
➢ Nonproductive cough other cardiac
symptoms
(palpitations).
Monitor respiratory
function at rest and
during exercise.
Notify physician if
patient experiences
any troublesome
wheezing, tightness
in the throat or chest,
or abnormal
bronchial secretions
doxylamine Bonjesta, Dicletin, ➢ Nausea and vomiting of
succinate– Diclegis pregnancy in women
pyridoxine who don't respond to
hydrochloride conservative
management
hydrOXYzine Antarax ➢ Adjust-a-dose (for all ➢ Evaluate alertness.
hydrochloride, indications): In elderly Drowsiness may
hydrOXYzine patients, initiate drug at occur and usually
pamoate the lower end of dosage disappears with
range and observe
continued therapy
closely.
or following
➢ Anxiety
➢ Preoperative and reduction of
postoperative dosage.
adjunctive therapy for ➢ Monitor condition
sedation of oral membranes
➢ Pruritus daily when patient
➢ Nausea and vomiting is on high dosage
of hydroxyzine.
➢ Reevaluate
usefulness of drug
periodically.
➢ Reduce dosage of
the depressant up
to 50% when CNS
depressants are
prescribed
concomitantly.
➢ Do not drive or
engage in other
potentially
hazardous activities
until response to
drug is known.
➢ Do NOT take
alcohol and
 hydroxyzine at the
same time.
➢ Notify physician
immediately if you
become pregnant.
➢ Relieve dry mouth
by frequent warm
water rinses,
increasing fluid
intake, and use of
a salivary substitute
(e.g., Moi-Stir, Xero-
Lube).
➢ Give teeth
scrupulous care.
Avoid irritation or
abrasion of gums
and other oral
tissues.
➢ Consult physician
before self-dosing
with OTC
medications.
➢ Do not breast feed
while taking this
drug without
consulting
physician.
levocetirizine Children's Xyzal ➢ Seasonal allergic rhinitis ➢ Monitor condition
dihydrochloride Allergy 24HR , Xyzal, (OTC only) of oral membranes
Xyzal Allergy 24HR ➢ Adjust-a-dose: Use in the daily when patient
presence of renal is on high dosage
impairment isn't of hydroxyzine.
recommended. ➢ Reevaluate
➢ Chronic idiopathic usefulness of drug
urticarial periodically.
➢ Adjust-a-dose: For
patients age 12 and
older with CrCl of 50 to
80 mL/minute, give 2.5
mg PO once daily; with
CrCl of 30 to 50
mL/minute, give 2.5 mg
PO every other day; with
CrCl of 10 to 30
mL/minute, give 2.5 mg
PO twice weekly (once
every 3 to 4 days). Use in
patients with ESRD, those
undergoing
hemodialysis, and
children younger than
age 12 with any renal
impairment is
contraindicated.
➢ Perennial allergic rhinitis
Adjust-a-dose: Use in the
presence of renal
 impairment is
contraindicated.

5. Antitussives dextromethorphan Balminil DM , ➢ Nonproductive cough ➢ Monitor for dizziness

hydrobromide Buckley’s Cough Adults and children age and drowsiness,
Mixture , Children’s 12 and older: 10 to 20 especially when
Robitussin mg PO every 4 hours, or concurrent therapy
Cough Long-Acting , 20 to 30 mg every 6 to 8
with CNS depressant is
Creomulsion , Creo- hours. Or, 60 mg
used.
Terpin *, Delsym , extended-release liquid
ElixSure Cough , Hold PO b.i.d. ➢ Avoid irritants such as
DM , Koffex DM , Little Maximum, 120 mg smoking, dust, fumes,
Colds Cough daily. Or 5 to 15 mg and other air
Formula , Robitussin , lozenges PO every 4 pollutants to lessen
Scot-Tussin , Triaminic hours, up to 120 unnecessary cough.
Long Acting Cough mg/day. Children ages Humidify ambient air
*, Trocal , Vicks 6 to 11: 5 to 10 mg PO to provide some relief.
Formula 44 every 4 hours, or 15 mg ➢ Note: Treatment aims
every 6 to 8 hours. Or, to decrease the
30 mg extended-
frequency and
release liquid PO b.i.d.
intensity of cough
Maximum, 60 mg daily.
Or 5 to 10 mg lozenges without completely
PO every 4 hours, up to eliminating protective
60 mg/day. Don’t cough reflex.
exceed four doses in 24 ➢ While
hours. Children ages 4 dextromethorphan is
to younger than 6: 2.5 available OTC, any
to 5 mg PO every 4 cough persisting
hours, or 7.5 mg every 6 longer than 1 wk–10 d
to 8 hours. Or, 15 mg needs to be medically
extended-release liquid
diagnosed.
PO b.i.d. Maximum, 30
mg daily.
 benzonatate Tessalon ➢ Symptomatic relief of ➢ Auscultate lungs
cough anteriorly and
Adults and children posteriorly at
older than age 10: 100 scheduled intervals.
to 200 mg PO t.i.d.; up
➢ Observe character
to 600 mg
and frequency of
daily.
coughing and volume
and quality of sputum.
Keep physician
informed.
➢ Do not chew or allow
perle to dissolve in
mouth; swallow whole.
If perle dissolves in
mouth, the mouth,
tongue, and pharynx
will be anesthetized.
Also it is unpleasant to
taste.
➢ Do not breast feed
while taking this drug
without consulting
physician.

II. DRUGS AFFECTING THE LRT

CLASSIFICATIONS GENERIC NAME DRUGS INDICATIONS NURSING CONSIDERATION
6. Drugs for Asthma
a) Bronchodilators albuterol sulfate Airomir , ProAir ➢ To prevent or treat ➢ Drug may decrease
Digihaler, ProAir HFA, bronchospasm in sensitivity of spirometry
ProAir RespiClick, patients with reversible used for diagnosis of
Proventil asthma.
obstructive airway
 HFA, Ventolin HFA, disease Tablets ➢ Syrup contains no
VoSpire ER (extended-release) alcohol or sugar and
➢ To prevent exercise- may be taken by
children as young
induced bronchospasm
as age 2.
