budecort or budesonide is a corticosteroid that is used as antiinflammotry drug in asthma and chronic obstructive pulmonary diseases.

1. DRUG
PRESENTATION
BUDECORT
PRESENTER :-
RITU CHAHAL
2017033

2. INTRODUCTION
• Budesonide (BUD), is a medication of the corticosteroid type. It is
available as an inhaler, pill, nasal spray, and rectal forms. The
inhaled form is used in the long-term management
of asthma and chronic obstructive pulmonary disease(COPD). The
nasal spray is used for allergic rhinitis and nasal polyps. The pills
in a delayed release form and rectal forms may be used
for inflammatory bowel disease including Crohn’s
disease, ulcerative colitis, and microscopic colitis.

3. CLASS
• Budesonide belongs to CORTICOSTEROID.

4. CLASSIFICATION
• Natural-
Mineralocorticoid & glucocorticoid aldosterone hydrocortisone
• Synthetic-
1.Short acting: (8-12hrs)hydrocortisone, Cortisone
2. Intermediate acting:(12-36hrs) prednisolone, triamcinolone
3. Long acting: (36-72hrs) dexamethasone, betamethasone
4. Inhalation: fluticasone, budesonide , beclamethasone
5. Topical: clobetasol, mometasone desonide
6. Mineralocorticoid: fludrocortisone

5. THERAPEUTIC ACTIONS
• ANTI-INFLAMMATORY EFFECTS, Glucocorticoid steroids such
as cortisol or budesonide have potent anti-
inflammatory actions that reduces inflammation and hyper-
reactivity (spasm) of the airways caused by asthma. When used
as an inhaler, the budesonide goes directly to the inner lining of
the inflamed airways to exert its effects.
• TRADE NAME : Budecort, Plumicort
• CHEMICAL NAME : Budesonide

6. MECHANISM OF ACTION
• Corticosteroids binds to the glucocorticosteroid receptor mediate change in
gene expression.
• Glucocorticoid inhibit neutrophil apoptosis and demargination, they inhibit
phospholipase A2. Decrease the formation of arachidonic acid derivatives.
• They inhibit inflammatory transcription factors
• They promote anti-inflammatory genes like INTERLEUKIN-10

7. PHARMACOKINETICS
• Onset of action:
Nebulization: 2–8 days;
Inhalation: 24 hours;
Nasal: 10 hours
• Protein binding: 85% to 90%
• Half-life elimination: 2–3.6 hours

8. CONT…
• Absorption: Orally inhaled budesonide is rapidly absorbed in the lungs and
peak concentration is typically reached within 20 minutes. After oral
administration of budesonide, peak plasma concentration was achieved in
about 1–2 hours and the absolute systemic availability was 6–13%, due to
extensive first-pass metabolism.
• Distribution: Crosses placenta, may enter breast milk.
• Metabolism: In vitro studies with human liver homogenates have shown that
budesonide was rapidly and extensively metabolized.
• Excretion/Elimination: Budesonide was preferentially cleared by the liver with
systemic clearance. Budesonide was excreted in urine(60%) and feces in the
form of metabolites.

9. DOSE AND ADMINISTRATION
Adults (including elderly) and Children over 12 Years
• 200-1,600 mcg daily, in divided doses.
• 200 mcg twice daily, in the morning and in the evening. During periods of severe asthma the
daily dosage can be increased up to 1600 mcg.
• In less severe cases and children over 12 years of age, 200 - 800 micrograms daily, in
divided doses, may be used.
• In patients whose asthma is well controlled, the daily dose may be reduced below 400 mcg
but should not go below 200 mcg.

10. CONT…
Children (5 – 12 Years)
• 200-800 mcg daily, in divided doses.
• The dose should be reduced to the minimum needed to maintain good asthma
control.
• Patients should be maintained on the lowest dose that will effectively control
symptoms.

11. AVAILABLE
FORMS
• Spray
• Dry Powder
• Capsules
• Inhalation Suspension

12. INDICATIONS
• Rhinocort Aqua: Management of symptoms of seasonal or personal allergies
rhinitis in adults and children 6year and older.
• Respules/Flexhaler: Maintenance treatment of asthma as prophylactic
therapy in adults and children 6 yr and for patients requiring corticosteroids for
asthma.
• Inhalation suspension: Maintenance treatment and prophylaxis therapy of
asthma in children 1-8 yr.
• Oral: Treatment and maintenance of clinical remission for upto 3 month of mild
to moderate active Crohn’s disease involving the ileum or ascending colon.
• Unlabeled use: Eosinophilic esophagitis in children.

13. CONTRAINDICATIONS
• Budesonide is contraindicated as a primary treatment of status asthmaticus or
other acute episode of asthma where intensive measures are required.
• It is also contraindicated for patients who have hypersensitivity to budesonide
or any of the excipients.
• Use cautiously with TB, systemic infection, lactation.

14. DRUG INTERACTION
• Those taking tablets or capsules orally should avoid
grapefruit and grapefruit juice and echinacea.
• Grapefruit juice may double bioavailability of oral budesonide.
• Echinacea diminishes bioavailability.
• Also, high-fat meals delay absorption but do not impede
absorption.

15. ADVERSE EFFECTS
• CNS: Headache, dizziness, lethargy, fatigue, paresthesis, nervousness
• Dermatologic: rash, edema, pruritis, alopecia.
• Endocrine: HPA suppression, Cushing’s syndrome with overdose and
systematic absorption.
• GI: Nausea, dyspepsia, dry mouth.
• Local: nasal irritation, fungal infection.
• Respiratory; Epistaxis, rebound congestion, pharyngitis, cough.
• Other: Chest pain, asthenia, moon face, acne, bruising, back pain.

16. NURSING RESPONSIBILITIES
Assessment
• History: Untreated local nasal infections, nasal trauma, septal ulcers, recent
nasal surgery, lactation
• Physical: BP, P, auscultation; R, adventitious sounds; examination of nares
Interventions
Nasal inhalation
• Prime pump eight times before first use. If not used for 2 consecutive days,
reprime with 1 spray or until fine mist appears. If not used for more than 14
days, rinse applicator and reprime with 2 sprays or until fine mist appears.

17. CONT…
Oral
• Make sure patient does not cut, crush, or chew capsules; they must be
swallowed whole.
• Administer the drug once each day, in the morning; do not administer with
grapefruit juice.
• Encourage patient to complete full 8 week of drug therapy.

18. NURSING TEACHING
Inhalation
• Do not use more often than prescribed; do not stop without consulting your health care provider.
• It may take several days to achieve good effects; do not stop if effects are not immediate.
• Use decongestant nose drops first if nasal passages are blocked.
• Prime unit before use for Pulmicort Turbuhaler; rinse mouth after each use.
• Store Respules upright, protect from light; discard open envelopes after 2 weeks; gently shake
before use.
• You may experience these side effects: Local irritation (use your device correctly), dry mouth
(suck sugarless lozenges).
• Report sore mouth, sore throat, worsening of symptoms, severe sneezing, exposure to
chickenpox or measles, eye infections.

19. CONT…
Oral
• Take the drug once a day in the morning. Do not cut, crush, or chew the capsules,
they must be swallowed whole.
• If you miss a day, take the capsules as soon as you remember them. Take the next
day’s capsules at the regular time. Do not take more than three capsules in a day.
• Take the full course of the drug therapy (8 weeks in most cases).
• Do not take this drug with grapefruit juice; avoid grapefruit juice entirely while using
this drug.
• Store respules upright, protected from light; discard open envelopes after 2 weeks.
Shake before use.
• You may experience these side effects: Dizziness, headache (avoid driving or