Questions and Answers
What is the generic name of the medication?
Fluticasone/salmeterol
What are the trade names for Fluticasone/salmeterol?
Advair Diskus, Advair HFA
What is the classification of Fluticasone/salmeterol?
Corticosteroid, long-acting β2-adrenergic agonist
What is the recommended dose for Advair Diskus?
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What is the recommended dose for Advair HFA?
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What is the route of administration for Fluticasone/salmeterol?
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How frequently should Fluticasone/salmeterol be administered?
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What is the peak effect time for Advair Diskus?
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What is the peak effect time for Advair HFA?
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What is the onset of action for Fluticasone/salmeterol?
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What is the duration of action for Advair Diskus?
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What is the duration of action for Advair HFA?
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What is the normal dosage range for Fluticasone/salmeterol?
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What laboratory alterations can be caused by Fluticasone/salmeterol?
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What are the primary uses of Fluticasone/salmeterol?
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What is the action of Fluticasone/salmeterol?
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What is a nursing implication when using Fluticasone/salmeterol?
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What should be assessed before administering Fluticasone/salmeterol?
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What are reasons to hold Fluticasone/salmeterol?
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What should be evaluated post-administration of Fluticasone/salmeterol?
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What are common side effects of Fluticasone/salmeterol?
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What are contraindications for Fluticasone/salmeterol?
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What are important nursing considerations when administering Fluticasone/salmeterol?
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What teaching points should be emphasized to patients on Fluticasone/salmeterol?
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What interactions might Fluticasone/salmeterol have with other medications?
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Study Notes
Fluticasone/Salmeterol Overview
- Generic Name: Fluticasone/salmeterol
- Trade Names: Advair Diskus, Advair HFA
- Classification: Combination of corticosteroid and long-acting beta-2 adrenergic agonist (LABA)
Dosage and Administration
- Dosage: Diskus - 1 inhalation every 12 hours; HFA - 2 inhalations every 12 hours
- Route of Administration: Inhalation
- Time/Frequency: Inhaled twice daily (q12hr)
Pharmacokinetics
- Onset of Action: Immediate
- Peak Effect: 1-2 hours for Diskus, 5 minutes for HFA
- Duration: Half-life of 8 hours for Diskus, 5.5 hours for HFA
Clinical Use
- Primary Uses: Long-term maintenance therapy for asthma and chronic obstructive pulmonary disease (COPD)
- Mechanism of Action: Reduces inflammation by inhibiting mast cells, macrophages, and leukotrienes, resulting in bronchial smooth muscle relaxation
Monitoring and Assessment
- Lab Values: Increase in liver function tests (LFTs) and decrease in potassium levels (K)
- Pre-administration Assessment: Monitor respiratory status, adrenal function, growth rates in children, blood glucose, and serum potassium
- Post-administration Evaluation: Observe for decreased severity of asthma symptoms
Side Effects and Adverse Reactions
- CNS Effects: Fever, headache (HA), nervousness, dizziness, insomnia, tremors, anxiety
- EENT Issues: Pharyngitis, sinusitis, nasal discharge, eye edema, conjunctivitis
- Gastrointestinal Effects: Diarrhea, abdominal pain, nausea, vomiting, oral candidiasis
- Metabolic Effects: Hyperglycemia, growth retardation in children, Cushingoid features
- Miscellaneous Effects: Anaphylaxis, adrenal insufficiency, osteoporosis, respiratory infections
Contraindications and Precautions
- Contraindications: Hypersensitivity reactions, severe asthma/COPD exacerbations, severe milk protein hypersensitivity
- Black Box Warning: Risk of asthma-related deaths
- Precautions: Use in pregnancy, breastfeeding, diabetes, active infections, and glaucoma
Nursing Considerations
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Administration Techniques:
- Diskus: For patients 4 years or older; requires sliding lever to activate dose, inhale slowly, hold breath for 10 seconds
- HFA: Requires shaking, priming with test sprays if not used for 4 weeks, and using a spacer if needed
- Mouth Care: Rinse mouth after use to minimize risk of oral candidiasis; discard after 1 month for Diskus, or after 120 sprays for HFA
Patient Education
- Use Guidelines: Bronchodilator should be used first; not for acute asthma attacks; may use short-acting beta-2 agonists for rescue
- Lifestyle Modifications: Avoid smoking and exposure to smoke, respiratory illnesses, and ensure vaccinations for chickenpox and measles
- Emergency Signs: Seek immediate help if wheezing worsens and is uncontrolled
Drug Interactions
- Increased CNS Stimulation: Theophylline
- Fluticasone Levels: Increased by CYP3A4 inhibitors and specific antiretrovirals
- Risk of Tendon Injuries: Quinolones can elevate risks of tendinitis and tendon rupture
- Hypokalemia Risk: Speeds up effects of loop diuretics, thiazides, and theophylline
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