https://padlet.com/knewton5952/sgsyymmki3c0 Amy Stein and Kendra Newton en-us 2017-09-08 00:00:02 UTC 2023-09-22 23:04:43 UTC hello@padlet.com knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726544 Chronic disorder with autoimmune (body's immune system attacks healthy cells) and inflammatory components.

Medications commonly used to treat Rheumatoid Arthritis:

Disease-Modifying Antirheumatic Drugs (DMARDs)
DMARDs 1:Major Nonbiologic DMARDs
Immunomodulator Meds:
Prototype:
                     Methotrexate
                     
DMARDs 2: Major Biologic Dmards

DMARDs 3: Minor Nonbiologic DMARDs

Action- slow joint degeneration and progression of RA

Glucocorticoids
Prototype: Prednisone
Action- provide symptomatic relief of inflammation and pain

NSAIDs
Prototype: Aspirin

Action- provide rapid, symptomatic relief of inflammation and pain

Complications/nursing considerations:

 Methotrexate
- Increased risk of infection
(advise pt to notify Dr immediately)
- Hepatic fibrosis and toxicity
(monitor liver function test, observe for anorexia, abdominal fullness, and jaundice)
- Bone marrow suppression
(obtain baseline CBC, include platelet count; repeat every 3-6 months)
- Ulcerative stomatitis
(inspect mouth, gums, and throat daily; advise pt to take meds with food or water; stop meds if symptoms occur)
- Fetal death/congenital abnormalities
(avoid use during pregnancy; use adequate contraception while taking meds)

Prednisone
- Risk of infection
(notify dr immediately if symptoms occur)
- osteoporosis
(take with calcium supplements)
- Adrenal suppression
(notify dr immediately if manifestations occur)
- Fluid retention
(monitor for signs of fluid excess-crackles, weight gain, edema)
- GI discomfort
(advise client to report symptoms of GI bleeding)
- Hyerpglycemia
(monitor blood glucose levels)
- Hypokalemia
(monitor serum potassium levels; tell pt to eat potassium rich foods or take potassium supplement)

Contraindications:

Methotrexate:
-pregnancy risk X
- liver failure
- alcohol use disorder
-use with caution with liver or kidney dysfunction, cancer, suppressed bone marrow function
- peptic ulcer disease
- ulcerative colitis
- use cautiously with children or women who are breastfeeding

Prednisone:
-systemic fungal infections
-live virus vaccines
- warn clients against abrupt discontinuation

Administration
-advise patient that effects of DMARDs are delayed and it may take 3-6 weeks, with full therapeutic effect taking months
-glucocorticoids can be used as oral agents or as intra-articular injections
-short term therapy can be used to control exacerbations of symptoms or while waiting for effects of DMARDs to develop. ]]> 2017-09-08 00:04:21 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726544 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726788 (aka gouty arthritis) Painful type of arthritis that is caused by elevated levels of uric acid, which can accumulate and cause localized inflammation in synovial areas.

Medications commonly used to treat Gout:

Anti-Inflammatory Agents:

Prototype: Colchicine
-once the drug of choice, but now only used to treat patients who do not respond to safer treatments.

Action: decrease inflammation relating to gout

Complications/nursing considerations:
Mild GI distress, which can progress to GI toxicity
( take oral meds with food; take antidiarrheal agents as prescribed; notify provider if distress occurs)

Agents for Hyperuricemia

Prototype: Allopurinol

Action: inhibit uric acid production

Complications:
-fever, rash, kidney and liver damage
( if administering IV, stop infusion- severe reaction can require  hemodialysis or glucocorticoids)
- kidney injury
(encourage 2-3 liters of fluids/daily; monitor I&O, BUN, Creatinine)
-Hepatitis
(monitor liver enzymes)
- GI distress
(administer with food)
- Increase in gout attacks
(instruct pt to report attacks to provider)

Administration:
- monitor uric acid levels, CBC, urinalysis, and liver and kidney function test
-advise patient to take with food or after meals to minimize GI distress
- instruct patients to concurrently take preventive measures, such as avoid alcohol and foods high in purine (red meat, scallops)

Colchicine- oral

Allopurinol- IV ( well diluted and administered over 30-60 minutes)


EBP Journal:
https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/61288/EBPJune2017pE01.pdf?sequence=1]]> 2017-09-08 00:06:39 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726788 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726891 Autoimmune condition that can cause damage to joints, skin, blood vessels, and organs.

