Sie sind auf Seite 1von 5

Methotrexate (Rheumatrex)

classified as a folate antimetabolite, antineoplastic, immunosuppressant drug to treat various


malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) to treat
rheumatoid arthritis and psoriasis.
The major adverse effects associated with methotrexate include bone marrow suppression,
hepatotoxicity, congenital abnormalities, and fetal death.
at risk for infection.  They should avoid crowded places and individuals with known infection and
should receive appropriate killed (inactivated) vaccines (eg, influenza, pneumococcal).  Live
vaccines (eg, herpes zoster) are contraindicated.
should not become pregnant while taking methotrexate or for at least 3 months after it is
discontinued as the drug is teratogenic and can cause congenital abnormalities and fetal death.
Avoid alcohol as the prescription drug is hepatotoxic and drinking alcohol increases the risk for
hepatotoxicity.

Immune thrombocytopenic purpura (ITP)


an autoimmune condition in which antibodies bind to and cause destruction of platelets.  Clients
with ITP have a platelet count <150,000/mm  are at increased risk of bleeding.
3

Key teaching to reduce the client's risk of bleeding includes:


 Use soft-bristle toothbrushes, gentle flossing, and nonalcoholic mouthwashes.  These
prevent periodontal disease and gingival bleeding
 Avoid activities that may cause trauma (eg, high-intensity sports).  Appropriate exercise
includes low-impact activity (eg, walking) while wearing nonskid footwear to help
prevent falls 
 Take prescribed stool softeners and laxatives as needed.  These medications prevent hard
stools and straining, which can cause anorectal fissuring, bleeding, and hemorrhoids 
Clients with ITP should use electric razors instead of safety or straight razors.  Electric razors
have a more complete guard, reducing the risk of accidentally nicking the skin.
Clients with ITP should avoid nonsteroidal anti-inflammatory drugs (eg, aspirin, ibuprofen,
ketorolac), which further impair platelet function.  Acetaminophen and opiates are better options
for pain management.

Sulfasalazine (Azulfidine)
sulfonamide (salicylate and sulfa antibiotic) and nonbiologic disease-modifying antirheumatic
drug (DMARD) used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and
inflammatory bowel disease (eg, ulcerative colitis).  It inhibits the production of prostaglandin, a
mediator in the body's inflammatory response.
Most "sulfa" medications (eg, trimethoprim, sulfamethoxazole) share common side effects,
including:
1. Crystalluria causing kidney injury – client should drink 8 glasses of water daily to
maintain adequate urine output (eg, 1200-1500 mL/day)
2. Photosensitivity and risk for sunburn – client should avoid sun exposure and apply
sunscreen
3. Folic acid deficiency (megaloblastic anemia and stomatitis) – client should eat folate-rich
foods and take 1 mg/day folic acid supplement
4. Rarely life-threatening agranulocytosis (leukopenia) – client should be monitored for
complete blood count at the start of therapy and report fever or sore throat immediately
5. Stevens-Johnson syndrome – client should stop the medicine if rash develops
Ulcerative colitis is characterized by bloody diarrhea, and the medication is taken to reduce this
effect.
Urine and skin can turn an orange-yellow color but will return to normal when the drug is
discontinued.  This is an expected finding.
Hydroxychloroquine (Plaquenil)
an antimalarial drug, but it is more commonly prescribed to reduce fatigue and treat the skin and
arthritic (eg, joint inflammation, pain) manifestations of systemic lupus erythematosus (SLE). 
Hydroxychloroquine can also help to reduce lupus exacerbations in clients with inactive to mild
disease, but several months can pass before its therapeutic effects become apparent.
Although rare, serious adverse drug reactions such as retinal toxicity and visual disturbances can
occur with hydroxychloroquine.  Therefore, clients are instructed to undergo
regular ophthalmologic examination every 6-12 months
Should be taken with food to decrease gastrointestinal upset (common side effect)
Some clients with severe SLE are prescribed long-term corticosteroid (prednisone) therapy to
prevent organ damage and are at risk for adverse reactions, such as accelerated osteoporosis. 
Osteoporosis is not an adverse reaction of hydroxychloroquine, and vitamin D and calcium
supplementation is not required

