betamethasone acetate and sodium phosphate
betamethasone acetate and sodium phosphate
Celestone SoluspanDuvoid (CA), Myotonachol (CA), Myotonine (UK), PMS-Bethanecol Chloride (CA), Urecholine
Pharmacologic class: Glucocorticoid (inhalation)
Therapeutic class: Antiasthmatic, antiinflammatory (steroidal)
Pregnancy risk category C
Pharmacologic class: Cholinergic
Therapeutic class: Urinary and GI tract stimulant
Pregnancy risk category C
Action
Stabilizes lysosomal neutrophils and prevents their degranulation, inhibits synthesis of lipoxygenase products and prostaglandins, activates anti-inflammatory genes, and inhibits various cytokines
Availability
Solution for injection: 3 mg betamethasone sodium phosphate with 3 mg betamethasone acetate/ml
Suspension for injection (acetate, phosphate): 6 mg (total)/ml
Syrup: 0.6 mg/5 ml
Tablets: 0.6 mg
Tablets (effervescent): 0.5 mg
Tablets (extended-release): 1 mg
⊘Indications and dosages
➣ Inflammatory, allergic, hematologic, neoplastic, autoimmune, and respiratory diseases; prevention of organ rejection after transplantation surgery
Adults: 0.6 to 7.2 mg/day P.O. as single daily dose or in divided doses; or up to 9 mg I.M. of betamethasone acetate and sodium phosphate suspension.
➣ Bursitis or tenosynovitis
Adults: 1 ml of suspension intrabursally
➣ Rheumatoid arthritis or osteoarthritis
Adults: 0.5 to 2 ml of suspension intra-articularly
Off-label uses
• Respiratory distress syndrome
Contraindications
• Hypersensitivity to drug
• Breastfeeding
Precautions
Use cautiously in:
• systemic infections, hypertension, osteoporosis, diabetes mellitus, glaucoma, renal disease, hypothyroidism, cirrhosis, diverticulitis, thromboembolic disorders, seizures, myasthenia gravis, heart failure, ocular herpes simplex, emotional instability
• patients receiving systemic corticosteroids
• pregnant patients
• children younger than age 6.
Administration
• Give as a single daily dose before 9:00 A.M.
• Give oral dose with food or milk.
• Administer I.M. injection deep into gluteal muscle (may cause tissue atrophy).
☞ Don't give betamethasone acetate I.V.
• Be aware that typical suspension dosage ranges from one-third to one-half of oral dosage given q 12 hours.
☞ To avoid adrenal insufficiency, taper dosage slowly and under close supervision when discontinuing.
• Know that drug may be given with other immunosuppressants.
Adverse reactions
CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure
CV: hypertension, thrombophlebitis, thromboembolism
EENT: cataracts, burning and dryness of eyes, rebound nasal congestion, sneezing, epistaxis, nasal septum perforation, difficulty speaking, oropharyngeal or nasopharyngeal fungal infections
GI: nausea, vomiting, anorexia, dry mouth, esophageal candidiasis, peptic ulcers
Metabolic: decreased growth, hyperglycemia, cushingoid appearance, adrenal insufficiency or suppression
Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis
Respiratory: cough, wheezing, bronchospasm
Skin: facial edema, rash, contact dermatitis, acne, ecchymosis, hirsutism, petechiae, urticaria, angioedema
Other: loss of taste, bad taste, weight gain or loss, Churg-Strauss syndrome, increased susceptibility to infection, hypersensitivity reaction
Interactions
Drug-drug.Amphotericin B, loop and thiazide diuretics, ticarcillin: additive hypokalemia
Barbiturates, phenytoin, rifampin: stimulation of betamethasone metabolism, causing decreased drug effects
Digoxin: increased risk of digoxin toxicity
Fluoroquinolones (such as ciprofloxacin, norfloxacin): increased risk of tendon rupture
Hormonal contraceptives: blockage of betamethasone metabolism
Insulin, oral hypoglycemics: increased betamethasone dosage requirement, diminished hypoglycemic effects
Live-virus vaccines: decreased antibody response to vaccine, increased risk of neurologic complications
Nonsteroidal anti-inflammatory drugs: increased risk of adverse GI effects
Drug-diagnostic tests.Calcium, potassium: decreased levels
Cholesterol, glucose: increased levels
Nitroblue tetrazolium test for bacterial
infection: false-negative result
Drug-herbs.Echinacea: increased immune-stimulating effects
Ginseng: increased immune-modulating effects
Drug-behaviors.Alcohol use: increased risk of gastric irritation and GI ulcers
Patient monitoring
• Monitor weight daily and report sudden increase, which suggests fluid retention.