Medications commonly used to treat SLE:

Monoclonal Antibody Medication
Prototype: Belimumab

Action: Disrupts activation of B-lymphocytes through interference with BLyS, a protein needed for B-cell activation

Complications/nursing considerations:
- GI Effects (nausea, vomiting, diarrhea)
(advise pt to take natural GI remedies such as ginger, tea, or hard candy)
- Headache, depressed mood
(notify provider immediately if feeling suicidal thoughts)
- Insomnia
(teach pt how to promote adequate sleep- quiet, dark, relaxing bedroom; no eating before bed; no exercising before bed)
-Infusion reaction
(infuse slowing over an hour; medication might be prescribed to minimize reaction)
- Increased risk for infection
(avoid being around sick people; no live vaccines within 30 days of medication; notify provider if fever, painful urination, or bloody diarrhea is present)

Contraindications:
- Pregnancy risk C
- Avoid breastfeeding
- severe renal impairment
- SLE effecting CNS
- caution in older adults
- caution in clients with depression, cardiac disorders, or infections


Administration:
-reconstitute with sterile water, and dilute with only 0.9% normal saline
-refrigerate solution no longer than 8 hours after reconstitution (allow solution to stand in room temp for 10-15 mins prior to use)
-administered via IV infusion, and given slowly over the course of an hour (monitor closely for infusion reactions and hypersensitivity)
-discard unused solution
-no administration of live virus vaccines within 30 days]]> 2017-09-08 00:07:10 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726891 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726952 Syndrome characterized by muscle pain and fatigue.

Medications commonly used to treat Fibromyalgia:

Serotonin-Norepinephrine Reuptake Inhibitors:
Prototypes:
                Duloxetine
                    Milnacipran

Action- Restores balance of neurotransmitters, serotonin, and norepinephrine

Gamma-Aminobutyric Acid Analogue (GABA)
PROTOTYPE: PREGABALIN

Action- binds to alpha-2-delta in CNS tissue

Complications/nursing considerations:
-Drowsiness, dizziness, blurred vison
(instruct patient not to drive or operate heavy machinery; change positions slowly, fall prevention strategies)
- Nausea, anorexia, weight loss
(monitor weight and food intake)
- headache, insomnia, anxiety
- Withdrawal syndrome -"headaches, nausea, visual disturbances, anxiety, dizziness, tremors"
(instruct pt to withdrawal from med gradually)
-Sexual dysfunction
(report sexual dysfunction to provider)
(GABA)- increased appetite, weight gain, constipation, abdominal pain  (patient teaching on ways to prevent weight gain)
-Rhabdomyolysis (acute onset of  severe muscle weakness and tenderness with elevation in serum creatinine kinase)
-(notify provider immediately)


Contraindications:

-Pregnancy Risk C
- hepatic or renal impairment
-MAOI within 14 days
-caution with patients with cardiac problems, hypertension, diabetes, GI disorders, and glaucoma

Administration:
-orally, no regard to food; swallow whole; taper withdrawal gradually over 2 weeks



]]> 2017-09-08 00:07:45 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/185726952 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/185730563 https://youtu.be/jgx8dIyP67g

Actemra:
https://www.youtube.com/watch?v=YaARULpYzis

https://www.youtube.com/watch?v=Bk5uyjPXMlo

]]> 2017-09-08 00:34:20 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/185730563 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/186842317 https://padlet.com/amy_stein/m495vuhpwp88

]]> 2017-09-12 15:53:14 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/186842317 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/186925891 2017-09-12 18:34:33 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/186925891 knewton5952 https://padlet.com/knewton5952/sgsyymmki3c0/wish/186931782

]]> 2017-09-12 18:45:22 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/186931782 amy_stein https://padlet.com/knewton5952/sgsyymmki3c0/wish/186936013 2017-09-12 18:53:32 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/186936013 amy_stein https://padlet.com/knewton5952/sgsyymmki3c0/wish/186937368 https://www.uptodate.com/contents/rituximab-and-other-b-cell-targeted-therapies-for-rheumatoid-arthritis]]> 2017-09-12 18:56:47 UTC https://padlet.com/knewton5952/sgsyymmki3c0/wish/186937368