Adjuvant therapy for acute ➢ In children, syrup may
treatment of moderate to rarely cause erythema
severe hyperkalemia multiforme or SJS.
➢ Monitor patient for
effectiveness. Using drug
alone may not be
adequate to control
asthma in some patients.
Long-term control
medications may be
needed.
formoterol Perforomist ➢ Maintenance treatment ➢ Alert: If maintenance
fumarate of bronchoconstriction regimen fails to
in patients with COPD provide usual
(chronic bronchitis, response, contact
emphysema) prescriber
immediately, as this
indicates COPD
destabilization.
➢ Alert: As with all
beta2 agonists, drug
may produce life-
threatening
paradoxical
bronchospasm. If
bronchospasm
occurs, treat
immediately and
 notify prescriber
promptly.
➢ Alert: If patient
develops
tachycardia, HTN, or
other adverse CV
effects,
drug may need to be
stopped.
➢ Watch for immediate
hypersensitivity
reactions, such as
anaphylaxis,
urticaria,
angioedema, rash,
and bronchospasm.
fluticasone Breo Ellipta ➢ Asthma ➢ • If not already
furoate–vilanterol ➢ Maintenance treatment prescribed, initiate
trifenatate of COPD an inhaled, short-
acting beta2 agonist
in
➢ patients taking this
drug.
➢ • Patients who have
been taking oral or
inhaled short-acting
beta2 agonists on
➢ a regular basis (q.i.d.)
should discontinue
regular use of these
drugs and use
➢ them only for relief of
acute respiratory
symptoms.
➢ Determine if patient
has an allergy or
intolerance to
lactose;
anaphylactic
➢ reactions have
occurred in patients
with severe milk
protein allergies.
➢ Monitor short-acting
beta2 agonist rescue
use. Increased use
signals disease
deterioration.
➢ Slowly wean patients
requiring oral
corticosteroids from
systemic
corticosteroid use
after switch to an
inhaler. Reduce daily
prednisone dosage
by 2.5 mg on a
weekly basis during
therapy with inhaled
drug.
➢ Patients may require
supplemental
corticosteroid during
times of stress
when weaning from
systemic
corticosteroids.
 ➢ Monitor lung function
and watch for COPD
signs and symptoms
and adrenal
insufficiency (fatigue,
lassitude, weakness,
nausea, vomiting,
hypotension).
➢ Discontinue drug
slowly if
hypercortisolism or
adrenal suppression
is suspected.
➢ Monitor patient
periodically for
candidal infections
of the mouth. Have
patient rinse mouth
after inhalation
without swallowing to
help reduce the
risk.
➢ Monitor patient for
signs and symptoms
of pneumonia.
➢ If paradoxical
bronchospasm
occurs, discontinue
drug and institute
indacaterol Onbrez Breezhaler ➢ Long-term ➢ Alert: Drug may
maleate maintenance therapy produce paradoxical
for COPD bronchospasm that
may be life-
 threatening. If
paradoxical
bronchospasm
occurs, discontinue
drug immediately
and institute
alternative therapy.
➢ Discontinue routine
use of short-acting
beta2 -adrenergic
agonists when
indacaterol therapy
is begun. Short-
acting beta2
-adrenergic agonists
should
be used only for
symptomatic relief of
acute symptoms.
➢ As long as the
capsule is empty
after inhalation, the
full dose of
medication
has been received
even if patient
coughs. Monitor
patient for worsening
of symptoms,
decreased
effectiveness, or
increased need for
short-acting rescue
inhaler.
ipratropium Atrovent HFA, ➢ Bronchospasm in ➢ If patient uses a face
bromide Ipravent chronic bronchitis and mask for a nebulizer,
emphysema take care to prevent
leakage
➢ Rhinorrhea caused by
around the mask
allergic and nonallergic because eye pain or
perennial rhinitis temporary blurring of
➢ Rhinorrhea caused by vision may occur.
the common cold ➢ Safety and
➢ Rhinorrhea caused by effectiveness of
seasonal allergic rhinitis intranasal use
beyond 4 days in
➢ Acute asthma
patients with a
exacerbations, in common cold
combination with a haven't been
short-acting beta established.
agonist
levalbuterol Xopenex ➢ To prevent or treat ➢ Alert: As with other
hydrochloride, bronchospasm in inhaled beta
levalbuterol patients with reversible agonists, drug can
tartrate obstructive airway produce paradoxical
disease bronchospasm or life-
threatening CV
effects. If this occurs,
stop drug
immediately and
notify prescriber.
➢ Drug may worsen
diabetes mellitus and
ketoacidosis.
➢ Monitor potassium
level, as drug may
temporarily decrease
potassium level.
 ➢ The compatibility of
levalbuterol mixed
with other drugs in a
nebulizer
hasn't been
established.
i. Sympathomimetics oxymetazoline Afrin Sinus , Dristan , ➢ Nasal congestion ➢ Monitor for S&S of excess
hydrochloride Duration Spray , Adults and children age use. If noted, discuss
(intranasal) Nasal Spray , Neo- 6 and older: 2 to 3 possibility of rebound
Synephrine 12 Hour sprays of 0.05% solution congestion.
Spray in each nostril b.i.d. ➢ Wash hands carefully
Don’t use for more than after handling
3 days. oxymetazoline.
Anisocoria (inequality of
pupil size, blurred vision)
can develop if eyes are
rubbed with
contaminated fingers.
➢ Do not to exceed
recommended dosage.
Rebound congestion
(chemical rhinitis) may
occur with prolonged or
excessive use.
➢ Systemic effects can
result from swallowing
excessive medication.
