Podcast
Questions and Answers
A client taking tofacitinib reports new onset chest pain and dyspnea. Which action should the nurse prioritize?
A client taking tofacitinib reports new onset chest pain and dyspnea. Which action should the nurse prioritize?
- Instruct the client to monitor symptoms and report any worsening.
- Immediately advise the client to go to the nearest emergency department. (correct)
- Advise the client to discontinue the tofacitinib until symptoms resolve.
- Reassure the client that these are common side effects and will likely subside.
A client with a history of diverticulitis is prescribed tofacitinib. What specific precaution should the healthcare provider consider?
A client with a history of diverticulitis is prescribed tofacitinib. What specific precaution should the healthcare provider consider?
- Increased risk of elevated liver enzymes
- Increased risk of gastrointestinal perforation (correct)
- Increased risk of anemia
- Increased risk of upper respiratory infection
A client on tofacitinib is prescribed ketoconazole for a fungal infection. How should the healthcare provider manage this situation?
A client on tofacitinib is prescribed ketoconazole for a fungal infection. How should the healthcare provider manage this situation?
- Administer both medications without any adjustments.
- Advise the client to discontinue tofacitinib temporarily.
- Replace ketoconazole with an alternative antifungal medication.
- Adjust the dosage of either tofacitinib, ketoconazole, or both, based on therapeutic drug monitoring. (correct)
A patient is started on tofacitinib for rheumatoid arthritis. Which baseline laboratory value is MOST important for the nurse to assess prior to initiating therapy?
A patient is started on tofacitinib for rheumatoid arthritis. Which baseline laboratory value is MOST important for the nurse to assess prior to initiating therapy?
A client taking tofacitinib reports a sore throat, fatigue, and a low-grade fever. What is the most appropriate nursing action?
A client taking tofacitinib reports a sore throat, fatigue, and a low-grade fever. What is the most appropriate nursing action?
When providing education to a client who is starting tofacitinib, what information should the nurse emphasize regarding vaccinations?
When providing education to a client who is starting tofacitinib, what information should the nurse emphasize regarding vaccinations?
A client on tofacitinib therapy is scheduled for surgery. What considerations should be made regarding their medication?
A client on tofacitinib therapy is scheduled for surgery. What considerations should be made regarding their medication?
Which of the following findings would be an indication to withhold tofacitinib and contact the provider?
Which of the following findings would be an indication to withhold tofacitinib and contact the provider?
Flashcards
Tofacitinib: Therapeutic Use
Tofacitinib: Therapeutic Use
Decreases joint inflammation and damage.
Tofacitinib: Neutropenia
Tofacitinib: Neutropenia
Low neutrophil count, increasing infection risk.
Tofacitinib: Infection Risks
Tofacitinib: Infection Risks
Upper respiratory, urinary tract, TB, pneumonia, cellulitis, herpes zoster
Tofacitinib: Lab Changes
Tofacitinib: Lab Changes
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Tofacitinib: Nursing Actions
Tofacitinib: Nursing Actions
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Tofacitinib: Client Teaching
Tofacitinib: Client Teaching
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Tofacitinib: Contraindications
Tofacitinib: Contraindications
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Tofacitinib: Interactions
Tofacitinib: Interactions
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Study Notes
Targeted Synthetic DMARDs – tofacitinib
- Therapeutic use decreases joint inflammation and subsequently joint damage.
Adverse Drug Reactions
- Neutropenia may occur
- There is an increased risk for upper respiratory tract infection, urinary tract infection, and more serious infections like tuberculosis, pneumonia, cellulitis, herpes zoster
- Elevated liver enzymes, serum creatinine, and lipids may occur
- Gastrointestinal perforation is a risk
Interventions
- Monitor complete blood count, liver enzymes, and lipid profile
- Monitor for manifestations of infection
- Monitor for abdominal pain
Administration
- Give as a tablet or oral solution once daily, or twice daily if using an extended release tablet
- Extended release tablets must be swallowed whole and not chewed, crushed, or split.
Client Instructions
- Report chest pain or dyspnea
- Report manifestations of infection
- Report edema, discoloration, tenderness, or swelling in the extremities
- Keep immunizations up to date, but avoid live vaccines
- Avoid breastfeeding while on this medication
Contraindications
- Anemia, neutropenia, and leukopenia can be contraindications
- Active infection or history of serious infection, such as tuberculosis, are contraindications
Precautions
- Exercise caution in clients who have increased risk for gastrointestinal perforation
- Use caution with clients with malignancy.
Interactions
- Concurrent use of other medications that have immunosuppressive effects like biologic DMARDs, cyclosporine, and corticosteroids may increase immunosuppressive effects of targeted synthetic DMARDs
- Avoid using ketoconazole, fluconazole, rifampin, and other anti-infectives, or adjust dosages to prevent additive or inhibiting effects of the anti-infective.
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