Anaphylactic shock
has an acute onset, and manifestations usually develop quickly (20-30 minutes).  Circulatory
failure and respiratory manifestations, including laryngeal edema (from inflammation) and
bronchoconstriction (primarily from release of histamine), can lead to cardiac/respiratory arrest.
Symptoms of an anaphylactic reaction include signs of respiratory compromise (eg, oral and
airway swelling, stridor, wheezing, chest tightness) and shock (eg, dizziness, loss of
consciousness).
The management of anaphylactic shock includes:
1. Ensure patent airway, administer oxygen
2. Remove insect stinger if present
3. IM epinephrine is the drug of choice and should be given to this client.  Epinephrine
stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle
(beta 2) and provides vasoconstriction (alpha 1).  The IM route (mid anterior lateral
thigh) is better than the subcutaneous route.  Repeat dose every 5-15 minutes.
4. Place in recumbent position and elevate legs
5. Maintain blood pressure with IV fluids, volume expanders or vasopressors
6. Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small
airways and reverse bronchoconstriction
7. Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction
and relieve pruritus
8. Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway
inflammation and swelling associated with the allergic reaction
9. Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema
Anaphylaxis
 Food (eg, nuts, shellfish)
Triggers  Medications (eg, β-lactam antibiotics)
 Insect stings
 Cardiovascular
o Vasodilation → hypotension & tissue edema
o Tachycardia
 Respiratory
Clinical o Upper airway edema → stridor & hoarseness
manifestations o Bronchospasm → wheezing
 Cutaneous
o Urticarial rash, pruritus, flushing
 Gastrointestinal
o Nausea, vomiting, abdominal pain

 Intramuscular epinephrine
Treatment  Airway management & volume resuscitation
 Adjunctive therapy (eg, antihistamines, glucocorticoids)

Sjögren's syndrome
a chronic autoimmune disorder in which moisture-producing exocrine glands of the body are
attacked by white blood cells.  The most commonly affected glands are the salivary and lacrimal
glands, leading to dry eyes (xerophthalmia) and dry mouth(xerostomia).  Dryness in these areas
can lead to corneal ulcerations, dental caries, and oral thrush.  Other areas that can be affected and
their symptoms include:
 Skin - dry skin and rashes
 Throat and bronchi - chronic dry cough
 Vagina - vaginal dryness and painful intercourse
Treatment is focused on alleviating symptoms as there is currently no cure for Sjögren's
syndrome.  Over-the-counter or prescribed drops are used to relieve itching, burning, dryness, and
gritty sensation in the eyes.  Wearing goggles may offer further protection from drying caused by
the wind.  Dry mouth is treated with sugarless gum and candy or artificial saliva.  Regular dental
appointments to prevent dental caries are recommended.  Lubricants (eg, K-Y Jelly) help to ease
vaginal dryness.  Use of lukewarm water and mild soap when showering can prevent dry skin. 
Avoiding low-humidity environments (eg, centrally heated houses, airplanes) and using
humidifiers to maintain adequate humidity (mainly at night) are also recommended.
avoid decongestants as they cause further dryness to the mouth and nasal mucosa.  These clients
should also avoid oral irritants (eg, coffee, alcohol, nicotine) and acidic drinks (eg, carbonated
beverages, juices) and instead sip water frequently.

Tuberculosis
an infection caused by the Mycobacterium tuberculosis microorganism.  A client with active,
primary TB disease has a positive tuberculin skin test (TST), usually feels sick, has symptoms,
and can spread the disease to others if not treated with medications.  A client with a latent
TB infection (LTBI) has a positive TST, negative chest x-ray, is asymptomatic, cannot transmit
the disease to others, and can complete a full course of treatment to prevent activation of the
disease.
Malignancy, immunosuppressant medications, including chemotherapy, and prolonged
debilitating disease (eg, HIV), can convert LTBI to active disease.

Systemic lupus erythematosus (SLE)


an autoimmune disorder (the body's immune system erroneously attacks body tissues) that results
in inflammation and damage to many body parts.  Symptoms vary widely among affected
individuals, but most experience painful/swollen joints, extreme fatigue, skin rashes, and kidney
problems. The characteristic cutaneous manifestation of SLE is a flat or raised red rash that forms
a butterfly shape across the bridge of the nose and cheeks. The symptoms typically appear for
periods of time (called flares) alternating with periods of remission.
There is no cure for SLE, but it can be treated with immunosuppressants (eg, corticosteroids) or
immunomodulators (eg, hydroxychloroquine).  Pneumonia and annual influenza vaccinations are
recommended for those with SLE as they are more susceptible to infections.  These individuals
should avoid contact with sick people and report fever to their health care provider.
Both physical and emotional stress can exacerbate SLE.  Therefore, clients should follow a
healthy lifestyle (eg, 7-8 hours of sleep, no smoking).  Balanced exercise with alternating periods
of rest is recommended.
Sunlight is known to worsen the rash of SLE and should be avoided when possible (especially
between 10 AM-4 PM); protective clothing and sunscreen application are recommended during
periods of sun exposure
The rash of SLE should be cleansed only with mild soap.  Harsh soap and chemicals should be
avoided.  The rash is not due to bacterial infection.
Increased creatinine (normal 0.6-1.3 mg/dL), increased blood urea nitrogen (normal 6-20 mg/dL),
and an abnormal urinalysis (eg, protein, red blood cells, cellular casts) can indicate the presence
of lupus nephritis (occurring in 50%), a potentially serious complication of SLE.  Early
recognition and aggressive immunosuppressive treatment are essential to preserve renal function
and prevent irreversible kidney damage 