➢ Do not breast feed while
using this drug without
consulting physician.
tetrahydrozoline Murine Tears Plus , ➢ Conjunctival ➢ Discontinue medication
hydrochloride Opti-Clear , Visine congestion, irritation, and consult physician if
(ophthalmic) and allergic conditions relief is not obtained
within 48 h or if
 Adults (all products) symptoms persist or
and children age 6 and increase.
older (Visine products): ➢ Do not exceed
Instill 1 to 2 drops in recommended dosage.
affected eye up to Rebound congestion
q.i.d., or as directed by and rhinitis may occur
prescriber. with frequent or
prolonged use of nasal
preparation.
➢ Do not breast feed while
using this drug without
consulting physician.
tetrahydrozoline Tyzine ➢ Nasal congestion ➢ Monitor BP and HR.
hydrochloride Adults and children age ➢ Drug should be used for
(intranasal) 6 and older: 2 to 4 only 3 to 5 days.
drops or 3 to 4 sprays of ➢ Overdose in young
0.1% solution in each children may cause
nostril no more often oversedation, coma,
than every 3 hours, bradycardia, or
p.r.n. Children ages 2 to respiratory depression.
5: Give 2 to 3 drops of
0.05% solution in each
nostril no more often
than every 3 hours,
p.r.n.
ii. Parasympatholytics Trospium Sanctura ➢ is used to treat an ➢ Monitor bowel and
overactive bladder (a bladder function. Report
condition in which the urinary hesitancy or
bladder muscles significant constipation.
contract uncontrollably ➢ Withhold drug and notify
and cause frequent physician if urinary
urination, urgent need retention develops.
to urinate, and inability ➢ Monitor for and report
to control urination). worsening of GI
 Trospium is in a class of symptoms in those with
medications called GERD.
antimuscarinics. ➢ Frequent monitoring of
IOP is required in those
with controlled narrow-
angle glaucoma.
Hyoscyamine Levsin ➢ is indicated along with ➢ Monitor signs of intestinal
morphine or other paralysis (paralytic ileus),
narcotics in including nausea, lack
symptomatic relief of of bowel sounds or
biliary and renal colic; movements, abdominal
as a “drying agent” in bloating/distention, and
the relief of symptoms vomiting. Report these
of acute rhinitis; in the signs to the physician
therapy of parkinsonism immediately. Be alert for
to reduce rigidity and decreased sweating
tremors and to control and altered/increased
associated sialorrhea body temperature
and hyperhidrosis (hyperpyrexia)
iii. Methylxanthines Uniphyl Theophylline ➢ For the treatment and ➢ Caution patient not to
prophylaxis of chew or crush enteric-
bronchospasm coated timed-release
associated with preparations. Give
asthma, chronic immediate release,
obstructive pulmonary liquid dosage forms with
disease and chronic food if GI effects occur.
bronchitis. Also Do not give timed-
indicated for the release preparations
treatment of left with food; these should
ventricular and be given on an empty
congestive cardiac stomach, 1 hr before or
failure 2 hr after meals
Lufyllin Dyphylline ➢ For relief of acute ➢ Relieve GI upset.
bronchial asthma and Administer oral drug with
 for reversible food or milk to relieve GI
bronchospasm irritation if GI upset is a
associated with chronic problem. Monitor drug
bronchitis and response.
emphysema.
b) Corticosteroids beclomethasone Beconase AQ, Qnasl, ➢ To relieve symptoms of ➢ Patient shouldn't receive
dipropionate, Rivanase AQ seasonal or perennial live-virus vaccines for 30
allergic and nonallergic days before or
(vasomotor) rhinitis; to concurrently with drug.
prevent nasal polyp ➢ IV drug should be
recurrence after administered only by a
surgical removal health care professional
(Beconase AQ) prepared to manage
➢ Adults and children age anaphylaxis.
12 and older: 1 or 2 ➢ Patient or caregiver may
sprays (42 to 84 mcg administer subcut after
Beconase proper training and if
AQ) in each nostril b.i.d. prescriber determines it's
Children ages 6 to 12: appropriate.
Initially, 1 spray (42 ➢ Watch for
mcg) in each nostril hypersensitivity
b.i.d. May increase to 2 reactions, even in
sprays in each nostril patients who previously
b.i.d. Once adequate tolerated infusions.
control is achieved, ➢ Monitor patient for
decrease to 1 spray in infection. Serious and
each nostril b.i.d. sometimes fatal
Maximum, 336 mcg infections have
daily. occurred in patients
➢ To relieve symptoms of receiving
seasonal or perennial immunosuppressants.
allergic rhinitis (Qnasl) ➢ Monitor patient for
Adults and children age depression, suicidal
12 and older: 2 sprays
 (160 mcg total) in each ideation, malignancies,
nostril once daily. allergic
Maximum, 320 reactions, and infusion
mcg/day. Children reactions.
ages 4 to 11: 1 spray (40 ➢ Assess patients with new-
mcg) in each nostril onset or deteriorating
once daily. neurologic signs and
➢ Maximum, 80 mcg/day. symptoms for JC virus–
associated PML. If PML is
confirmed, therapy may
have to be
discontinued.
azelastine Dymista ➢ Symptoms of seasonal ➢ Monitor patient for
hydrochloride– allergic rhinitis fungal, bacterial, or
fluticasone viral infections.
propionate ➢ Monitor patient for
localized
nasopharyngeal
Candida albicans
infection with
prolonged use.
➢ Ensure that patient
receives regular eye
exams to screen for
cataracts and
glaucoma with long-
term use.
➢ Monitor growth rate
in children using the
spray long-term.
➢ Monitor patient for
adrenal insufficiency
(tiredness, weakness,
 nausea, vomiting,
hypotension).
beclomethasone QVAR RediHaler ➢ Chronic asthma ➢ Check mucous
dipropionate Adults and children membranes
(inhalation) age 12 and older: frequently for signs
Starting dose, 40 to and symptoms of
80 mcg b.i.d. fungal
when patient infection.
previously used ➢ During times of stress
bronchodilators (trauma, surgery, or
alone, or 40 to 320 infection), systemic
mcg b.i.d. corticosteroids may
when patient be needed to
previously used prevent adrenal
inhaled insufficiency in
corticosteroids. If previously
patient doesn't corticosteroid-
respond adequately dependent patients.
to initial dosage ➢ Periodic
after 2 weeks, measurement of
increasing dosage growth and
may development may
provide additional be needed during
asthma control. high-dose or
Maximum, 320 mcg prolonged therapy in
b.i.d. Children ages children.
