Joint and bone meds part 1

rheumatoid arthritis (RA)

chronic disorder with autoimmune and inflammatory components

RA medications

provide symptomatic relief and some delay in the progression of the disorder

RA different categories of meds that can be used alone or in combination

- disease modifying antiheumatic meds (DMARDs)

- glucocorticoids

- immunosuppressants

- NSAIDs

RA affects

- joints

- causes joint deformity

- can occur at any age but mostly people over 60

RA pain typically worse

after resting

RA cause

- unknown cause

- usually genetic

DMARDs I

Methotrexate

glucocorticoids

prednisone

methotrexate administered

- PO

- SQ

- IM

- Parenterally

- intrathecally

methotrexate MOA

- acts to diminish immune response

- interferes w folic acid metabolism

- results in inhibition of DNA synthesis + cell reproduction

- slows joint degeneration + progression of RA

methotrexate uses

- slow/delay the worsening of disease

- maintenance of joint function

- management of inflammatory bowel disease

methotrexate complications

- inc risk of infection

- hepatic fibrosis

- bone marrow suppression

- ulcerative stomatitis

- dizziness

- nausea & vomiting

- headaches

methotrexate contraindications

- pregnancy

- liver failure

- alcohol disorder

- blood dycrasias

- use w caution in children

methotrexate Drug-Drug Interactions

- salicylates

- other NSAIDs

- sulfonamides

- PCN

- tetracycline

- echinacea

- folic acid

methotrexate client education

- 3-6 weeks feel any effects

- can take several months to achieve full therapeutic effect

- drink 2-3 L of fluid daily can cause renal toxicity

- good oral hygiene

methotrexate nurse monitor

- looks for signs of infection + fever

- monitor H+H, WBCs, + liver labs

- monitor GI bleeding

- ALT/AST enzymes, Jaundice

- bun/creatine kidney function

- I+O

prednisone MOA

- suppresses inflammation & the normal immune response

- symptomatic relief of inflammation & pain

- delay of disease progression

prednisone uses

- slow/delay the worsening of the disease

- short term therapy until long acting DMARDs

- prevention of organ rejection

- management of inflammatory bowel disease

prednisone complications

- risk of infection

- osteoporosis

- adrenal suppression

- fluid retention

- GI discomfort

- hyperglycemia

- hypokalemia

prednisone drug/drug interactions

- diuretics as they promote potassium loss

- digoxin

- NSAIDs

- use extreme caution if client

prednisone nursing education

- can be taken PO or intra-articular (a joint injection)

- take Ca supplements & vitamin D

- must not stop med abruptly

prednisone nursing interventions

- monitor blood glucose levels

- monitor WBCs & H/H levels

- monitor for fluid retention

- monitor for output (BUN & creatinine)

Gout

specific form of acute arthritis

Hyperuricema occurs because of

inc production of uric acid or as result of dec excretion of uric acids by kidneys

gout develops when

serum uric acid is above 6 mg/dL

gout causes

severe attacks of pain and redness, most often big toe

gout can be brought on by

- alcohol or drug use

- foods high in purine

gout early attack generally get better

within 3-10 days

gout occurs more often in

overweight men

medication to treat gout

- anti inflammatory agents

- NSAIDS

- glucocorticoids

- agents of hyperuricemia

anti inflammatory agents

Colchicine

glucocorticoids gout

prednisone

Colchicine therapeutic use

- abort acute gout

- treatment of gout attacks after its already developed to reduce inflammation

Colchicine usually taken along w

NSAIDs for better pain control

Colchicine administered

PO

Colchicine MOA

- dec inflammation caused by gout

- interferes w WBCs = dec inflammation

Colchicine complications

- Mild GI distress, which can progress to GI toxicity

- Thrombocytopenia, suppressed bone marrow

- Rhabdomyolysis

Rhabdomyolysis

- muscle breakdown

- results in death of muscle fiber can lead to kidney failure

- coca cola urine

Colchicine contraindications/precautions

- severe renal, cardiac, hepatic, GI dysfunction

- caution in clients who have blood disorders

- mild to moderate hepatic dysfunction

Colchicine drug to drug interactions

- avoid alcohol (will inc side effects)

- grapefruit juice

Colchicine education

- take with food

- no purine

- inc fluid intake bc of inc kidney dysfunction risk

- adequate weight + exercise

purine foods

- red organ meats (liver)

- shellfish

- alcohol

- soft drinks

- fish

- salmon

Colchicine nursing interventions

- monitor for infection d/t bone marrow suppression

- s/s of bleeding

- onset of muscle pain (potentially rhabdomyolysis)

- renal failure

- monitor lab values (CBC, UA, LFT, BUN, creatinine)

Allopurinol administered

- PO

- IV

Allopurinol theraputic use

- prevention of gout

- treatment of chronic gout attacks

hyperuricemia d/t

chronic gout or secondary to cancer chemotherapy

Allopurinol MOA

inhibits uric acid production

Allopurinol complications

- steven johnson rash

- fever

- kidney & liver damage

- hepatitis

- inc in gout attack

- GI upset

Allopurinol inc in gout attacks

- during first few months

- can take colchicine or NSAIDs to prevent

Allopurinol contraindications/precautions

- Idiopathic hemochromatosis

- A hereditary disease characterized by progressive

iron overload

Allopurinol drug-drug interactions

warfarin (inc risk of bleeding)

Allopurinol education

- if administered IV: dilute and administer 30-60 mins

- advise to use soft bristled toothbrush & electric razors to prevent bleeding

Allopurinol nursing interventions

- ensure adequate fluid intake to avoid uric acid from crystalizing

- monitor output and input

- monitor lab values: INR, PT, BUN, creatinine, ALT/AST

Hyperuricemia (high uric acid) males

7 mg/dL

Hyperuricemia (high uric acid) females

6 mg/dL

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