Monitor respiratory status and lung sounds. Pulmonary function tests may be assessed periodically during and for several mo after a transfer from systemic to inhalation corticosteroids.
Assess patients changing from systemic 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 highest risk for HPA suppression.
May cause increased serum and urine glucose concentrations if significant absorption occurs.
After desired clinical effect is obtained, 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.
Inhaln Allow at least 1 min between inhalations of aerosol medication.
Advise patient to take medication as directed. Take missed doses 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 health care professional if sore throat or mouth occurs.
Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a warning card indicating the need for supplemental systemic corticosteroids in the event of stress or severe asthma attack unresponsive to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.
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. If not used for more than 3 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 and hold breath for as long as possible to ensure deep instillation of medication. Remove inhaler from mouth and breath 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. Wash inhalation assembly at least daily in warm running water (see medication administration techniques).
Management of the symptoms of chronic asthma.
Improvement in asthma symptoms.
triamcinolone (inhalation) is a sample topic from the Davis's Drug Guide.
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