4 to 11: 40 mcg ➢ Cataracts and
b.i.d. May increase decreases in bone
to 80 mcg b.i.d. mineral density can
after 2 weeks if occur. Closely
needed. Maximum, monitor
80 mcg b.i.d. patients for vision
changes and for
decreased bone
 mineral content,
especially
patients with major
risk factors.
➢ Alert: Taper oral
corticosteroid
therapy slowly. Acute
adrenal insufficiency
and death may
occur in patients with
asthma who change
abruptly from oral
corticosteroids to
beclomethasone.
➢ Alert: Bronchospasm
may occur after
dosing; discontinue
drug and treat
immediately with a
short-acting inhaled
bronchodilator.
beclomethasone Beconase AQ, Qnasl, ➢ To relieve symptoms of ➢ Observe patient for
dipropionate Rivanase AQ seasonal or perennial fungal infections.
(intranasal) allergic and nonallergic ➢ Drug isn't effective
for acute
(vasomotor) rhinitis; to
exacerbations of
prevent nasal polyp rhinitis.
recurrence after Decongestants or
surgical removal antihistamines may
(Beconase AQ) be needed.
➢ Stop drug if no
To relieve symptoms of significant symptom
seasonal or perennial improvement occurs
allergic rhinitis (Qnasl) after 3 weeks.
 ➢ Monitor growth
routinely in pediatric
patients; reduction in
growth rate may
occur.
➢ Glaucoma and
cataracts can occur.
Closely monitor
patients for vision
changes and
increased IOP.
➢ Watch for
hypercorticism and
adrenal suppression
with very high doses,
or with standard
doses in susceptible
patients. If signs and
symptoms occur,
taper and
discontinue drug.
budesonide Pulmicort Flexhaler, ➢ As a preventative in ➢ Alert: When
(inhalation, Pulmicort Respules, maintenance of transferring from
intranasal) Pulmicort Turbuhaler , asthma systemic
Rhinocort Allergy ➢ Symptoms of seasonal corticosteroid to
or perennial allergic inhalation drug,
rhinitis use caution and
gradually decrease
corticosteroid dose
to prevent adrenal
insufficiency.
➢ Inhalation drug
doesn't remove the
need for systemic
 corticosteroid
therapy
in some situations.
➢ Systemic effects of
corticosteroid
therapy may occur if
recommended daily
dosage is exceeded.
➢ If bronchospasm
occurs after
inhalation use, stop
therapy and treat
with a
bronchodilator.
➢ Lung function may
improve within 24
hours of starting
therapy, but
maximum benefit
may not be
achieved for 1 to 2
weeks or longer.
➢ For Pulmicort
Respules, lung
function improves in
2 to 8 days, but
maximum benefit
may not be seen for
4 to 6 weeks.
➢ Watch for Candida
infections of the
mouth or pharynx.
➢ Alert: Corticosteroids
may increase risk of
 developing serious or
fatal
infections in patients
exposed to viral
illnesses, such as
chickenpox or
measles.
➢ In rare cases, inhaled
corticosteroids have
been linked to
increased IOP and
cataract
development. Stop
drug if local irritation
occurs.
➢ Monitor bone mineral
density in patients at
risk for decreased
bone mineral
content (prolonged
immobilization, family
history of
osteoporosis,
postmenopausal
status).
➢ Monitor children for
reduction in growth
velocity. Use lowest
effective
dose.
➢ Monitor patients for
hypercorticism and
adrenal suppression
and if they
 occur, reduce
dosage slowly.
➢ Rare cases of
eosinophilic
conditions and
Churg-Strauss
syndrome have
occurred when
systemic
corticosteroids have
been reduced or
withdrawn.
➢ Monitor patients for
eosinophilia,
vasculitic rash,
worsening pulmonary
symptoms, cardiac
symptoms, and
neuropathy.
budesonide (oral, Entocort EC, Uceris ➢ Mild to moderate ➢ Reduced liver
rectal) active Crohn disease function affects
involving the ileum, elimination of this
ascending colon, or drug; systemic
both (capsules) availability
➢ To maintain remission in of drug may increase
mild to moderate Crohn in patients with liver
disease that involves cirrhosis. Consider
the ileum or ascending dosage
colon (capsules) reduction.
➢ Induction of remission in ➢ Patients undergoing
active mild to surgery or other
moderate ulcerative stressful situations
colitis (tablets) may need systemic
➢ Induction of remission in glucocorticoid
mild to moderate distal supplementation in
ulcerative colitis (rectal addition to
foam) budesonide therapy.
➢ Carefully monitor
patients transferred
from systemic
glucocorticoid
therapy to
budesonide for signs
and symptoms of
corticosteroid
withdrawal. Watch
For
immunosuppression,
especially in patients
who haven't had
diseases such
as chickenpox or
measles; these can
be fatal in patients
who are
immunosuppressed
or receiving
glucocorticoids.
➢ Replacement of
systemic
glucocorticoids with
this drug may
unmask allergies,
such as eczema and
rhinitis, which were
previously controlled
by
 systemic drug.
➢ Long-term use of
drug may cause
hypercorticism and
adrenal suppression.
betamethasone Diprolene, Diprolene ➢ Inflammation and ➢ Drug isn't for
dipropionate AF, Sernivo pruritus from ophthalmic use.
betamethasone Luxiq corticosteroid- ➢ Because of alcohol
valerate responsive dermatoses content of vehicle,
➢ Inflammation and gel products may
pruritus from cause mild,
corticosteroid- transient stinging,
responsive dermatoses especially when used
of scalp (valerate only) on or near
➢ Mild to moderate excoriated skin.
plaque psoriasis ➢ If antifungal or
antibiotic combined
with corticosteroid
fails to provide
prompt
improvement, stop
corticosteroid until
infection is
controlled.
