Triamcinolone Hexacetonide Nursing Implications

Triamcinolone

(trye-am-sin′oh-lone)

Atolone, Kenacort, Kenalog-E

Triamcinolone Acetonide

Azmacort, Cenocort A2, Kenalog, Nasacort HFA, Triam-A, Triamonide, Trikort, Trilog, Tri-Nasal

Triamcinolone Diacetate

Kenacort

Triamcinolone Hexacetonide

Aristospan

Classification: ADRENAL CORTICOSTEROID; GLUCOCORTICOID

Therapeutic: ANTI-INFLAMMATORY; IMMUNOSUPPRESSANT

Prototype: Prednisone

Pregnancy Category: C

AVAILABILITY

Triamcinolone: Tablet; syrup. Triamcinolone acetonide: Solution for injection;

aerosol; inhaler; spray; nasal spray; cream, ointment, lotion; topical spray. Triamcinolone diacetate: Tablet. Triamcinolone hexacetonide: Solution for injection

ACTION & THERAPEUTIC EFFECT

Immediate-acting synthetic fluorinated adrenal corticosteroid with glucocorticoid properties. Possesses minimal sodium and water retention properties in therapeutic doses. Anti-inflammatory and immunosuppressant drug that is effective in the treatment of bronchial asthma.

USES

An anti-inflammatory or immunosuppressant agent. Orally inhaled: Bronchial asthma in patient who has not responded to conventional inhalation treatment. Therapeutic doses do not appear to suppress HPA (hypothalamicpituitary- adrenal) axis.

CONTRAINDICATIONS

Hypersensitivity to corticosteroids or benzyl alcohol; kidney dysfunction; glaucoma; acute bronchospasm; fungal infection.

CAUTIOUS USE

Coagulopathy, hemophilia, diabetes mellitus, GI disease; CHF; herpes infection; infection; IBD; myasthenia gravis; MI; ocular exposure, ocular infection; osteoporosis; peptic ulcer disease; PVD; skin abrasion; pregnancy (category C), lactation. Safe use in children younger than 6 y not established.

ROUTE & DOSAGE

Inflammation, Immunosuppression

Adult: IM/Subcutaneous 4–48mg/day in divided doses

Intra-articular/Intradermal 4–48 mg/day

Inhaled 2–4 inhalations q.i.d.

Topical See Appendix A

Child: IM/Subcutaneous 3.3–50 mg/m2/day in divided doses

Intra-articular/Intradermal 3.3–50 mg/m2/day

Acetonide

Adult: IM 60 mg, may repeat with 20–100 mg q6wk

Intradermal 1 mg/injection site (max: 30 mg total)

Intra-articular 2.5–4.0 mg

Inhalation See Appendix A

Child (6–12 y): IM 0.03–0.2 mg q1–7days Inhalation See Appendix A

Hexacetonide

Adult: Intralesional Up to 0.5 mg/in2 of skin

Intra-articular 2–20 mg q3–4wk

Triamcinolone Hexacetonide Nursing Implications

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ADMINISTRATION

Inhalation

• Follow manufacturer’s directions for specific oral or nasal inhaler and instruct patient on proper administration technique.

Subcutaneous/Intramuscular

• Do not give triamcinolone injection IV.
• IM injections should only be given into a large, well developed muscle such as the gluteal muscle.
• Store at 15°–30° C (59°–86° F). Protect from light.

ADVERSE EFFECTS (≥1%)

CNS: Euphoria, headache, insomnia, confusion, psychosis. CV: CHF, edema. GI: Nausea, vomiting, peptic ulcer. Musculoskeletal: Muscle weakness, delayed wound healing, muscle wasting, osteoporosis, aseptic necrosis of bone, spontaneous fractures. Endocrine: Cushingoid features, growth suppression in children, carbohydrate intolerance, hyperglycemia. Special Senses: Cataracts. Hematologic: Leukocytosis. Metabolic: Hypokalemia. Skin: Burning, itching, folliculitis, hypertrichosis, hypopigmentation.

INTERACTIONS

Drug: BARBITURATES, phenytoin, rifampin increase steroid metabolism—may need increased doses of triamcinolone; amphotericin mB, DIURETICS add to potassium loss; ambenonium, neostigmine, pyridostigmine may cause severe muscle weakness in patients with myasthenia gravis; may inhibit antibody mresponse to VACCINES, TOXOIDS.

PHARMACOKINETICS

Absorption: Readily absorbed from all routes. Onset: 24–48 h PO, IM. Peak: 1–2 h PO; 8–10 h IM. Duration: 2.25 days PO; 1–6 wk IM. Metabolism: In liver. Elimination: In urine. Half-Life: 2–5 h; HPA suppression, 18–36 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Notify prescriber if wheezing occurs immediately following a dose of inhaled triamcinolone.
• Do not use occlusive dressing over topical application unless specifically ordered to do so.
• Monitor growth in children receiving prolonged, systemic triamcinolone therapy.
• Monitor for signs of negative nitrogen balance (e.g., muscle atrophy), especially in older or debilitated patients receiving prolonged therapy.
• Report to prescriber immediately if a local infection develops at site of topical application.
• Report symptoms of hypercortisolism or Cushing’s syndrome (see Appendix F), hyperglycemia (see Appendix F), and glucosuria (e.g., polyuria). These may arise from systemic absorption after topical application, especially in children and if used over extensive areas for prolonged periods or if occlusive dressings are used.
• Monitor lab tests: Periodic serum electrolytes and blood glucose.

Patient & Family Education

• Report promptly any of the following: Sore throat, fever, swelling of feet or ankles, or muscle weakness.
• Adhere to drug regimen; do not increase or decrease established regimen and do not discontinue abruptly.
• Asthmatics should report promptly worsening of asthma symptoms following oral inhalation.

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Ditulis oleh Unknown pada tanggal Friday, September 25, 2015