Rheumatoid Arthritis Flashcards
What is a chronic inflammatory disorder affecting many joints including those in the hands/feet?
Rheumatoid arthritis
What are the hallmark signs of RA?
Bilateral pain and stiffness/tenderness that’s worse in morning and persists for 1hr+,
Important diagnostic tests?
ESR, C-reactive protein, WBC and rheumatoid factor
What’s the diff b/t RA and osteoarthritis?
RA is autoimmune and progressive to other joints
Who is consulted for exercise to keep joints moving early to prevent further progression?
PT/OT
DMARDs can cause what? And what should you not mix them w/?
Birth defects or hepatoxicity; Aspirin/alcohol
What NSAID is often used in RA? and dosing?
Celebex 100mg PO BID
What DMARD is often used in RA? and dosing?
Methotrexate 7.5mg PO weekly for 1st 3mon then increase to 10mg weekly
What should you look out for in Celebrex?
Can cause heart/weight/stroke issues, watch out for chest pain/SOB
What should you look out for in Methotrexate?
Thrombocytopenia- PLT, excess bruise/bleed
When should NSAID/DMARD be contraindicated?
Pregnancy, liver disorder or history of ulcers/ulcerative colitis
Pain, impaired mobility, fatigue, and stress, are all what?
Diagnosis
What is important to teach in a pt receiving Remicade?
Need to get @ infusion center, is a biologic response modifier so can cause severe infections
To avoid an anaphylactic reaction from a Remicade infusion what should you give prior to?
Benadryl/tylenol
What 2 NSAIDs are usually used in combo for inflammation/pain in RA?
Celebrex/Aspirin
What are common side effects of NSAIDs?
GI effects: bleed, ulcers, erosions and stomach lining irritation, so take w/ food
What can reduce the risk of GI bleed when taking NSAIDs?
Proton pump inhibitors: Protonix, Nexium, Prevacid, Cytotec
Complications of NSAIDs?
Nephrotoxicity, hepatoxicit and BP alterations causing cardiovascular disorders
What corticosteroids are often used for inflammation/pain in RA?
Prednisone, methylprednisone or triamcinolone
What are some things to consider when taking corticosteroids?
Associated w/ poor wound healing, increased risk for infections, osteoporosis, GI bleed, wt. gain and cushingoid effects, don’t stop abrupt, take accu checks
What meds are continued w/ Disease-Modifying Antirheumatic Drugs (DMARDs) bc of their anti-inflammatory effect being minimal?
NSAIDs
What are the diff types of drugs used in DMARD therapy?
Immunosuppressants, sulfasalazine, antimalarials, Tumor Necrosis Factor (TNF) inhibitors and gold salts
What type of immunosuppressives are used?
Methotrexate, Cyclophophamide, azathioprine and monoclonal antibodies
What are frequent side effects of methotrexate?
Gastric irritation and stomatitis; can be controlled w/ folic acid @ same time
Nursing consideratiosn for Immunosuppressives?
Monitor CBC, PLT, kidney and LFT, be alert for thrombocytopenia: unusual bleed/bruise
Pt teaching for Methotrexate?
Avoid folate can alter effects and use contraception during and for 3mon following therapy
Nursing considerations for sulfasalazine?
(Azulfidine) Monitor CBC and LFT
Nursing considerations for antimalarials?
(Chloroquine/hydroxychloroquine (Plaquenil)) Monitor for visual changes/weakness, CBC and admin med w/ food or milk to reduce GI effects
Nursing considerations for TNF?
Etanercept (Enbrel), Remicade (Inflixumab) Adalimumab (Humira) Monitor for infections
Nursing considerations for gold salts?
Monitor for hypersensitivity, CBC and urinalysis for toxicity; contraindicated in pts w/ renal disease, hepatic dysfunction, CHF and DM