➢ Systemic absorption
is likely with
prolonged or
extensive body
surface
treatment. Watch for
symptoms of HPA axis
suppression,
manifestations of
 Cushing syndrome,
hyperglycemia, and
glycosuria. If HPA axis
suppression
occurs, attempt to
withdraw drug or
substitute a less
potent steroid.
Withdraw
gradually.
➢ Evaluate patient for
HPA axis suppression
by using the urinary
free cortisol
and corticotropin
stimulation tests.
➢ Drug may increase
risk of posterior
subcapsular
cataracts and
glaucoma.
Consider referral to
an ophthalmologist
for evaluation if
symptoms develop.
➢ Alert: Children may
demonstrate greater
susceptibility to HPA
axis
suppression and
Cushing syndrome.
➢ Avoid using plastic
pants or tight-fitting
 diapers on treated
areas in young
children. Children
may absorb larger
amounts of drug and
be more
susceptible to
systemic toxicity.
➢ Alert: Diprolene and
Diprolene AF may
not be replaced with
generics
because other
products have
different potencies.
ciclesonide Alvesco, Omnaris, ➢ Preventative during ➢ Alert: Don't use for
(inhalation, Zetonna asthma maintenance acute bronchospasm
intranasal) (Alvesco) or acute asthma.
➢ Signs and symptoms of ➢ Assess patient for
perennial allergic rhinitis bone loss during
➢ Signs and symptoms of long-term use.
seasonal allergic rhinitis ➢ Watch for evidence
of localized mouth
infections,
glaucoma,
cataracts, and
immunosuppression.
➢ Monitor infants born
to mothers using drug
during pregnancy for
hypoadrenalism.
➢ Monitor patients who
are switched from
 systemic to inhaled
corticosteroids
for worsening of signs
and symptoms and
other adverse effects
of withdrawal.
➢ Monitor children for
decline in growth
rate; the potential to
regain growth
after drug is stopped
hasn't been studied.
➢ Monitor patients for
nasal adverse
effects.
➢ For patients who
don't respond
adequately to
starting dose after 4
weeks of
therapy, higher doses
may provide
additional asthma
control.
➢ After asthma stability
has been achieved,
titrate to lowest
effective dosage
to minimize systemic
effects.
clobetasol Clobex, Clodan, ➢ Short-term topical ➢ If antifungal or
propionate Impoyz, Olux, Olux-E, treatment for moderate antibiotic combined
Tovet to severe plaque-type with corticosteroid
psoriasis of nonscalp fails to provide
 regions, excluding the prompt
face and intertriginous improvement, stop
areas corticosteroid until
➢ Inflammation and infection is
pruritus from controlled.
corticosteroid- ➢ Stop drug and notify
responsive dermatoses prescriber if skin
➢ Short-term topical infection, striae, or
treatment of mild to atrophy occurs.
moderate plaque-type ➢ HPA axis suppression
psoriasis of nonscalp occurs at doses as
regions, excluding the low as 2 g daily.
face and intertriginous
areas
➢ Inflammation and
pruritus of moderate to
severe
corticosteroidresponsive
dermatoses of the scalp
➢ Moderate to severe
scalp psoriasis
desoximetasone Topicort ➢ Inflammation from ➢ If fever develops and
corticosteroid- occlusive dressing is
responsive dermatoses in place, notify
(except spray) prescriber and
➢ Plaque psoriasis (spray remove occlusive
only) dressing.
➢ If antifungal or
antibiotic combined
with corticosteroid
fails to provide
prompt
improvement, stop
corticosteroid until
 infection is
controlled.
➢ Systemic absorption
is likely with use of
occlusive dressings,
prolonged
treatment, or
extensive body
surface treatment.
Watch for symptoms
of HPA axis
suppression, Cushing
syndrome,
hyperglycemia, and
glycosuria.
➢ Avoid using plastic
pants or tight-fitting
diapers on treated
areas in young
children. Children
may absorb larger
amounts of drug and
be more susceptible
to systemic toxicity.
➢ Gel contains alcohol
and may cause
burning or irritation in
open lesions.
➢ Look alike–sound
alike: Don't confuse
desoximetasone with
dexamethasone.
dexamethasone Dexamethasone ➢ Cerebral edema ➢ Alert: Epidural
(oral), Intensol* corticosteroid
dexamethasone ➢ Palliative management injections to treat
sodium phosphate of recurrent or neck and back pain
injection inoperable brain tumors and radiating pain in
➢ Inflammatory the arms and legs
conditions, neoplasias may result in rare but
➢ Acute, self-limited serious adverse
allergic disorders; acute events (vision loss,
exacerbations of stroke, paralysis,
chronic allergic death). The use of
disorders epidural
➢ Shock corticosteroid
➢ Dexamethasone injections isn't
suppression test for approved by the
Cushing syndrome FDA.
➢ Adrenocortical ➢ Most adverse
insufficiency reactions to
➢ Acute exacerbation of corticosteroids are
MS dose- or duration-
➢ Adjunctive therapy for dependent.
short-term ➢ For better results and
administration in less toxicity, give
synovitis of osteoarthritis, once-daily dose in
RA, bursitis, acute gouty morning.
arthritis, epicondylitis, ➢ Always adjust to
acute nonspecific lowest effective
tenosynovitis, dose.
posttraumatic ➢ Monitor patient's
osteoarthritis; lesions weight, BP, and
(keloids; localized, electrolyte levels.
hypertrophic, infiltrated, ➢ Monitor patient for
inflammatory lesions of cushingoid effects,
lichen planus, psoriatic including moon face,
plaques, granuloma buffalo hump,
annulare, or lichen
simplex chronicus; central obesity,
discoid lupus thinning hair, HTN,
erythematosus; and increased
necrobiosis lipoidica susceptibility to
diabeticorum; alopecia infection.
areata; cystic tumors of ➢ Watch for depression
an aponeurosis or or psychotic
tendon [ganglia]) episodes, especially
in high-dose
therapy.
