Test 1 IV/Pharm part 1

Disease-Modifying Antirheumatic Drugs (DMARDs)

• DMARDs are used to slow joint degeneration and progression of rheumatoid arthritis.
• They are used when other treatments are ineffective in controlling pain.
• DMARDs suppress the immune system, increasing the risk of infections.
• Adverse reactions include nausea, stomatitis, alopecia, skin rash, fever, cough, easy bruising, visual changes, tinnitus, and hearing loss.
• Sulfur-containing DMARDs can also cause ocular changes, GI upset, and mild pancytopenia.
• Pancytopenia affects all blood cells (red blood cells, white blood cells, and platelets).
• Methotrexate is contraindicated in patients with renal insufficiency, liver disease, alcohol abuse, folate deficiency, and pre-existing pancytopenia.
• Humira and Remicade are contraindicated in patients with heart failure or neurological demyelinating diseases.
• DMARDs are teratogenic and should not be taken during pregnancy.
• Women who are pregnant or may become pregnant should use barrier methods to prevent transmission of the drug through semen.
• Liver and renal function should be monitored every three months for patients taking DMARDs.
• DMARDs are taken once a week on the same day.
• Patients taking DMARDs should notify their provider of any sore mouth, diarrhea, fever, sore throat, easy bruising, rash, itching, nausea, or vomiting.
• DMARDs can interact with sulfa drugs, aspirin, and NSAIDs, increasing the risk of Methotrexate toxicity.
• Labs should be monitored for thrombocytopenia, leukopenia, anemia, liver enzymes, liver function tests, and kidney function.
• Patient teaching for DMARDs:
  • Take the medication at the same time each day as prescribed.
  • Use effective birth control methods.
  • Monitor for signs and symptoms of infection, bleeding, or allergic reactions.
  • Subtle signs of infection may occur due to immunosuppression.

Bone Resorption Inhibitors (Bisphosphonates)

• Bisphosphonates inhibit normal and abnormal bone resorption.
• They are used to treat osteoporosis, hypercalcemia of malignant diseases, and Paget's disease.
• Osteoporosis weakens bones, making them brittle and prone to fractures.
• Paget's disease disrupts the replacement of old bone tissue with new bone tissue, resulting in fragile, misshapen bones.
• Adverse reactions of Bisphosphonates include nausea, diarrhea, bone pain, headache, esophagitis, esophageal ulceration, dyspepsia, acid regurgitation, dysphagia, abdominal pain, constipation, visual disturbances, and an increased risk of bleeding.
• They can be nephrotoxic if administered intravenously.
• Nephrotoxicity is a serious side effect that can cause kidney damage. Monitor BUN and creatinine levels and watch for signs of decreased urine output, fluid retention, or edema.
• Contraindications for Bisphosphonates include pregnancy, lactation, hypocalcemia, dysphagia, serious kidney impairment, and esophageal issues or disorders.
• Interactions with Bisphosphonates include antacids, aspirin, Theophylline, caffeine, orange juice, magnesium supplements, iron, and calcium.
• Patient teaching for Bisphosphonates:
  • Take the medication with eight ounces of water.
  • Sit upright for at least 30 minutes after taking the medication.
  • Take the medication first thing in the morning on an empty stomach.
  • Take calcium and vitamin D supplements if dietary intake is inadequate.
  • Get a bone scan every 12 to 18 months to monitor the effectiveness of treatment.
  • Monitor blood calcium levels.
  • Exercise for 30 to 40 minutes each day, such as walking, to strengthen bones.

Uric Acid Inhibitors

• Used to treat acute attacks of gout and prevent future attacks.
• Gout is a condition caused by a buildup of uric acid crystals in the joints, resulting in pain, inflammation, and swelling.
• Gout is most commonly seen in the great toe.
• Adverse effects include nausea, vomiting, diarrhea, skin rash (including Stevens-Johnson Syndrome), hepatitis, kidney damage, severe nausea and vomiting, bone marrow depression, thrombocytopenia, anemia, leukopenia, and rhabdomyolysis.
• Stevens-Johnson Syndrome is a serious skin reaction that can be mild or severe.
• Rhabdomyolysis is a condition that causes severe muscle pain.
• Colchicine is used to treat acute attacks of gout, and it can cause severe nausea and vomiting as well as bone marrow depression.
• Allopurinol is used to prevent acute attacks of gout and can cause skin rash, Stevens-Johnson Syndrome, hepatitis, and kidney damage.
• Probenecid is used to prevent acute attacks of gout and can cause renal stones and kidney injury.
• Contraindications for uric acid inhibitors include pregnancy, lactation, peptic ulcer disease, serious GI, renal, hepatic, and cardiac disorders, blood dyscrasias, pancytopenia, and children under the age of two.
• Interactions include grapefruit juice (which can increase the side effects of allopurinol), ampicillin, Theophylline, probenecid, penicillins, NSAIDs, barbiturates, salicylates, oral anticoagulants (which can increase the risk of bleeding), and sobutamide (which can increase the risk of hypoglycemia).
• Patient teaching for Uric Acid Inhibitors
  • Take the medication as prescribed with meals.
  • Drink plenty of water (about 3,000 mL or 10 glasses per day) to help flush out uric acid and prevent kidney stones.
  • Monitor urine for blood.
  • With colchicine, monitor joint improvement every two hours.
  • Drink plenty of water, especially during acute attacks.
  • Avoid foods high in purines (such as red meat, organ meats, and shellfish).

This quiz focuses on Disease-Modifying Antirheumatic Drugs (DMARDs) and their role in managing rheumatoid arthritis. It covers their mechanisms, side effects, contraindications, and special considerations for patients, including teratogenic effects. Test your knowledge on how DMARDs can affect joint health and overall well-being.