QVAR
beclomethasone dipropionate
Pharmacologic class: Corticosteroid
Therapeutic class: Anti-inflammatory agent
Pregnancy risk category C
Action
Unclear. May decrease inflammation by stabilizing leukocytic lysosomal membrane, decreasing number and activity of inflammatory cells, inhibiting bronchoconstriction (leading to direct smooth muscle relaxation), and reducing airway hyperresponsiveness.
Availability
Inhalation aerosol: 40-mcg metered inhalation in 7.3-g canister; 80-mcg metered inhalation in 7.3-g canister
Inhalation capsules: 100 mcg, 200 mcg
Nasal spray: 0.042% (25-g bottle containing 180 metered inhalations)
Indications and dosages
➣ Maintenance treatment of asthma as prophylaxis; asthma patients who require systemic steroids for whom adding an inhaled steroid may reduce or eliminate the need for systemic steroids
Adults and children ages 12 and older: When previous therapy was bronchodilator alone, 40 to 80 mcg by oral inhalation (QVAR) b.i.d.; maximum of 320 mcg b.i.d. When previous therapy was inhaled steroid, 40 to 160 mcg by oral inhalation (QVAR) b.i.d.; maximum of 320 mcg b.i.d.
Children ages 5 to 11: When previous therapy was bronchodilator alone, 40 mcg by oral inhalation (QVAR) b.i.d.; maximum of 80 mcg b.i.d. When previous therapy was inhaled steroid, 40 mcg by oral inhalation (QVAR) b.i.d.; maximum of 80 mcg b.i.d.
➣ Seasonal or perennial rhinitis
Adults and children ages 12 and older: One or two inhalations (42 to 84 mcg Beconase AQ Nasal Spray) in each nostril b.i.d.
Children ages 6 to 12: One inhalation (42 mcg Beconase AQ Nasal Spray) in each nostril b.i.d.
Contraindications
• Hypersensitivity to drug
• Status asthmaticus
Precautions
Use cautiously in:
• active untreated infections, diabetes mellitus, glaucoma, underlying immunosuppression
• patients receiving concurrent systemic corticosteroids
• pregnant or breastfeeding patients
• children younger than age 6.
Administration
• Use spacer device to ensure proper delivery of dose and to help prevent candidiasis and hoarseness.
• After inhalation, tell patient to hold his breath for a few seconds before exhaling.
• For greater efficacy, wait 1 minute between inhalations.
• If patient is also receiving a bronchodilator, administer it at least 15 minutes before beclomethasone.
• Discontinue drug after 3 weeks if symptoms don't improve markedly.
Adverse reactions
CNS: headache
EENT: cataracts, nasal irritation or congestion, epistaxis, perforated nasal septum, nasopharyngeal or oropharyngeal fungal infections, hoarseness, throat irritation
GI: esophageal candidiasis
Metabolic: adrenal suppression Respiratory: cough, wheezing, bronchospasm
Skin: urticaria, angioedema
Other: anosmia, Churg-Strauss syndrome, hypersensitivity reactions
Interactions
None significant
Patient monitoring
• Assess patient's mouth daily for signs of fungal infection.
• Observe patient for proper inhaler use.
Patient teaching
• Instruct patient to hold inhaled drug in airway for several seconds before exhaling and to wait 1 minute between inhalations.
• Advise patient to rinse mouth after using inhaler and to wash and dry inhaler thoroughly to help prevent fungal infections and sore throat.
• Encourage patient to document use of drug and his response in a diary.
• If patient is also using a bronchodilator, teach him to use it at least 15 minutes before beclomethasone.
• As appropriate, review all other significant and life-threatening adverse reactions.
beclomethasone
(be-kloe-meth-a-sone) beclomethasone,Qvar
(trade name)Classification
Therapeutic: anti inflammatories steroidalPharmacologic: corticosteroids
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (improvement in symptoms)
| ROUTE | ONSET | PEAK | DURATION |
| Inhalation | within 24 hr | 1–4 wk* | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
Ear, Eye, Nose, Throat
- cataracts
- dysphonia
- oropharyngeal fungal infections
- pharyngitis
- rhinitis
- sinusitis
Respiratory
- bronchospasm
- cough
- wheezing
Endocrinologic
- adrenal suppression (increased dose, long-term therapy only)
- decreased growth (children)
Musculoskeletal
- back pain
Interactions
Drug-Drug interaction
None known.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Monitor respiratory status and lung sounds. Pulmonary function tests may be assessed periodically during and for several months following a transfer from systemic to inhalation corticosteroids.
- Assess patients changing from systemic corticosteroids to inhalation corticosteroids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. If these signs appear, notify physician or other health care professional immediately; condition may be life-threatening.
- Monitor for withdrawal symptoms (joint or muscular pain, lassitude, depression) during withdrawal from oral corticosteroids.
- Monitor growth rate in children receiving chronic therapy; use lowest possible dose.
- Lab Test Considerations: Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at greatest risk for HPA suppression.
- May cause increased serum and urine glucose concentrations if significant absorption occurs.
Potential Nursing Diagnoses
Ineffective airway clearance (Indications)Risk for infection (Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Implementation
- After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount required to control symptoms. Gradually decrease dose every 2–4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose.
- Inhalation: Allow at least 1 min between inhalations of aerosol medication.
Patient/Family Teaching
- Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose. Advise patient not to discontinue medication without consulting health care professional; gradual decrease is required.
- Advise patients using inhalation corticosteroids and bronchodilator to use bronchodilator first and to allow 5 min to elapse before administering the corticosteroid, unless otherwise directed by health care professional.
- Advise patient that inhalation corticosteroids should not be used to treat an acute asthma attack but should be continued even if other inhalation agents are used.
- Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status.
- Caution patient to avoid smoking, known allergens, and other respiratory irritants.
- Advise patient to notify physician if sore throat or mouth occurs.
- Instruct patient whose systemic corticosteroids have recently been reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to bronchodilators.
- Metered-Dose Inhaler: Instruct patient in the proper use of the metered-dose inhaler. Canister must be primed prior to first use. Do this by releasing 2 actuations into air away from face. Canister will remain primed for 10 days. If not used for more than 10 days, reprime with 2 actuations. Shake inhaler well. Exhale completely and then close lips firmly around mouthpiece. While breathing in deeply and slowly, press down on canister. Hold breath for as long as possible to ensure deep instillation of medication. Remover inhaler from mouth and breathe out gently. Allow 1–2 min between inhalations. Rinse mouth with water or mouthwash after each use to minimize fungal infections, dry mouth, and hoarseness. Clean only the mouthpiece weekly with clean dry tissue or cloth. Do not place in water (see ).
Evaluation/Desired Outcomes
- Management of the symptoms of chronic asthma.
- Improvement in asthma symptoms.