• Monitor blood glucose level for hyperglycemia.
• Assess serum electrolyte levels for sodium and potassium imbalances.
• Watch for signs and symptoms of infection (which drug may mask).
Patient teaching
• Advise patient to report signs and symptoms of infection.
• Tell patient to report visual disturbances (long-term drug use may cause cataracts).
• Instruct patient to eat low-sodium, high potassium diet.
☞ Advise patient to carry medical identification describing drug therapy.
• Inform female patients that drug may cause menstrual irregularities.
☞ Caution patient not to stop taking drug abruptly.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
bethanechol chloride
Pharmacologic class: Cholinergic
Therapeutic class: Urinary and GI tract stimulant
Pregnancy risk category C
Action
Stimulates parasympathetic nervous system and cholinergic receptors, leading to increased muscle tone in bladder and increased frequency of ureteral peristaltic waves. Also stimulates gastric motility, increases gastric tone, and restores rhythmic GI peristalsis.
Availability
Tablets: 5 mg, 10 mg, 25 mg, 50 mg
⊘Indications and dosages
➣ Postpartal and postoperative non-obstructive urinary retention; urinary retention caused by neurogenic bladder
Adults: 10 to 50 mg P.O. three to four times daily; dosage may be determined by giving 5 or 10 mg q hour until response occurs or a total of 50 mg has been given.
Contraindications
• Hypersensitivity to drug
• GI or GU tract obstruction
• Hyperthyroidism
• Active or latent asthma
• Bradycardia
• Hypotension
• Atrioventricular conduction defects
• Coronary artery disease
• Seizure disorders
• Parkinsonism
• Peptic ulcer disease
Precautions
Use cautiously in:
• sensitivity to cholinergics or their effects and tartrazine (some products)
• pregnant or breastfeeding patients
• children.
Administration
• Give drug on empty stomach 1 hour before or 2 hours after a meal to help prevent nausea and vomiting.
Adverse reactions
CNS: headache, malaise, seizures
CV: bradycardia, hypotension, heart block, syncope with cardiac arrest
EENT: excessive lacrimation, miosis
GI: nausea, vomiting, diarrhea, abdominal discomfort, belching
GU: urinary urgency
Respiratory: increased bronchial secretions, bronchospasm
Skin: diaphoresis, flushing
Other: hypothermia
Interactions
Drug-drug.Anticholinergics: decreased bethanechol efficacy
Cholinesterase inhibitors: additive cholinergic effects
Depolarizing neuromuscular blockers: decreased blood pressure
Ganglionic blockers: severe hypotension
Procainamide, quinidine: antagonism of cholinergic effects
Drug-herbs.Angel's trumpet, jimson-weed, scopolia: antagonism of cholinergic effects
Patient monitoring
• Monitor blood pressure. Be aware that hypertensive patients may experience sudden blood pressure drop.
• Stay alert for orthostatic hypotension, a common adverse effect.
• Monitor fluid intake and output and residual urine volume.
Patient teaching
• Tell patient that drug is usually effective within 90 minutes of administration.
• Advise patient to take drug on empty stomach 1 hour before or 2 hours after a meal to avoid GI upset.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from blood pressure decrease.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.