NURS 306 Lecture Notes - Lecture 5: Rheumatoid Arthritis, Hydroxychloroquine, Methotrexate
Document Summary
Nondrug measures: balance between rest and exercise, massage, warm baths, heat to affected extremities. Drug therapy: nsaids, glucocorticoids, disease modifying antiehrumatic drugs (dmards) Nsaids and glucocorticoids for management of symptoms until dmards take effect and for flares. Dmards- biologic & nonbiologic, slow progression: nonbiologic: Methotrexate (immunosuppressant) reduces activity of t & b lymphocytes toxicities: hepatic fibrosis, bone marrow suppression, gi ulceration, pneumonitis sulfasalazine anti-inflammatory and immunomodulatory actions adverse reactions: n/v/d, anorexiea, abdominal pain, hepatitis, bone marrow suppression. Plaquenil early use improves long term outcome combined with methotrexate take with food or milk. Most serious toxicity= retinal damage (pre eye exam & every 6 mos. ) Tnf starts the inflammatory process in the joint. Enbrel: adverse effects: injection site reactions, serious infections, severe allergic reactions, heart failure, hematologic disorders, cancer, liver injury, cns demyeliating disorders, interactions: live vaccines, immunosuppressant drugs. Gout: recurrent inflammatory disorder seen mostly in men. Nsaids= first choice: indomethacin, naproxen, diclofene glucocorticoids.
