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1 Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying

immunosuppression (due to disease or concurrent therapy); Systemic corticoste-
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fluticasone (floo-ti-ka-sone) roid therapy (should not be abruptly discontinued when inhalable therapy is started;
Flovent HFA, Flovent Diskus additional corticosteroids needed in stress or trauma); Hepatic dysfunction; Severe
Classification milk protein allergy (powder for oral inhalation contains lactose); OB, Lactation,
Therapeutic: anti-inflammatories (steroidal) Pedi: Pregnancy, lactation, or children ⬍4 yr (safety not established; prolonged or
Pharmacologic: corticosteroids high-dose therapy may lead to complications).
Pregnancy Category C Adverse Reactions/Side Effects
CNS: headache, dizziness. EENT: dysphonia, hoarseness, oropharyngeal fungal in-
Indications fections, nasal stuffiness, rhinorrhea, sinusitis. Resp: bronchospasm, cough, upper
Maintenance and prophylactic treatment of asthma. May decrease requirement for or respiratory tract infection, wheezing. GI: diarrhea. Endo: adrenal suppression
avoid use of systemic corticosteroids and delay pulmonary damage that occurs from (high-dose, long-term therapy only),pbone mineral density,pgrowth (in children),
chronic asthma. Cushing’s syndrome. MS: muscle pain. Misc: hypersensitivity reactions including
ANAPHYLAXIS, LARYNGEAL EDEMA, URTICARIA, and BRONCHOSPASM, CHURG-STRAUSS SYN-
Action DROME, fever.
Potent, locally acting anti-inflammatory and immune modifier. Therapeutic Ef-
fects: Decreases frequency and severity of asthma attacks. Interactions
Drug-Drug: Strong CYP3A4 inhibitors, including ritonavir, atazanavir, cla-
Pharmacokinetics rithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfina-
Absorption: ⬍1% (aerosol), 8% (powder). Action is primarily local after inhala- vir, saquinavir, and telithromycinpmetabolism andqlevels; concurrent use not
tion. recommended.
Distribution: 10– 25% of inhaled corticosteroids is deposited in the airways if a
spacer device is not used. With the use of a spacer, a greater percentage may reach Route/Dosage
the respiratory tract. Crosses the placenta and enters breast milk in small amounts.
Protein Binding: 91%. Aerosol for oral inhalation
Metabolism and Excretion: Metabolized by the liver (primarily by CYP3A4) af- Inhaln (Adults and Children ⱖ12 yr): Patients whose previous asthma therapy
ter absorption from lungs; ⬍5% excreted in urine; remainder excreted in feces. included bronchodilators alone— 88 mcg twice daily initially, may bequp to 440
Half-life: 7.8 hr. mcg twice daily; Patients whose previous therapy included other inhaled cortico-
TIME/ACTION PROFILE (improvement in symptoms) steroids— 88– 220 mcg twice daily initially, may bequp to 440 mcg twice daily; Pa-
tients whose previous therapy included oral corticosteroids— 440 mcg twice
ROUTE ONSET PEAK DURATION daily initially, may bequp to 880 mcg twice daily.
Inhalation within 24 hr 1–4 wk† several days after DC Inhaln (Children 4– 11 yr): 88 mcg twice daily (not to exceed 88 mcg twice
†Improvement in pulmonary function; decreased airway responsiveness may take longer daily).
Contraindications/Precautions Powder for oral inhalation
Contraindicated in: Hypersensitivity (contains propellants); Acute attack of Inhaln (Adults and Children ⱖ12 yr): Patients whose previous asthma therapy
asthma/status asthmaticus. included bronchodilators alone— 100 mcg twice daily initially, may bequp to 500
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● May causeqserum and urine glucose concentrations if significant absorption oc-

curs.
mcg twice daily; Patients whose previous therapy included other inhaled cortico- PDF Page #2
steroids— 100– 250 mcg twice daily initially, may bequp to 500 mcg twice daily; Potential Nursing Diagnoses
Patients whose previous therapy included oral corticosteroids— 500– 1000 mcg Ineffective airway clearance (Indications)
Risk for infection (Side Effects)
twice daily.
