Podcast
Questions and Answers
Why is it important for clients to be current on their vaccinations before starting tofacitinib?
Why is it important for clients to be current on their vaccinations before starting tofacitinib?
- Live vaccines can cause infection in clients taking tofacitinib due to its immunosuppressive effects. (correct)
- Tofacitinib can cause a paradoxical increase in vaccine effectiveness, leading to potential overdose.
- Being up-to-date on vaccinations minimizes potential allergic reactions when tofacitinib is administered.
- Vaccinations compete with tofacitinib for receptor binding, reducing the drug’s efficacy.
A client with a history of which condition should be prescribed tsDMARDs with caution?
A client with a history of which condition should be prescribed tsDMARDs with caution?
- Type 2 Diabetes
- Osteoarthritis
- Benign Prostatic Hyperplasia
- Lymphoma (correct)
Which medication, when taken concurrently with tofacitinib, requires dosage adjustments or avoidance due to potential interactions?
Which medication, when taken concurrently with tofacitinib, requires dosage adjustments or avoidance due to potential interactions?
- Amoxicillin
- Aspirin
- Rifampin (correct)
- Ibuprofen
Why should caution be exercised when prescribing tsDMARDs to clients at increased risk for gastrointestinal perforation?
Why should caution be exercised when prescribing tsDMARDs to clients at increased risk for gastrointestinal perforation?
What is a primary concern when prescribing tsDMARDs in conjunction with other immunosuppressive medications like cyclosporine?
What is a primary concern when prescribing tsDMARDs in conjunction with other immunosuppressive medications like cyclosporine?
Tofacitinib, a targeted synthetic DMARD, primarily works by disrupting which of the following processes?
Tofacitinib, a targeted synthetic DMARD, primarily works by disrupting which of the following processes?
Which of the following adverse effects is most closely associated with Tofacitinib use, requiring close monitoring?
Which of the following adverse effects is most closely associated with Tofacitinib use, requiring close monitoring?
Before starting a client on tofacitinib, which baseline laboratory test is most important to assess according to the guidelines?
Before starting a client on tofacitinib, which baseline laboratory test is most important to assess according to the guidelines?
A client taking tofacitinib reports experiencing new onset chest pain and shortness of breath. What is the most appropriate immediate action?
A client taking tofacitinib reports experiencing new onset chest pain and shortness of breath. What is the most appropriate immediate action?
A client is prescribed tofacitinib extended-release tablets. Which instruction should the nurse provide to the client regarding the administration of this medication?
A client is prescribed tofacitinib extended-release tablets. Which instruction should the nurse provide to the client regarding the administration of this medication?
A client who is taking both methotrexate and corticosteroids for rheumatoid arthritis is started on tofacitinib. What specific risk should the nurse monitor for in this client?
A client who is taking both methotrexate and corticosteroids for rheumatoid arthritis is started on tofacitinib. What specific risk should the nurse monitor for in this client?
Which of the following infections would be of most concern in a patient taking Tofacitinib?
Which of the following infections would be of most concern in a patient taking Tofacitinib?
A patient reports elevated lipid levels 6 weeks after starting Tofacitinib therapy. What is the most appropriate action?
A patient reports elevated lipid levels 6 weeks after starting Tofacitinib therapy. What is the most appropriate action?
Flashcards
Tofacitinib and Vaccines
Tofacitinib and Vaccines
Clients need to be current on vaccinations before starting Tofacitinib.
Live Vaccines & Tofacitinib
Live Vaccines & Tofacitinib
Avoid live vaccines while taking tofacitinib due to increased risk of infection.
tsDMARD Contraindications
tsDMARD Contraindications
Active infection, leukopenia, neutropenia, or anemia.
Tofacitinib Interactions
Tofacitinib Interactions
Signup and view all the flashcards
Tofacitinib and Immunosuppressants
Tofacitinib and Immunosuppressants
Signup and view all the flashcards
Targeted Synthetic DMARDs (tsDMARDs)
Targeted Synthetic DMARDs (tsDMARDs)
Signup and view all the flashcards
Tofacitinib
Tofacitinib
Signup and view all the flashcards
tsDMARD Adverse Effects
tsDMARD Adverse Effects
Signup and view all the flashcards
Monitor for...
Monitor for...
Signup and view all the flashcards
tsDMARD Monitoring
tsDMARD Monitoring
Signup and view all the flashcards
Tofacitinib Contraindications
Tofacitinib Contraindications
Signup and view all the flashcards
Methotrexate/Corticosteroids + Tofacitinib
Methotrexate/Corticosteroids + Tofacitinib
Signup and view all the flashcards
tsDMARD: Report Immediately
tsDMARD: Report Immediately
Signup and view all the flashcards
Study Notes
- Targeted synthetic (ts) DMARDs are the newest group of DMARDs.
Prototype and Other Medications
- Tofacitinib is the prototype tsDMARD, which is a Janus kinase (JAK) inhibitor.
- Other JAK inhibitors include baricitinib and upadacitinib.
Expected Pharmacologic Action
- Tofacitinib and other JAK inhibitors disrupt signaling pathways involved in inflammatory and immune responses.
Adverse Drug Reactions
- Increased risk of upper respiratory and urinary tract infections.
- Higher risk of serious infections like tuberculosis, pneumonia, cellulitis, and herpes zoster.
- Potential for neutropenia, elevated liver enzymes, serum creatinine, and lipids.
- Reported cases of lymphoma and other cancers, myocardial infarction, and thrombosis.
- Increased risk of gastrointestinal perforation, especially with NSAID use or diverticulitis.
Interventions
- Monitor for infection manifestations: fever, chills, fatigue, cough.
- Assess baseline CBC, WBC, and liver enzymes before treatment and every 3 months thereafter.
- Assess baseline lipid profile and monitor within 4 to 8 weeks of starting treatment.
- Do not administer tofacitinib to clients with anemia, neutropenia, or leukopenia.
- Be aware that concurrent use of methotrexate or corticosteroids with tofacitinib increases the risk of serious infections.
Administration
- Administer as a tablet or oral solution twice daily, or as an extended-release tablet once daily.
- Do not chew, crush, or split the extended-release tablet.
Client Instructions
- Report any manifestations of infection to a provider immediately.
- Report chest pain, dyspnea, edema, discoloration, tenderness, or swelling of extremities, abdominal pain, or changes in stool immediately.
- A pregnancy exposure registry has been established for this medication
- Breastfeeding is not recommended during treatment.
Safety Alert
- Clients should be up to date on all vaccines before starting tofacitinib.
- Avoid live vaccines while taking tofacitinib.
Contraindications and Precautions
- Contraindicated in clients with active infection, leukopenia, neutropenia, or anemia.
- Use with caution in clients with a history of serious infections or exposure to tuberculosis.
- Exercise caution in those at increased risk for gastrointestinal perforation or with a history of lymphoma or other malignancies.
Interactions
- Some anti-infectives can have additive or inhibitory effects on tofacitinib.
- Avoid or adjust dosage of ketoconazole, fluconazole, and rifampin when taken with tofacitinib.
- Biologic DMARDs and other immunosuppressants (e.g., cyclosporine) can increase immunosuppressive effects of tsDMARDs.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Tofacitinib is a prototype tsDMARD that inhibits Janus kinase, disrupting inflammatory and immune responses. Adverse effects include increased infection risk, neutropenia, elevated enzymes, and potential for serious conditions. Monitor for infections and assess lab values before treatment.
