CTDs

 Drugs  –  CH  20  

DRUG   DOSE   USE   S/E   IMPLICATIONS  
Acetaminophen/   <  4000   APA   -­‐Risk  for   -­‐Remind  patients  
Tylenol   mg/da recommends   liver   to  read  labels  of  
y   this  as  the   damage  if   OTC  drugs  that  
primary  drug   dose  >  4000   could  contain  
of  choice    for   mg,  have   acetaminophen  
pain  relief.   alcoholism  or   before  taking  
have  liver   them.  
disease.       -­‐Teach  that  liver  
-­‐Older  adults   enzymes  will  be  
particularly   monitored  while  
at  risk  due  to   taking  this  drug  
changes  of  
aging  
(slowed  
excretion  of  
drug  
metabolites).  
Lidocaine  5%  patches     Temporary   -­‐Skin   -­‐Apply  patch  on  
relief  of  joint   irritation.   clean,  intact  skin  
pain.   for  12  hours  each  
day.  
-­‐Can  apply  up  to  3  
patches  to  painful  
joints  at  one  time.  
 
Topical  Salicylate     Useful  for      
-­‐-­‐OTC     some  as  
Aspercreme   temporary  
  pain  reliever  
  (esp.  knee  
-­‐-­‐prescription   pain)  
1%    diclofenac    
sodium/Voltaren  
NSAIDS   Depend   Used  if  topical   -­‐Thought  to   -­‐Baseline  labs  
-­‐-­‐1st  choice     on   agents  or   cause  cardio-­‐ obtained  (CBC,  
Used  unless  patient  has   which   acetaminophe vascular   kidney  &  liver  
HTN,  renal  dz  or  cardio-­‐ drug  is   n  does  not   disease,  MI   function  tests)  
vascular  dz   being   relieve  pain   and  may  be   -­‐Teach  about  
Cant  be  given  to  those   used.   only  if  pt  can   unavailable   adverse  effects  
with  recent  open  heart   tolerate    them     in  the  future   and  the  need  to  
surgery.     -­‐dark  tarry   report  them  to  
Celecoxib/     Relieves   stools,  SOB,     HCP    
Celebrex    (COX-­‐2   chronic  pain   dyspepsia/   -­‐Observe  for  fluid  
inhibitor)   by  inhibiting   indigestion   retention,  
  prosta-­‐ -­‐CNS  changes   increased  BP,  
 glandin   in  older   changes  in  renal  
synthesis.   adults     function  (sodium  
(dizziness,   retention)  
confusion).   -­‐Monitor  CBC  and  
GI  bleeding   electrolytes  
(increased  sodium  
can  cause  bone  
marrow  
suppression)  
NSAIDS   -­‐Severe  GI   -­‐Baseline  labs  
-­‐-­‐older   side  effects   obtained  (CBC,  
ibuprofen   (decreased   kidney  &  liver  
  when  given   function  tests)  
with  a  H2   -­‐Teach  about  
blocking   adverse  effects  
agent  like   and  the  need  to  
Zantac  or   report  them  to  
Cytotec)   HCP  
-­‐Bleeding   -­‐Observe  for  fluid  
-­‐ARF   retention,  
-­‐dark  tarry   increased  BP,  
stools,  SOB,     changes  in  renal  
dyspepsia/   function  (sodium  
indigestion   retention)  
-­‐  CNS   -­‐Monitor  CBC  and  
changes  in   electrolytes  
older  adults     (increased  sodium  
(dizziness,   can  cause  bone  
confusion)   marrow  
  suppression)  
  -­‐If  no  change  after  
  6-­‐8  weeks  may  
d/c  NSAID  and  try  
another  one  
Opioids   As  low   Used  when  all   -­‐confusion,   -­‐Teach  patient  and  
as   other  drug   sedation,   family  to  monitor  
possible therapy  does   respiratory   for  adverse  effects  
,  esp.  for   not  control   depression,   in  older  adults  
older   pain.   hallucination (confusion,  
adults.   s   sedation,  
  respiratory  
depression,  
hallucinations)  
-­‐Teach  patient  to  
take  a  mild  
stimulant  laxative  
or  stool  softener  
as  needed  (esp  if  
 codeine  products  
are  taken)  

Cortisone  injection     Temporary      

pain  relief  
(knee,  base  of  
thumb,  
shoulder,  
trochanteric  
bursa  aka  hip)  
Hyaluronate/Hyalgan     Joint      
Hylan  GF  20/Synvisc   injections    
(joint  fluid  
implants)  for  
the  knee  to  
replace  or  
supplement  
the  body’s  
natural  
hyaluronic  
acid    which  is  
broken  down  
by  
inflammation.  
Cyclobenzaprine     Muscle     -­‐Do  not  drive  or  
hydrochloride/  Flexeril   relaxants   operate  machinery  
sometimes   when  taking  
given  for   muscle  relaxants.  
muscle  
spasms  (esp  
those  in  the  
back)  
Hydroxychloroquine   200  mg   Antimalarial   Can  cause   Have    frequent  eye  
sulfate/Plaquenil   orally     agent  that   retinal   exams  (q  6-­‐12  
2x  daily   helps   damage,  mild   mos).  
or  400   decrease   stomach  
mg  ea   inflammation   discomfort,  
evening   and  slow   light  
with  a   disease   headedness  
light   process.     or  headache.  
snack   Slows  
progression  of  
mile  
rheumatoid  
dz.    
Sometimes  
used  as  the  
 initial  
treatments  for  
mild  disease.  