➢ Diabetic patient may
need increased
insulin; monitor
glucose levels.
➢ Drug may mask or
worsen infections,
including latent
amebiasis.
➢ Elderly patients may
be more susceptible
to osteoporosis with
long-term
use.
➢ Inspect patient's skin
for petechiae.
➢ Gradually reduce
dosage after long-
term therapy.
➢ Look alike–sound
alike: Don't confuse
dexamethasone with
desoximetasone.
flunisolide flunisolide (intranasal) ➢ Symptoms of seasonal ➢ Drug isn't effective
(intranasal) or perennial allergic for acute
rhinitis exacerbations of
rhinitis.
Decongestants or
antihistamines may
be needed.
➢ Don't give for more
than 3 weeks unless
there is significant
symptom
improvement.
➢ Look alike–sound
alike: Don't confuse
flunisolide with
fluocinonide.
fluocinolone Capex, Derma- ➢ Inflammation from ➢ If an occlusive
acetonide Smoothe/FS, corticosteroid- dressing has been
Dermotic, Flac, responsive dermatoses applied and a fever
Synalar, Synalar TS, (cream, ointment, develops, notify
Xilapak solution) prescriber and
➢ Atopic dermatitis remove dressing.
➢ Scalp psoriasis ➢ If antifungal or
➢ Seborrheic dermatitis of antibiotic combined
the scalp with corticosteroid
➢ Eczematous external fails to provide
otitis prompt
improvement, stop
corticosteroid until
infection is
controlled.
➢ Systemic absorption
is likely with use of
 occlusive dressings,
prolonged
treatment, or
extensive body
surface treatment.
Watch for symptoms,
such as
hyperglycemia,
glycosuria, HPA axis
suppression, or
Cushing syndrome.
➢ Avoid using plastic
pants or tight-fitting
diapers on treated
areas in young
children. Children
may absorb larger
amounts of drug and
be more
susceptible to
systemic toxicity.
➢ Alert: Body oil and
scalp oil formulations
contain peanut oil.
➢ Look alike–sound
alike: Don't confuse
fluocinolone with
fluocinonide
or fluticasone.
fluocinonide Lidex, Vanos ➢ Inflammation from ➢ If an occlusive
corticosteroid- dressing has been
responsive dermatoses applied and a fever
develops, notify
 prescriber and
remove dressing.
➢ If antifungal or
antibiotic combined
with corticosteroid
fails to provide
prompt
improvement, stop
corticosteroid until
infection is
controlled.
➢ Systemic absorption
is likely with use of
occlusive dressings,
prolonged
treatment, or
extensive body
surface treatment.
Watch for such
symptoms as
hyperglycemia,
glycosuria, and HPA
axis suppression.
➢ Avoid using plastic
pants or tight-fitting
diapers on treated
areas in young
children. Children
may absorb larger
amounts of drug and
be more
susceptible to
systemic toxicity.
 ➢ Look alike–sound
alike: Don't confuse
fluocinonide with
fluocinolone
or fluticasone.
fluticasone Flonase Allergy Relief ➢ As preventive in ➢ Because of risk of
propionate , Flovent Diskus, maintenance of systemic absorption
Flovent HFA, Xhance chronic asthma in of inhaled
patients requiring oral corticosteroids,
corticosteroid observe patient
➢ Nasal symptoms of carefully for
seasonal and perennial evidence of systemic
allergic and nonallergic corticosteroid
rhinitis effects.
➢ Nasal polyps (Xhance) ➢ Alert: Monitor
patient, especially
postoperatively,
during periods of
stress
or severe asthma
attack for evidence
of inadequate
adrenal response.
➢ Alert: During
withdrawal from oral
corticosteroids, some
patients may
experience signs and
symptoms of
systemically active
corticosteroid
withdrawal, such as
joint or muscle pain,
 lassitude, and
depression, despite
maintenance or
even improvement
of respiratory
function. Deaths due
to adrenal
insufficiency have
occurred with
transfer from active
corticosteroids
to fluticasone
propionate inhaler.
➢ For patients starting
therapy who are
currently receiving
oral corticosteroid
therapy, reduce
dose of prednisone
to no more than 2.5
mg/day on a weekly
basis, beginning after
at least 1 week of
therapy with
fluticasone.
➢ Alert: As with other
inhaled asthma
drugs, bronchospasm
may occur, with
an immediate
increase in wheezing
after a dose. If
bronchospasm
occurs after
 a dose of inhalation
aerosol, treat
immediately with a
fast-acting inhaled
bronchodilator.
➢ Drug may increase
risk of glaucoma and
cataracts. Monitor
patient.
➢ Inhaled
corticosteroids can
reduce growth
trajectory in children.
Monitor growth.
➢ If a dosage regimen
fails to provide
adequate control of
asthma, reevaluate
the therapeutic
regimen and
consider additional
therapeutic options,
such as replacing the
current strength with
a higher strength,
initiating an inhaled
corticosteroid and
long-acting beta2
-agonist combination
product, or
initiating oral
corticosteroids.
➢ After asthma stability
has been achieved,
 titrate to the lowest
effective
dosage to reduce
the possibility of
adverse effects.
fluticasone Breo Ellipta ➢ Asthma ➢ If not already
furoate–vilanterol ➢ Maintenance treatment prescribed, initiate
trifenatate of COPD an inhaled, short-
acting beta2 agonist
in patients taking this
drug.
➢ Patients who have
been taking oral or
inhaled short-acting
beta2 agonists on
a regular basis (q.i.d.)
should discontinue
regular use of these
drugs and use
them only for relief of
acute respiratory
symptoms.
➢ Determine if patient
has an allergy or
intolerance to
lactose;
anaphylactic
reactions have
occurred in patients
with severe milk
protein allergies.
➢ Monitor short-acting
beta2 agonist rescue
 use. Increased use
signals disease
deterioration.
