Common drugs for arthritis and connective tissue disease

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  1. NSAID's
    Dosage: vares depending on which drug is being used

    Purpose: relieves chronic pain by inhibiting prostaglandin synthesis

    Nursing Implications: observe for fluid retention, increased blood pressure, and changes in renal function

    tionales: Most NSAID's cause sodium retention, which can lead to edema, hypertension, renal damage, and heart failure. Drugs should be used with caution in older adults

    Monitor electrolyte and CBC values; most NSAID's cause increased sodium levels and can cause bone marrow suppression

    Observe for CNS changes (dizziness, confussion); most NSAID's can cause CNS effects, especially in older adults
  2. Hydroxychloroquine sulfate (Plaquenil)
    • Dosage: 200mg orally daily
    • Purpose: an antimalarial agent that helps decrease inflammation and slow disease process

    Nursing implications: instruct patient to have frequent (every 6-12 months) ophthalmologic examination

    Rationale: drug can cause retinal damage
  3. Immunosuppressive agents (e.g., methotrexate [Rheumatrex]most commonly used, azathioprine [Imuran], cyclophosphamide [cytoxan])
    Purpose: supresses bone marrow to reduce immune response

    Nursing implications:Monitor for side effects and toxic effects, including buat not limited to nausea/vomiting, bone marrow suppression, and increased liver enzymes

    instruct patient to avoid crowds and people with infections such as influenza, if ill seek medical attention

    Rationale: the side effects ans toxic effects of these drugs can be devastating

    immune suppression increases the risk of infection
  4. Prednisone (Deltasone, Ao-prednisone)
    Purpose: decreases inflammatory and immune response by decreasing WBC count

    • Nursing implications: observe for cushingoid changes, buffalo hump, moon face, striae, acne, thin skin, bruising, fluid retention, and increased blood pressure.
    • Monitor electrolyte and glucose levels. Monitor weight.

    Rationale: these changes are expected and tend to be dose related changes diminish as dose decreases

    chronic steroid therapy can cause sodium or fluid retention, potassium depletion, and elevated glucose level

    • Nursing implications cont: observe for long-term effects of chronic steroid therapy, such as osteoporosis, attaracts, hypertension diabetes, and impaited healing
    • Rationale: these complications may need to be treated with other drugs or modalities

    Teach patient to increase dietaty calcium and vitamin D and take supplement

    instruct patient to avoid crowds and persons with infections such as influenza

    Rationale: drug suppress immune system (lymphocytes) and increases risk of infection or decreased healing
  5. Sulfasalazine (Azulfidine)
    Purpose: decreases inflammation and slows disease process

    Nursing implications: check for sulfa allergy or kidney or liver disease

    teach patient to drink adequate fluids

    teach men that the drug can lower sperm count

    Rationales: drug is a sulfa medication that has potential renal/liver toxicities

    failure to drink fluids may cause formation of urine crystals

    low sperm count may interfere with ability to conceive
  6. Leflunomide (Arava)
    Purpose: decreases inflammation by inhibiting an enzyme

    Nursing implcations: teach patient to have prescribed laboratory test, usually every 6-8 weeks

    avoid alcohol while taking drug

    Rationales: increased liver enzymes and decreased bloood count have been reported

    alcohol can increase liver enzymes
  7. Biological response modifiers(BRMs)
    Purpose: Neutralize biological activity of either TNF or IL to decrease immune response

    Nursing implications: do not give BRMs if patient has a serious infection, TB, or MS

    Rationale: drugs may exacerbate infections, MS, or lupus
  8. BRMs
    Etanercept (Enbrel)
    Infliximab (Remicade)
    Adalimumab (Humira)
    Anakinra (Kineret)
    Abatacept (Orencia)
    Rituximab (Rituxan)
    Nursing implication:
    • teach patient to report site reaction
    • refrigerate to prevent decomposition
    • report chest pain
    • difficulty breathing during infusion
    • monitor blood pressure
    • monitor WBC count
    • report cough, dizziness, and sore throat
    • monitor for dyspnea, wheezing, flushing, itching
    • observe for infusion reaction
  9. Infliximag (Remicade)
    Do not refrigerate it is the only BRM that you do not refrigerate
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Common drugs for arthritis and connective tissue disease
Common drugs for arthritis and connective tissue disease
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