Inhaln (Children 4– 11 yr): Patients whose previous asthma therapy included Implementation
bronchodilators alone— 50 mcg twice daily initially, may bequp to 100 mcg twice ● Do not confuse Flovent with Flonase (fluticasone nasal spray).
daily; Patients whose previous therapy included other inhaled corticosteroids— ● After the desired clinical effect has been obtained, attempts should be made to de-
50 mcg twice daily initially, may bequp to 100 mcg twice daily. crease 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,
NURSING IMPLICATIONS dose may briefly return to starting dose.
Assessment ● Inhaln: Allow at least 1 min between inhalations of aerosol medication.
● Monitor respiratory status and lung sounds. Assess pulmonary function tests peri-
odically during and for several months after a transfer from systemic to inhalation Patient/Family Teaching
● Advise patient to take medication as directed. If a dose is missed, take as soon as
corticosteroids.
remembered unless almost time for next dose. Instruct patient to read the Patient
● Assess patients changing from systemic corticosteroids to inhalation corticoste-
Information and Instructions for Use before using and with each Rx refill, in
roids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hy- case of new information. Advise patient not to discontinue medication without
potension, hypoglycemia) during initial therapy and periods of stress. If these consulting health care professional; gradual decrease is required.
signs appear, notify health care professional immediately; condition may be life- ● Advise patients using inhalation corticosteroids and bronchodilator to use bron-
threatening. chodilator first and to allow 5 min to elapse before administering the corticoste-
● Monitor for withdrawal symptoms (joint or muscular pain, lassitude, depression) roid, unless otherwise directed by health care professional.
during withdrawal from oral corticosteroids. ● Advise patient that inhalation corticosteroids should not be used to treat an acute
● Monitor growth rate in children receiving chronic therapy; use lowest possible asthma attack but should be continued even if other inhalation agents are used.
dose. ● Patients using inhalation corticosteroids to control asthma may require systemic
● May cause decreased bone mineral density during prolonged therapy. Monitor corticosteroids for acute attacks. Advise patient to use regular peak flow monitor-
patients with increased risk (prolonged immobilization, family history of osteopo- ing to determine respiratory status.
rosis, post-menopausal status, tobacco use, advanced age, poor nutrition, chronic ● Advise patient to stop using medication and notify health care profes-
use of drugs that can reduce bone mass [anticonvulsants, oral corticosteroids]) sional immediately if signs and symptoms of hypersensitivity reactions
for fractures. occur.
● Monitor for signs and symptoms of hypersensitivity reactions (rash, ● Caution patient to avoid smoking, known allergens, and other respiratory irritants.
pruritis, swelling of face and neck, dyspnea) periodically during ther- ● Advise patient to notify health care professional if sore throat or mouth occurs.
apy. ● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
● Lab Test Considerations: Periodic adrenal function tests may be ordered to tamins, or herbal products being taken and consult health care professional be-
assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in fore taking other Rx, OTC, or herbal products.
chronic therapy. Children and patients using higher than recommended doses are ● Advise female patients to notify health care professional if pregnancy is planned or
at highest risk for HPA suppression. suspected or if breast feeding.
䉷 2015 F.A. Davis Company CONTINUED
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fluticasone
● Instruct patient whose systemic corticosteroids have been recently 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.
● Aerosol for Inhalation: Instruct patient in the proper use of the metered-dose
inhaler. Inhaler should be primed before using for first time by releasing 4 sprays
into air, away from face. When inhaler has not been used for more than 7 days,
reprime unit by releasing 1 spray into air away from face. Shake inhaler well. Ex-
hale 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 mouth-
wash after each use to minimize fungal infections, dry mouth and hoarseness.
Wash inhalation assembly at least once weekly in warm running water.
● Powder for Inhalation: Do not use with a spacer. 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. After inhalation, rinse mouth with water and spit out. Never
wash the mouthpiece or any part of the Diskus inhaler. Discard Diskus inhaler de-
vice 6 wks (50-mcg strength) or 2 mo (100-mcg and 250-mcg strengths) after re-
moval from protective foil overwrap pouch or after all blisters have been used
(whichever comes first).
Evaluation/Desired Outcomes
● Management of the symptoms of chronic asthma.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.