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rheumatoid arthritis

drugs

QuestionAnswer
what are the 3 types of drugs used to treat rheumatoid arthritits? NSAIDS (non seroidail anti-inflammitory drugs), Glucocorticoids, Disease modifying Anti-Rheumatic Drugs(DMARDS)
what action do DMARDS have on the bones/joints? DMARDS decrease joint inflammation, joint damage
what should you also give with the use of DMARDS initially? why? when can the patient stop using DMARDS? give with NSAIDS bc DMARDS have a slow onset of therapeutic effect. the patient may discontinue use when therapeutic effect is reached
how many types of DMARDS are there? I, II, III
WHAT IS RA? AUTOIMMUNE DISORDER IN WHICH THE BODY ATTACKS ITS OWN TISSUES AND IMMUNE SYSTEM
NAME DMARD1 DRUGS: what do DMARDS do? methotrexate/Rheumatrex leflunomide/Arava suppress the immune response
what are the side effects of methotrexate? liver damage, bone marrow suppression, GI ulceration, pulmonary fibrosis, methotrexate is category D drug for pregnancy and category X for leflunomide
the nurse should watch for what with a patient taking methotrexate DMARDI drugs? monitor for decreased platelets, watch for GI bleeding, Jaundice, monitor wbc/rbc counts, decreased oxygenation and respiratory distress
route given for methotrexate? only give once per week, oral sub q or IM
what instructions should the nurse provide to the patient regarding methotrexate? the nurse should instruct the patient to take 8-10 glasses of water, report infection, yellow eyes, ulcerations in mouth, bleeding, SOB, do not get pregnant for at least 6 moths after treatment and do not use alcohol
what precautions and contraindications are advised with methotrexate? do not use active vaccines, watch with peptic ulcers, contraindications: pregnancy, liver insufficiency, hepatitis, renal failure
what drugs may interact with methotrexate? NSAIDS, asprin(increase toxicity risk), sulfonamides, alcohol(increase risk of liver failure), digoxin(serum levels may be reduced)
DMARDII DRUGS ARE: etanercept/Enbrel infliximab/ Remicade Adalimumab/Humira
what are the therapeutic effect of Enbrel/infliximab? immunosuppression is the therapeutic effect, tumor necrosis factor antagonist
can you give DMARD II drugs with DMARDI drugs? yes, you can give with methotrexate
what are the side effects of Enbril/Humira? susceptible to infections, sever skin reactions(Steven-Johnson syndrome, toxic epidermal necrolysis, erythem)HF, TB reactivation
the nurse should swatch monitor or do what for a patient taking enbrel? monitor for skin reactions, infection signs and symptoms, cough, sob, heart rate elevated bp (signs of heart failure), give TB test
what patient instructions should the nurse provide to to the patient taking enbrel? patients should report infection symptoms, skin rashes, injection site reactions
what are the contraindications and precautions for enbrel/infliximab? contraindications: active infection, hematoligic disease, malignancy, caution: autoimune disorders(MS), live vaccines
what are the four main types of drugs to treat osteoporosis? SERMs, Bisphosphates, calcitonin, calcium supplements
what are the therapeutic effects of SERMs(selective estrogen receptor modulators)? prevention and treatment of post menopausal osteoporosis and reduce risk of estrogen dependent or receptor-positive breast cancer
what are the prototype drugs for SERM drugs? raloxifene/Evista -used more bc it poses less risk for uterine cancer. tamoxifen (Nolvadex)
what do SERMs (raloxifin/Evista) do? decrease bone resorption and bone loss, increase risk of endometrial cancer, and block access to estrogen receptors in breast tissue
what are the side effects of ralixifin? DVT, endometrial cancer, pumonary embolo, hot flashes.
what nursing interventions should be taken with a patient taking raloxifin? monitor bone density, monitor for signs/symptoms of thrombolemboli in lungs and lower legs
SERMS may be taken how? PO, daily, with or without food
patients should do what if taking SERMs? consume adequate Vit-D, weight bearing exercises, use contraception/do not breast feed during treatment, caution about hot flashes
what are Bisphosphates therapeutic uses? preventiion post menopausal osteoporosis, age related osteoporosis in men, gluccorticoid related osteoporosis
what are the names of the bisphosphate drugs? aldronate/Fosamax Actonel/Risedronate lbandronate/Boniva
what is the pharmacological action of Bisphosphates? decrease bone resorption by decreasing the number and action of osteoclasts
waht are the side effect of aldronate/Fosomax? esophogitis, GI problems, muscle/joint pain, eye pain and vision changes
what administration precautions should be followed with fosomax? give 30 before breakfast, with full glass of water, pt. should sit upright, avoid eating, for 30 min after dose,
contraindications of Fosomax are: esophageal disorders, difficulty swallowing, pt. unable to sit for 30 min, renal insufficiency, hypocalcemia
what substances interact with fosomax? calcium supplements, and dairy products
what nursing interventions should be done with a patinet on fosomax? monitor for muscle and joint pain, changes in vision and esophogitis
Created by: mabrlg6240
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