➢ Slowly wean patients
requiring oral
corticosteroids from
systemic
corticosteroid use
after switch to an
inhaler. Reduce daily
prednisone dosage
by 2.5 mg on a
weekly basis during
therapy with inhaled
drug.
➢ Patients may require
supplemental
corticosteroid during
times of stress
when weaning from
systemic
corticosteroids.
➢ Monitor lung function
and watch for COPD
signs and symptoms
and
adrenal insufficiency
(fatigue, lassitude,
weakness, nausea,
vomiting,
hypotension).
➢ Discontinue drug
slowly if
hypercortisolism or
 adrenal suppression
is suspected.
➢ Monitor patient
periodically for
candidal infections
of the mouth. Have
patient rinse mouth
after inhalation
without swallowing to
help reduce the
risk.
➢ Monitor patient for
signs and symptoms
of pneumonia.
➢ If paradoxical
bronchospasm
occurs, discontinue
drug and institute
alternative therapy.
➢ Monitor patient for
increased IOP and
for development or
worsening of
glaucoma or
cataracts.
➢ Monitor patient for
hypokalemia and
hyperglycemia.
➢ Serious or even fatal
courses of
chickenpox or
measles can occur in
susceptible patients.
➢ Monitor patient for
CV effects
(tachycardia, HTN,
supraventricular
tachycardia,
extrasystoles).
➢ Monitor patient for
reduction in bone
mineral density
(BMD) initially and
periodically with
long-term use.
Patients who use
tobacco and those
with prolonged
immobilization, family
history of
osteoporosis,
postmenopausal
status, advanced
age, poor nutrition,
or long-term use of
other drugs that can
reduce BMD
(anticonvulsants, oral
corticosteroids) are
at increased risk.
➢ Alert: Orally inhaled
corticosteroids may
slow growth rate
when given to
children and
adolescents.
fluticasone Beser, Cutivate ➢ Inflammation and ➢ Don't mix drug with
propionate pruritus from other bases or
(topical dermatoses responsive vehicles because
to corticosteroids doing so may affect
➢ Inflammation and potency.
pruritus from atopic ➢ If adverse reactions
dermatitis occur, prescriber
may order less
potent drug.
➢ Stop drug if local
irritation or systemic
infection, absorption,
or hypersensitivity
occurs.
➢ May cause
suppression of HPA
axis in patients
receiving high doses
for prolonged
periods, particularly
in children.
➢ Absorption of
corticosteroid is
increased when drug
is applied to
inflamed
or damaged skin,
eyelids, or scrotal
area; it's lowest when
applied to intact
normal skin, palms of
hands, or soles of
feet.
 ➢ Look alike–sound
alike: Don't confuse
fluticasone with
fluconazole,
fluocinolone, or
fluocinonide.
fluticasone Advair Diskus 100/50, ➢ Treatment of asthma for ➢ Alert: Patient
propionate– Advair Diskus 250/50, patients not adequately shouldn't be
salmeterol Advair Diskus 500/50, controlled on a switched from
(inhalation) Advair HFA 45/21, longterm asthma systemic
Advair HFA 115/21, control medication corticosteroids to
Advair HFA 230/21, such as inhaled Advair Diskus or
Airduo corticosteroid (ICS) or Advair HFA because
RespiClick, Wixela whose disease warrants of HPA axis
Inhub initiation of treatment suppression. Death
with both ICS and from adrenal
longacting beta2 - insufficiency can
adrenergic agonist occur. Several
(LABA) months are required
➢ Maintenance therapy for recovery of
for airflow obstruction in HPA function after
patients with COPD; to withdrawal of
reduce exacerbations systemic
of COPD in patients with corticosteroids.
a history of ➢ Don't start therapy
exacerbations during rapidly
deteriorating or
potentially life-
threatening episodes
of asthma. Serious
acute respiratory
events, including
fatality, can occur.
➢ The benefit of Advair
250/50 in treating
patients with COPD
for more than
6 months is unknown.
If drug is used for
longer than 6
months, periodically
reevaluate patient to
assess for benefits or
risks of therapy.
➢ Monitor patient for
urticaria,
angioedema, rash,
bronchospasm, or
other signs of
hypersensitivity.
➢ Don't use this drug to
stop an asthma
attack. Patients
should carry an
inhaled, short-acting
beta2 agonist (such
as albuterol) for
acute symptoms.
➢ If drug causes
paradoxical
bronchospasm, treat
immediately with a
short-acting inhaled
bronchodilator (such
as albuterol), and
notify prescriber.
 ➢ Monitor patient for
increased use of
inhaled short-acting
beta2 agonist. The
dose of Advair may
need to be
increased.
➢ Closely monitor
children for growth
suppression.
hydrocortisone Colocort, Cortef, ➢ Rheumatic disorders ➢ Determine whether
(oral, injection, Cortenema (adjunctive therapy for patient is sensitive to
rectal), Solu-Cortef short-term other corticosteroids.
hydrocortisone administration in ➢ Most adverse
sodium succinate psoriatic arthritis, RA reactions to
(injection) including juvenile RA, corticosteroids are
ankylosing spondylitis, dose- or duration-
acute and subacute dependent.
bursitis, acute ➢ For better results and
nonspecific less toxicity, give a
tenosynovitis, acute once-daily dose in
gouty arthritis, morning.
posttraumatic ➢ Alert: Salts aren't
osteoarthritis, synovitis of interchangeable.
osteoarthritis, ➢ Alert: Only
epicondylitis); collagen hydrocortisone
diseases (SLE, acute sodium succinate
rheumatic carditis, can be given IV.
systemic ➢ Alert: Epidural
dermatomyositis); corticosteroid
dermatologic diseases injections to treat
(pemphigus, bullous neck and back pain
dermatitis herpetiformis, and radiating pain in
severe erythema the arms and legs
 multiforme [SJS], may result in rare but
exfoliative dermatitis, serious adverse
mycosis fungoides, events (vision loss,
severe psoriasis, severe stroke, paralysis,
seborrheic dermatitis) death). The use of
➢ Severe or intractable epidural
allergic states (seasonal corticosteroid
or perennial allergic injections isn't
rhinitis, bronchial approved by the
asthma, contact FDA.
