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5 Cards in this Set
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Prednisone
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Sterapred (anti inflammatories steroidal
(intermediate acting) immune modifiers) Therapeutic Effect: Suppression of inflammation and modification of the normal immune response Action: • In pharmacologic doses, suppresses inflammation and the normal immune response • Has numerous intense metabolic effects (see Adverse Reactions and Side Effects) • Suppresses adrenal function at chronic doses of 5 mg/day • Replaces endogenous cortisol in deficiency states • Has minimal mineralocorticoid activity Common SE: depression,euphoria ,hypertension ,anorexia, nausea,↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, muscle wasting, osteoporosis, cushingoid appearance (moon face, buffalo hump) RN Considerations: • Indicated for many conditions. Assess involved systems before and periodically during therapy • Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy • Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur • Pedi: Children should have periodic evaluations of growth Lab Test Considerations • Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged courses of therapy should routinely have hematologic values, serum electrolytes, and serum and urine glucose evaluated. May decrease WBC counts. May ↓ serum potassium and calcium and ↑ serum sodium concentrations » Guaiac-test stools. Promptly report presence of guaiac-positive stools » May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I » Suppress reactions to allergy skin tests |
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Hydroxychloroquine
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Plaquenil (antimalarials, antirheumatics)
Therapeutic Effect: • Death of plasmodia responsible for causing malaria • Also has anti-inflammatory properties Action: Inhibits protein synthesis in susceptible organisms by inhibiting DNA and RNA polymerase Common SE: (non listed as common) LIFE THREATENING SEIZURES,AGRANULOCYTOSIS, APLASTIC ANEMIA RN Considerations: • Assess deep tendon reflexes periodically to determine muscle weakness. Therapy may be discontinued should this occur » Patients on prolonged high-dose therapy should have eye exams prior to and every 3–6 mo during therapy to detect retinal damage Malaria or Lupus Erythematosus • Assess patient for improvement in signs and symptoms of condition daily throughout course of therapy Rheumatoid Arthritis • Assess patient monthly for pain, swelling, and range of motion Lab Test Considerations • Monitor CBC and platelet count periodically throughout therapy. May cause decreased RBC, WBC, and platelet counts. If severe decreases occur that are not related to the disease process, hydroxychloroquine should be discontinued |
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Azathioprine
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Azasan, Imuran (immunosuppressants)
Therapeutic Effect: Suppression of cell-mediated immunity and altered antibody formation Action: Antagonizes purine metabolism with subsequent inhibition of DNA and RNA synthesis Common SE: anorexia, hepatotoxicity, nausea, vomiting, anemia, leukopenia, pancytopenia, thrombocytopenia, chills, fever RN Considerations: • Assess for infection (vital signs, sputum, urine, stool, WBC) during therapy » Monitor intake and output and daily weight. Decreased urine output may lead to toxicity with this medication Rheumatoid Arthritis • Assess range of motion; degree of swelling, pain, and strength in affected joints; and ability to perform activities of daily living before and periodically during therapy Lab Test Considerations • Monitor renal, hepatic, and hematologic functions before beginning therapy, weekly during the 1st mo, bimonthly for the next 2–3 mo, and monthly thereafter » Leukocyte count of <3000 or platelet count of <100,000/mm3 may necessitate a reduction in dose or temporary discontinuation » A ↓ in hemoglobin may indicate bone marrow suppression » Hepatotoxicity may be manifested by ↑ alkaline phosphatase, bilirubin, AST, ALT, and amylase concentrations. Usually occurs within 6 mo of transplant, rarely with rheumatoid arthritis, and is reversible on discontinuation of azathioprine » May ↓ serum and urine uric acid and plasma albumin |
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Etanercept
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Enbrel (antirheumatics)
Therapeutic Effect: Decreased inflammation and slowed progression of arthritis, spondylitis or psoriasis Action: Binds to tumor necrosis factor (TNF), making it inactive. TNF is a mediator of inflammatory response Common SE: headache, upper respiratory tract infection, injection site reactions RN Considerations: • Assess range of motion, degree of swelling, and pain in affected joints before and periodically during therapy • Assess patient for injection site reaction (erythema, pain, itching, swelling). Reactions are usually mild to moderate and last 3–5 days after injection • Monitor patients who develop a new infection while taking etanercept closely. Discontinue therapy in patients who develop a serious infection or sepsis. Do not initiate therapy in patients with active infections • Assess for signs and symptoms of systemic fungal infections (fever, malaise, weight loss, sweats, cough, dypsnea, pulmonary infiltrates, serious systemic illness with or without concomitant shock). Ascertain if patient lives in or has traveled to areas of endemic mycoses. Consider empiric antifungal treatment for patients at risk of histoplasmosis and other invasive fungal infections until the pathogens are identified. Consult with an infectious diseases specialist. Consider stopping etanercept until the infection has been diagnosed and adequately treated Lab Test Considerations » Monitor CBC with differential periodically during therapy. May cause leukopenia, neutropenia, thrombocytopenia, and pancytopenia. Discontinue etanerceptif symptoms of blood dyscrasias (persistent fever) occur |
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ibandronate
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Boniva (bone resorption inhibitor/biphosphonate)
Therapeutic Effect: Reversal/prevention of progression of osteoporosis with decreased fractures Action: Inhibits resorption of bone by inhibiting ostoclast activity, Common SE: diarrhea, dyspepsia, musculoskeletal pain, pain in arms/legs RN Considerations: Osteoporosis • Assess patients for low bone mass before and periodically during therapy Lab Test Considerations • Assess serum calcium before and periodically during therapy. Hypocalcemia and vitamin D deficiency should be treated before initiating ibandronate therapy » May cause ↓ total alkaline phosphatase levels » May cause hypercholesterolemia |
