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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
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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
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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
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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
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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
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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
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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
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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
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Infliximag (Remicade)
Do not refrigerate it is the only BRM that you do not refrigerate
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