dermatitis, atopic ➢ Enema may produce
dermatitis, serum same systemic
sickness, drug effects as other forms
hypersensitivity of hydrocortisone. If
reactions, transfusion enema therapy must
reactions) exceed 21 days,
➢ Severe acute and taper off by giving
chronic allergic and every other night for
inflammatory processes 2 to 3 weeks.
involving the eye and its ➢ High-dose therapy
adnexa (allergic usually isn't
conjunctivitis, keratitis, continued beyond
allergic corneal 48 hours.
marginal ulcers, herpes ➢ Always adjust to
zoster ophthalmicus, iritis lowest effective
and iridocyclitis, dose.
chorioretinitis, anterior ➢ Monitor patient's
segment inflammation, weight, BP, and
diffuse posterior uveitis electrolyte levels.
and choroiditis, optic ➢ Monitor patient for
neuritis, sympathetic cushingoid effects,
ophthalmia) including moon face,
➢ Respiratory diseases buffalo hump,
(symptomatic
 sarcoidosis, Loeffler central obesity,
syndrome not thinning hair, HTN,
manageable by other and increased
means, berylliosis, susceptibility to
fulminating or infection.
disseminated ➢ Unless
pulmonary TB when contraindicated,
used concurrently with give a low-sodium
appropriate diet that's high in
antituberculous potassium and
chemotherapy, protein. Give
aspiration pneumonitis) potassium
➢ Hematologic disorders supplements.
(ITP in adults [IM form is ➢ Drug may mask or
contraindicated], worsen infections,
secondary including latent
thrombocytopenia in amebiasis.
adults, acquired ➢ Stress (fever, trauma,
[autoimmune] surgery, and
hemolytic anemia, emotional problems)
erythroblastopenia, may increase
congenital [erythroid] adrenal insufficiency.
hypoplastic anemia) Increase dosage.
➢ Neoplastic diseases ➢ Watch for depression
(palliative or psychotic
management of episodes, especially
leukemias and during high-dose
lymphomas in adults therapy.
and acute leukemia of ➢ Inspect patient's skin
childhood) for petechiae.
➢ Edematous states (to ➢ Diabetic patient may
induce diuresis or need increased
remission of proteinuria insulin; monitor
in nephrotic syndrome, glucose level.
 without uremia, of the ➢ Periodic
idiopathic type or that is measurement of
due to SLE) growth and
➢ Ulcerative colitis, development may
regional enteritis be needed during
➢ Nervous system high-dose or
disorders (cerebral prolonged therapy in
edema associated with children.
brain tumors or ➢ Elderly patients may
craniotomy [IV], be more susceptible
tuberculous meningitis to osteoporosis with
with subarachnoid prolonged
block or impending use.
block when used ➢ Gradually reduce
concurrently with dosage after long-
appropriate term therapy.
antituberculotics, ➢ Look alike–sound
trichinosis with alike: Don't confuse
neurologic or Solu-Cortef with Solu-
myocardial Medrol.
involvement) ➢ Don't confuse
➢ Endocrine disorders hydrocortisone with
(adrenal insufficiency, hydrocodone,
congenital adrenal hydroxychloroquine,
hyperplasia, or
nonsuppurative hydrochlorothiazide.
thyroiditis, Don't confuse Cortef
hypercalcemia with Coreg or Lortab.
associated with cancer)
➢ Adjunctive treatment
for ulcerative colitis and
proctitis
➢ Acute exacerbations of
MS
hydrocortisone Ala-Cort, Ala-Scalp, ➢ Inflammation and ➢ If an occlusive
(topical), Anusol HC, pruritus from dressing is applied
hydrocortisone Cortizone-10 , corticosteroid- and a fever
acetate (topical, Proctocort, responsive dermatoses, develops, notify
rectal), Scalpicin , Texacort adjunctive topical prescriber
hydrocortisone Anusol HC , Cortaid , management of and remove dressing.
butyrate, Corticaine , seborrheic dermatitis of ➢ If antifungal or
hydrocortisone Cortifoam, Gynecort scalp antibiotic combined
probutate, 10 , ➢ Inflammation from with corticosteroid
hydrocortisone Micort-HC proctitis; adjunctive fails to provide
valerate Locoid, Locoid treatment of chronic prompt
Lipocream ulcerative colitis, improvement, stop
Pandel cryptitis corticosteroid until
infection is
controlled.
➢ Systemic absorption
is likely with use of
occlusive dressings,
prolonged
treatment, or
extensive body
surface treatment.
Watch for symptoms,
such as
hyperglycemia,
glycosuria, and HPA
axis suppression.
➢ Avoid using plastic
pants or tight-fitting
diapers on treated
areas in young
children. Children
may absorb larger
amounts of drug and
 be more susceptible
to systemic toxicity.
➢ Monitor patient for
fluid or electrolyte
disturbances (sodium
and fluid retention,
potassium loss,
hypokalemic
alkalosis, negative
nitrogen balance
from catabolism of
protein).
➢ Drug may suppress
skin reaction testing.
➢ Look alike–sound
alike: Don't confuse
hydrocortisone with
hydrocodone,
hydroxychloroquine,
or
hydrochlorothiazide.
c) Cromolyn Sodium Cromolyn Sodium Nasalcrom ➢ is an FDA-approved ➢ Withhold drug and notify
medication used for physician if any of the
prophylaxis of mild to following occur;
moderate bronchial angioedema or
asthma and adjunctive bronchospasm.
treatment of allergic ➢ Monitor for exacerbation
rhinitis and systemic of asthmatic symptoms
mast cell disease including breathlessness
(mastocytosis) in and cough that may
pediatric patients and occur in patients
adults. receiving cromolyn
during corticosteroid
withdrawal.
➢ For patients with asthma,
therapeutic effects may
be noted within a few
days but generally not
until after 1–2 wk of
therapy.