Betamethasone

A Drug Study Presented to the Faculty of the Nursing Department

Ms. Dela Cerna, Joann B., RN, MN

In Partial Fulfillment of the Requirements in NCM 209

OB GYNE ROTATION

By:

Francis Marcel E. Peteros, St. N

BSN-2H GROUP 3

April 17, 2020

Generic name: Betamethasone

Brand name: Celestone Soluspan

Classification: Betamethasone is a long-acting corticosteroid with immunosuppressive and anti-inflammatory properties.

It can be used topically to manage inflammatory skin conditions such as eczema, and parenterally to manage several
disease states including autoimmune disorders. Betamethasone has potent glucocorticoid activity and negligible
mineralocorticoid activity.

Mode of action: Glucocorticoids inhibit neutrophil apoptosis and demargination, and inhibit NF-Kappa B and other
inflammatory transcription factors. They also inhibit phospholipase A2, leading to decreased formation of arachidonic acid
derivatives. In addition, glucocorticoids promote anti-inflammatory genes like interleukin-10.

Corticosteroids like betamethasone can act through nongenomic and genomic pathways. The genomic pathway is slower
and occurs when glucocorticoids activate glucocorticoid receptors and initiate downstream effects that promote
transcription of anti-inflammatory genes including phosphoenolpyruvate carboxykinase (PEPCK), IL-1-receptor
antagonist, and tyrosine amino transferase (TAT). On the other hand, the nongenomic pathway is able to elicit a quicker
response by modulating T-cell, platelet and monocyte activity through the use of existing membrane-bound receptors and
second messengers.
Route and dosage: Betamethasone topical comes in a 0.05 percent ointment or lotion.

After you've applied betamethasone topical to the affected area, expose it to air: Do not cover the area with a bandage or
other material. Don't apply betamethasone topical to your face, underarms, or groin unless your doctor tells you to do so.

Apply no more than 50 grams of betamethasone topical to your skin a week. You can stop using betamethasone when
you no longer have symptoms.

Indication: As a member of the corticosteroid family, betamethasone is indicated for the treatment of several
inflammatory conditions. As topical monotherapy, betamethasone is indicated to relieve pruritic and inflammatory
symptoms of corticosteroid-responsive-dermatoses. Betamethasone can be used topically in combination with a vitamin D
analog such as calcipotriene to treat plaque psoriasis. The corticosteroid is also available as an injectable suspension and
can be used to manage a range of inflammatory conditions including endocrine disorders, gastrointestinal disorders, and
rheumatic disorders among other conditions.

Contraindication:

 Systemic fungal infection

 Hypersensitivity to betamethasone
 Traumatic brain injury (high doses)
 Untreated serious infections
 Administration of live, attenuated vaccines is contraindicated in patients receiving immunosuppressive doses of
corticosteroids
Side effects:

The most common side effect from betamethasone topical is stinging. Other side effects include:

 Burning, itching, or dryness of the skin

 Red bumps around the mouth
 Extremely thick hair growth on unusual areas of the body
 Skin lightening or loss of natural skin color
 Thinning of the skin
 Stretch marks

Adverse effects: 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.

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.
Drug interaction: If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware
of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any
medicine before checking with your doctor, health care provider or pharmacist first.

Interactions of betamethasone include:

 aminoglutethimide
 amphotericin B injection and potassium-depleting agents
 antibiotics, specifically macrolide
 anticholinesterases
 oral anticoagulants
 antidiabetics
 antitubercular drugs
 cholestyramine
 cyclosporine
 digitalis glycosides
 estrogens, including oral contraceptives
 hepatic enzyme inducers (barbituarates, phenytoin, carbamazepine, rifampin)
 ketoconazole
 nonsteroidal anti-inflammatory agents (NSAIDs)
 diminished response to vaccines
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell
your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this
information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical
advice, or if you have health questions, concerns or for more information about this medicine.

Nursing responsibilities:
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 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

Bibliography: RxList (2019). BETAMETHASONE. Retrieved 04/17/2020, from:

https://www.rxlist.com/consumer_betamethasone_celestone_b
etaject/drugs-condition.htm

Drugbank (2020). BETAMETHASONE. Retrieved 04/17/2020, from:

https://www.drugbank.ca/drugs/DB00443