Fibromyalgia (FM)
Results from abnormal central nervous system pain transmission and processing.  It is
characterized by chronic, bilateral musculoskeletal axial pain (above and below the
waist), multiple tender points, fatigue, and sleep/cognitive disturbances.
Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor that has both
antidepressant and pain-relieving effects.  It is used to relieve chronic pain that interferes with
normal sleep patterns in clients with FM.  With the restoration of normal sleep patterns, fatigue
often improves as well.  Other effective drugs to treat the chronic pain associated with FM
include pregabalin and amitriptyline (Elavil), an older tricyclic antidepressant drug.

Lyme disease
develops after a bite from a tick infected with Borrelia burgdorferi.  Initial symptoms are flu-like
(eg, headache, fever, myalgia, fatigue).  Many clients develop a bull's-eye rash; however, it is not
always present.  Any of these symptoms should be reported immediately to a health care provider
The client will likely be prescribed antibiotics (eg, doxycycline, amoxicillin) to treat Lyme
disease and prevent it from spreading to other organs (eg, heart, brain, joints)
Clients are taught to prevent tick bites by avoiding tall grass and wooded areas and to hike in the
center of the trail only. Clients should use insect repellent and wear long pants tucked into boots
or closed-toed shoes.
promptly and properly remove a tick using tweezers, being careful to grasp the tick close to the
attachment site and not to crush it during removal.
more visible on light-colored clothing
Bumetanide
A potent loop diuretic (eg, furosemide, torsemide) used to treat edema associated with heart
failure and liver and renal disease.  The diuretic inhibits reabsorption of sodium and water from
the tubules and promotes renal excretion of water and potassium.

Isoniazid
First-line antitubercular drug used to treat latent or active tuberculosis.
increased liver function tests (eg, alanine aminotransferase, aspartate aminotransferase) can
indicate development of drug-induced hepatitis

Calcium acetate (PhosLo)


Phosphate binder used to treat hyperphosphatemia (normal phosphorous: 2.4-4.4 mg/dL ) in
clients with chronic kidney disease.  Calcium acetate lowers the serum phosphorous level by
binding to dietary phosphate and excreting it in feces.

Carvedilol (Coreg)
a beta blocker used to improve cardiac output and slow the progression of heart failure.

Metronidazole (Flagyl)
The first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile. 
Leukocytosis is expected with this bacterial infection.

**  frequent eye examinations are required for clients prescribed the nonbiologic antimalarial
DMARD hydroxychloroquine (Plaquenil) as it can cause retinal damage.
** Lansoprazole (Prevacid) is a proton pump inhibitor used to treat ulcer disease, erosive
esophagitis, and gastroesophageal reflux disease.
** Metronidazole (Flagyl) is an antimicrobial medication used to treat IBD
**  Sulfasalazine (Azulfidine) is a gastrointestinal anti-inflammatory medication used to treat
IBD
** Clients with infection should not take tumor necrosis factor (TNF) inhibitors (eg, infliximab,
adalimumab, etanercept) as these suppress the immune response.  Before starting drug therapy,
clients should be tested for tuberculosis and receive the inactivated (injectable) influenza
vaccine.  Clients taking TNF inhibitors should avoid live vaccines.

Sodium polystyrene sulfonate (Kayexalate)


retention enema is a medicated enema administered to clients with high serum potassium levels.
The resin in Kayexalate replaces sodium ions for potassium ions in the large intestine and
promotes evacuation of potassium-rich waste from the body, thereby lowering the serum
potassium level. Kayexalate can also be given orally and is much more effective. Kayexalate can
rarely be associated with intestinal necrosis.

Das könnte Ihnen auch gefallen