Immunosuppressive   7.5-­‐20   Suppresses   N&V,  bone   Monitor  for  side  

Agents   mg   bone  marrow   marrow   effect  and  toxic  
Methotrexate/   metho-­‐ to  reduce  an   suppression,     effects  (mouth  
Rheumatrex  (most   trexate   immune   increased   sores,  acute  
common);   PO  a   response.   liver   dyspnea  from  
azathioprine/  Imuran;   week     enzymes,   pneumonitis)  
cyclophosphamide/   (gen-­‐ Effective,   decreasing    
Cytoxan   erally  <   Inexpensive.   WBCs  and   Observe  for  
  25mg/     platelets   desired  effects  
  week),     Slow  acting,   (result  of   (decrease  in  joint  
but   takes  4-­‐6   bone  marrow   pain  and  swelling)  
dosage   weeks  to   suppression),   Avoid  alcoholic  
varies   begin  to   lymphoma   beverages  (liver  
dependi control   (lymph  node   toxicity)  
ng  on   inflammatory   tumor),  birth   Folic  acid  given  to  
disease   joint   defects.   help  decrease  s/e  
activity   symptoms.   Strict  BC  
and   recommended  
route  of   (must  d/c  3  mos.  
admin-­‐ before  planned  
istratio pregnancy)  
n  
Prednisone/  Deltasone   10-­‐150   Decreases   Observe  for   Monitor  and  
mg  PO   inflammatory   cushingoid   electrolyte  and  
daily   and  immune   symptoms   glucose  levels.  
  response  by   (moon  face,   Monitor  weight.  
maint   decreasing   buffalo   Observe  for  long  
dose=   WBC  count   hump,  striae,   term  side  effects  
give   acne,  thin   of  chronic  steroid  
dose   skin,   therapy  
every   bruising,   (osteoporosis,  
other   fluid   cataracts,  HTN,  
day  to   retention,   DM,  impaired  
allow   increased   healing),  
adrenal   BP)   Teach  patient  to  
glands   increase  dietary  
to   calcium  and  
function   vitamin  D  and  to  
take  a  supplement.    
Instruct  patient  to  
avoid  crowds  and  
persons  with  
infections  such  as  
influenza.  
 Sulfasalazine/  Azulfidine   500  to   Decrease   Low  sperm   Check  for  sulfa  
Patients  with  an  allergy  to   3000   inflammation   count,  renal  /   allergy  or  kidney  
sulfa  drugs  or  aspirin   mg   and  slow   liver   or  liver  disease.    
should  not  take  this  drug.   orally   disease   toxicities,   Teach  patient  to  
daily  in   progression,   failure  to   drink  adequate  
2-­‐4   prescribed  for   drink  fluids   fluids  and  teach  
doses   mild  to   can  result  in   men  it  can  lower  
OR   moderate   urine   their  sperm  count.  
1000   inflammatory   crystals,  GI   Monitor  CBC  
mg  2x   arthritis  such   effects,  sulfa   (WBCs  and  
daily   as  RA   taste,   platelets)  
taken   bloating,  
with   stomach  
break-­‐ discomfort,  
fast  and   gas  
supper.  
Leflunomide/  Arava     Loading   Decreases   Increased   Teach  patient  to  
dose  of   inflammation   liver   have  prescribed  
100  mg   by  inhibiting   enzymes  and   lab  tests,  usually  q  
daily  for   an  enzyme.     decreased   6-­‐8  weeks.  
3  days,   Diminishes   blood  count.   Avoid  alcohol  
followe inflammatory   Can  cause   while  taking  this  
d  by  30   arthritis   birth  defects,   drug.  
mg   symptoms  of   Hair  loss,   Remind  patient  to  
daily   joint  swelling   diarrhea,   use  strict  birth  
after.   and  stiffness   decreased   control.  –  contact  
  and  improves   WBCs  and   HCP  immediately  
(10  to   mobility.   platelets.   if  pregnancy  
20  mg     occurs  (drugs  like  
daily   Slow  acting  :   Questran  can  be  
PO)   4-­‐6  weeks  or   given  to  block  
up  to  3  mos  to   drugs  effect)  
reach  full  
benefit.  
Biological  Response     Neutralize      
Modifiers  (BRMs)     biological      
Do  not  give  if  the  patient     activity  of      
has  a  serious  infection  (TB     either  TNF  or      
or  MS)  because  it     IL  to  decrease      
exacerbates  infections.     immune      
    response.      
         
Etanercept/          
Enbrel   Usually     Painful  site   -­‐Teach  patient  to  
  25  mg     reactions,     report  sit  reaction.  
  SubQ        
Infliximab/   weekly        
Remicade           -­‐Refrigerate  all  
   Varies       BRMs  except  
  from       Remicade  to  
  200-­‐     prevent  
Adalimumab/   400  mg       decomposition.  
Humira   IV  q  2       -­‐Teach  patient  to  
  mos.       report  chest  pain,  
        or  difficulty  
        breathing  during  
  40  mg       infusion;  monitor  
  SQ  q  2       BP.  
Anakinra/   weeks        
Kineret   with     Severe   -­‐teach  patient  to  
metho-­‐ decrease  in   monitor  site  for  
trexate   WBCs  and   reaction.  
or  q   make  patient   -­‐monitor  WBC  
week   susceptible   count  
with  no   to  infection    
metho-­‐  
trexate    
typicall  
y  100    
mg  SQ    
daily