betamethasone (Drug Study)-

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Drug Name Dosages Therapeutic Actions

Indications Adverse effects Contraindications

Nursing considerations

betamethasone

(bay ta meth' a sone)

betamethasone

Topical dermatologic ointment, cream, lotion, gel

betamethasone dipropionate Topical dermatologic ointment, cream, lotion, aerosol: Diprolene, Diprolene AF, Diprosone, Maxivate, Taro-Sone (CAN), Teladar

betamethasone sodium phosphate Systemic, including IV and local injection: Betnesol (CAN), Celestone Phosphate

betamethasone sodium phosphate and acetate Systemic, IM, and local intra-

PO Allergic and inflammatory disorders; congenital adrenal hyperplasia 0.5-5 mg/day. IM Allergic and inflammatory disorders As betamethasone Na phosphate and betamethasone acetate: Initial: 0.25-9 mg/day in 1-2 divided doses. Ophth Allergic and inflammatory conditions of the eye As 0.1% soln: As Na phosphate: Instill 1-2 hrly until symptoms are controlled. As 0.1% oint: As Na phosphate: Apply 2-4 times/day or at night w/ the eye drops. Topical Skin disorders As dipropionate (0.05%) or valerate (0.025 or 0.1%): Apply as directed.

Betamethasone is a corticosteroid with mainly glucocorticoid activity. It prevents and controls inflammation by controlling the rate of protein synthesis, depressing the migration of polymorphonuclear leukocytes and fibroblasts, and reversing capillary permeability and lysosomal stabilisation.

Systemic administration Hypercalcemia

associated with cancer

Short-term management of inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders

Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia

Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas

Trichinosis with neurologic or myocardial involvement

Intra-articular or soft-tissue administration Arthritis, psoriatic

plaques, and so forth

Dermatologic

Sodium and fluid retention, potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing; hirsutism, bruising, striae, acne; raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, DM. Suppression of pituitary-adrenocortical axis. Growth retardation in children (prolonged therapy). Increased susceptibility for infections. Topical use: Dermal atrophy, local irritation, folliculitis, hypertrichosis. Inhalation: Hoarseness, candidiasis of mouth and throat. Topical application to the eye: Corneal ulcers, raised IOP and reduced visual acuity. Intradermal injection: Local hypopigmentation of deeply pigmented skin. Intra-articular injection: Joint damage, fibrosis, esp in load bearing joints.

Hypersensitivity; systemic fungal or acute infections.

Assessment History (systemic

administration): Infections, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; kidney or liver disease; hypothyroidism; ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF; hypertension; thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation

Physical: Baseline weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose

Interventions

Systemic use Give daily dose

before 9 AM to mimic


articular, intralesional, intradermal injection: Celestone Soluspan

betamethasone valerate Topical dermatologic ointment, cream, lotion: Betaderm (CAN), Beta-Val, Luxiq, Prevex B (CAN), Psorion Cream, Valisone

Pregnancy Category C

Drug classes Corticosteroid

(long acting) Glucocorticoi

d

Hormone

preparations Relief of

inflammatory and pruritic manifestations of steroid-responsive dermatoses

Potentially Fatal: Abrupt withdrawal leading to acute adrenal insufficiency manifesting as malaise, weakness, mental changes, muscle and joint pains, dystonia, hypoglycaemia, hypotension, dehydration and death. Rapid IV inj may cause CV collapse.

normal peak corticosteroid blood levels.

Increase dosage when patient is subject to stress.

Taper doses when discontinuing high-dose or long-term therapy.

Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Topical dermatologic preparations Examine area for

infections and skin integrity before application.

Administer cautiously to pregnant patients; topical corticosteroids have caused teratogenic effects and can be absorbed from systemic site.

WARNING: Use caution when occlusive dressings or tight diapers cover affected area; these can increase systemic absorption of the drug.

Avoid prolonged use near eyes, in genital


and rectal areas, and in skin creases.

Teaching points

Systemic use Do not stop taking the

oral drug without consulting your health care provider.

Take single dose or alternate-day doses before 9 AM.

Avoid exposure to infections; ability to fight infections is reduced.

Wear a medical alert tag so emergency care providers will know that you are on this medication.

You may experience these side effects: Increase in appetite, weight gain (counting calories may help); heartburn, indigestion (eat frequent small meals; take antacids); poor wound healing (consult with your care provider); muscle weakness, fatigue (frequent rest periods will help).

Report unusual weight gain, swelling of the extremities,


muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of original disorder.

Intrabursal, intra-articular therapy Do not overuse joint

after therapy, even if pain is gone.

Topical dermatologic preparations Apply sparingly; do

not cover with tight dressings.

Avoid contact with the eyes.

Report irritation or infection at the site of application

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betamethasone (Drug Study)-