fluticasone (topical)

General

Pronunciation
floo-TI-ka-sone [Pronunciation]

Trade Name(s)

• Cutivate

Indications

Management of inflammation and pruritis associated with various allergic/immunologic skin problems.

Action

Suppresses normal immune response and inflammation.

Therapeutic Effect(s):
Suppression of dermatologic inflammation and immune processes.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may ↑ systemic absorption.

Distribution: Remains primarily at site of action.

Metabolism and Excretion: Usually metabolized in skin.

Half-life: Unknown.

TIME/ACTION PROFILE (response depends on condition being treated)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity or known intolerance to corticosteroids or components of vehicles (ointment or cream base, preservative, alcohol, formaldehyde);

• Untreated bacterial or viral infections.

• Hepatic dysfunction;

• Diabetes mellitus, cataracts, glaucoma, or tuberculosis (use of large amounts of high-potency agents may worsen condition);

• Patients with pre-existing skin atrophy;

• OB: Lactation: Pedi: Chronic high-dose usage may result in adrenal suppression in mother, growth suppression in children; children may be more susceptible to adrenal and growth suppression.

Adverse Reactions/Side Effects

Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae.

Misc: adrenal suppression (use of occlusive dressings, long-term therapy).

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
None significant.

Route/Dosage

• Topical (Adults): Apply to affected area(s) twice daily..

Availability

• Cream: 0.05%

• Lotion: 0.05%

• Ointment: 0.005%

Assessment

• Assess affected skin prior to and daily during therapy. Note degree of inflammation and pruritus. Notify health care professional if symptoms of infection (increased pain, erythema, purulent exudate) develop.

• Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic topical therapy if suspected. Children and patients with dose applied to a large area, using an occlusive dressing, or using high-potency products are at highest risk for HPA suppression.

» May cause ↑ serum and urine glucose concentrations if significant absorption occurs.

Potential Nursing Diagnoses

• Risk for impaired skin integrity (Indications)

• Risk for infection (Side Effects)

• Deficient knowledge , related to medication regimen (Patient/Family Teaching)

Implementation

• Choice of vehicle depends on site and type of lesion. Ointments are more occlusive and preferred for dry, scaly lesions. Creams should be used on oozing or intertriginous areas, where the occlusive action of ointments might cause folliculitis or maceration. Creams may be preferred for aesthetic reasons even though they may be more drying to skin than ointments.

• Topical: Apply ointment, cream, and lotion sparingly as a thin film to clean, slightly moist skin. Wash hands immediately after application. Apply occlusive dressing only if specified by physician or other health care professional.

Patient/Family Teaching

• Instruct patient on correct technique of medication administration. Emphasize importance of avoiding the eyes. If a dose is missed, it should be applied as soon as remembered unless almost time for the next dose.

• Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.

• Advise patient to avoid excessive natural or artificial exposure (tanning booth, sun lamp) to areas where lotion is applied.

• Caution women that medication should not be used extensively, in large amounts, or for protracted periods in patients who are pregnant or planning to become pregnant.

• Advise patient to consult health care professional before using medicine for condition other than indicated.

• Instruct patient to inform health care professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.

Evaluation/Desired Outcomes

Resolution of skin inflammation, pruritus, or other dermatologic conditions.