ANTIREUMATIC DRUGS- Rheumatoid Arthritis o Autoimmune disorder causing inflammation and tissue damage in jointso Diagnosis primarily symptomatico Treatment NSAIDs  Glucocorticoids  Disease-modifying antirheumatic drugs (DMARDs)- Goal of Treatment o Alleviate current symptomso Prevent further damage of the joints - Disease-Modifying Antirheumatic Drugs (DMARDs) o Modify the disease of rheumatoid arthritiso Exhibit antiinflammatory, antiarthritic, and immunomodulating effects o Inhibit the movement of various cells into an inflamed, damaged area, such as a jointo Slow onset of action of several weeks, versus minutes to hours for NSAIDs Give with NSAIDs at firsto Also referred to as slow-acting antirheumatic drugs (SAARDs) - Nursing Implications o Thorough history and physical Note joint damage! Pain scale!o Assess for conditions that may be contraindicationso Assess baseline blood counts, cardiac function, and liver function studieso Assess for presence of infection prior to any injection! Bacterial, herpes, active and latent tuberculosis- Nursing Implications o Monitor for gastrointestinal bleeding or jaundice ? symptomso Monitor for symptoms of pulmonary fibrosis Respiratory distress and decreased oxygenationo Monitor for symptoms of heart failure Cough, shortness of breath, elevated blood pressure and heart rate, pink sputumo Give TB skin test - Patient Teaching Pointso Drink 8-12 glasses of water dailyo Report symptoms of adverse effects Yellowing of skin/eyes Fatigue, shortness of breath Fever (100.5° or higher), achiness, sore throat, petechiae  Skin Rash Injection site reaction that doesn’t get better in a few days- Patient Teaching Points  Avoid pregnancy during treatment and for six months after completing therapy with methotrexate!- Nursing Implications: Evaluation o Monitor  Reduction in pain More mobility in joints Overall increased sense of improvement and well-being Symptom control during periods of emotional stress OSTEOPORISIS- Osteoporosis o Low bone masso Increased risk of fractureso Primarily affects womeno 20% with this condition are men- Drug Therapy for Prevention of Osteoporosis o Calcium supplements and vitamin D may be recommended for women at high risk for osteoporosiso Current recommendations are that women, especially those older than age 60, consider taking calcium and vitamin D supplements for bone health- Nursing Implications - Assess baseline vital signs, weight, blood glucose levels, renal and liver function studies - Assess whether the patient smokes- Assess history and medication history- Assess contraindications, including potential pregnancy- For bisphosphonates, ensure that patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose; assess for muscle orjoint pain; and monitor for changes in vision- For SERMs, assess for symptoms of pulmonary emboli or DVT- For calcitonin, monitor for ulceration in nostrils if using intranasal calcitonin - For calcium supplements, Monitor for signs of hypercalcemia and kidney stones- Patient Teaching Points o Bisphosphonates  Instruct patients to take medication upon rising in the morning, with a full glass of water, and 30 minutes before eating Emphasize that patients should sit upright for at least 30 minutes after taking the medication No eating/drinking for 30 minutes after taking drugo SERMs Instruct patients that the medication will need to be discontinued 72 hours before and during any prolonged immobility (such as surgery or a long trip) Consume adequate amounts of calcium and vitamin Do calcitonin (Calcamar) Consume adequate amounts of calcium and vitamin Do Calcium Supplements Signs/symptoms of hypercalcemia  Encourage high fiber diet Take calcium supplements 1 hour or 2 hours after glucocorticoids, synthroid, tetracycline Take antacids 1 hour after meals – no more than 600mg at a time- Nursing Implications: Evaluation o Monitor for signs of therapeutic response Increased bone density Prevention or management of osteoporosiso Monitor for signs of adverse reactions for each of the drug types CNS Part 1- CNS Depressants o Drugs are classified as a sedative or hypnotic based on degree it depresses CNSo Sedatives: calms patient down without causing sleep; large doses will cause sleepo Hypnotics: cause sleep and more potento Sedative-Hypnotics: drugs that can act as either sedative or hypnotic depending on dose and how patient responds - First Step Treatment of Sleeplessness o NON-PHARMACOLOGICAL Quiet environment Warm milk or tea Shower or bath Reading Massage Be aware of cultural preferences - Nursing Assessment o ALLERGIES/CONTRAINDICATIONS AND PRECAUTIONSo For any CNS depressant drugo Sleep Diary (page 201 text)o Baseline vitals and physical assessmento Changes in mental status, memoryo Herbal useo Other medicationso Diet - Nursing Interventions o Give hypnotics 30 to 60 minutes before bedtime for maximum effectiveness in inducing sleep (depends on drug’s onset)o Make sure patient has 8 hours available for sleep o Most benzodiazepines cause REM rebound and a tired feeling the next day; use with caution in the elderlyo Instruct patients to avoid alcohol and other CNS depressantso Instruct patients not to drive if feel drowsy - Nursing Interventions o Safety is importanto Keep side rails up or use bed alarmso Do not permit smoking (also interfers with benzodiazepine’s absorption)o Assist patient with ambulation (especially the elderly)o Keep call light within reacho Monitor for adverse effects & toxicityo Ataxia, uncoordinated muscle movements - Nursing Interventions o Monitor for therapeutic effectso Increased ability to sleep at nighto Fewer awakeningso Shorter sleep-induction timeo Improved sense of well-being because of improved sleepo For muscle relaxants:o Decreased spasticity, decreased rigidityANTIUPLILEPTIC (anticonvulsant)- Epilepsy- Syndrome of CNS dysfunction that can cause symptoms ranging from momentary sensory disturbance to convulsive seizures- Seizure: Brief episode of abnormal electrical activity in nerve cells of the brain- Convulsion: Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles- Epilepsy: Chronic, recurrent pattern of seizures- Classification of Seizures o