Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (408 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
(trye-am-sin′oh-lone)
Aristospan, Kenalog-10, Tac-3, Triesence
Func. class.:
Corticosteroid, synthetic
Chem. class.:
Glucocorticoid, intermediate acting
See ophthalmic in
Appendix B
Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization
Severe inflammation, immunosuppression, neoplasms, asthma (steroid dependent); collagen, respiratory, dermatologic/rheumatic disorders
Hypersensitivity, neonatal prematurity; epidural/intrathecal administration (Triamcinolone acetonide injections [Kenalog])
Precautions:
Pregnancy (C), breastfeeding, diabetes mellitus, glaucoma, osteoporosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, esophagitis, peptic ulcer, acne, cataracts, coagulopathy, head trauma, children <2 yr, psychosis, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, AIDS, TB, adrenal insufficiency, acute bronchospasm
Calculator
• Adult:
IM
(acetonide, diacetate) 40 mg/wk; (diacetate, acetonide) 5-48 mg into neoplasms; (diacetate, acetonide) 2-40 mg into joint or soft tissue; (hexacetonide) 0.5 mg/in
2
of affected intralesional skin; (hexacetonide) 2-20 mg into joint or soft tissue
• Adult:
IM
(Trivaris) 60 mg, titrate, usual range 40-80 mg
• Child:
IM
(Trivaris) 0.11-1.6 mg/kg/day (3.2-48 mg/m
2
/day) in 3-4 divided doses
Available forms:
Inj 25, 40 mg/ml diacetate; inj 3, 10, 40 mg/ml acetonide; inj 20, 5 mg/ml hexacetonide
•
After shaking susp (parenteral)
•
Titrated dose; use lowest effective dose
•
IM inj deep in large muscle mass; rotate sites; avoid deltoid; use 21G needle
•
In 1 dose in
AM
to prevent adrenal suppression; avoid SUBCUT administration, may damage tissue
CNS:
Depression, flushing, sweating
, headache, mood changes
CV:
Hypertension
,
circulatory collapse, thrombophlebitis, embolism,
tachycardia, edema
EENT:
Fungal infections, increased intraocular pressure, blurred vision
GI:
Diarrhea, nausea, abdominal distention
,
GI hemorrhage,
increased appetite
,
pancreatitis
HEMA:
Thrombocytopenia
INTEG:
Acne, poor wound healing, ecchymosis, petechiae
MS:
Fractures, osteoporosis, weakness
PO/IM:
Peak 1-2 hr, half-life 2-5 hr
Increase:
side effects—alcohol, salicylates, indomethacin, amphotericin B, digoxin, cycloSPORINE, diuretics
Increase:
action of triamcinolone—salicylates, estrogens, indomethacin, oral contraceptives, ketoconazole, macrolide antiinfectives
Decrease:
action of triamcinolone—cholestyramine, colestipol, barbiturates, rifampin, ePHEDrine, phenytoin, theophylline
Decrease:
effects of anticoagulants, anticonvulsants, antidiabetics, ambenonium, neostigmine, isoniazid, toxoids, vaccines, anticholinesterases, salicylates, somatrem
•
Hypokalemia: aloe, cascara, senna
Increase:
cholesterol, sodium, blood glucose, uric acid, calcium, urine glucose
Decrease:
Ca, K, T
4
, T
3
, thyroid
131
I uptake test, urine 17-OHCS, 17-KS, PBI
False negative:
skin allergy tests
•
Potassium, blood glucose, urine glucose while patient receiving long-term therapy; hypokalemia and hyperglycemia
•
Weight daily; notify prescriber if weekly gain of >5 lb
•
B/P, pulse; notify prescriber if chest pain occurs
•
I&O ratio; be alert for decreasing urinary output, increasing edema
•
Plasma cortisol levels during long-term therapy (normal level: 138-635 nmol/L SI units when drawn at 8
AM
)
•
Infection:
increased temp, WBC even after withdrawal of medication; product masks infection
•
Potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness
•
Edema, hypertension, cardiac symptoms
•
Mental status: affect, mood, behavioral changes, aggression
•
Assistance with ambulation for patient with bone-tissue disease to prevent fractures
•
Use of spacer device for geriatric patients with inhaler
•
Therapeutic response: ease of respirations, decreased inflammation
•
That emergency ID as corticosteroid user should be carried
•
To notify prescriber if therapeutic response decreases; that dosage adjustment may be needed
•
To avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber
•
About cushingoid symptoms
•
About the symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(try-am-sin′oh-lone)
Kenalog, Triacet, Triderm
Func. class.:
Corticosteroid, topical
Crosses cell membrane to attach to receptors to decrease inflammation, itching; inhibits multiple inflammatory cytokines
Inflammation/itching in corticosteroid-responsive dermatoses on the skin or inflammation in the mouth
Hypersensitivity, use on face, ear canal, infections
Precautions:
Pregnancy (C), breastfeeding, children
Calculator
•
Apply to the affected areas bid-qid
Available forms:
Aerosol 0.2 mg; paste (dental) 0.1%; lotion, cream, ointment 0.025%; ointment 0.05%; lotion, cream, ointment 0.1%; ointment, cream 0.5%
•
May be used with occlusive dressings
•
Cream/Ointment/Lotion:
apply sparingly in a thin film and rub gently into the cleansed, slightly moist affected area
•
Paste:
apply without rubbing, press into lesion until film develops
•
Spray:
spray a small amount of preparation onto the lesion
ENDO:
HPA axis suppression, Cushing syndrome
INTEG:
Burning, folliculitis, pruritus, dermatitis, maceration, hypopigmentation
META:
Hyperglycemia; glycosuria
Onset 8-12 hr
Increase:
blood glucose
•
Skin reactions: burning pruritus, folliculitis, mouth lesions
•
Decreasing itching, inflammation on the skin, decreasing mouth lesions
•
How to use each product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert