Osteoarthritis Pharm Therapy: Medications, Risks, and Treatments (PDF)

Highlighted green- Degrosa commented Highlighted blue- red in PowerPoint Judge the appropriateness and safety of the more common medications used for the treatment of connective tissue disorders *osteoarthritis pharm therapy table 21.1* Implement Pharm Therapy for Osteoart...

Highlighted green- Degrosa commented Highlighted blue- red in PowerPoint Judge the appropriateness and safety of the more common medications used for the treatment of connective tissue disorders *osteoarthritis pharm therapy table 21.1* Implement Pharm Therapy for Osteoarthritis Oral Systematic Meds Uses Possible side effects Acetaminophen Mild to moderate pain ​ Hepatic toxicity especially in those who use alcohol regularly ​ Potential of warfarin ​ Don’t exceed 4 g NSAIDs Mild to moderate pain ​ Nephrotic toxicity unresponsive to ​ Gastrointestinal Acetaminophen or severe bleeding/ ulceration pain ​ anticoagulation Nonacetylated salicylates Use as an alternative to ​ Ototoxicity NSAIDs for high risk patients Opioid analgesics — use Moderate to severe pain ​ Nausea sparingly ​ Constipation ​ Confusion ​ Drowsiness ​ Respiratory depression ​ Addiction Topical Local Meds Uses Possible side effects Intra-articular Use in conjunction with ​ Local discomfort corticosteroids oral medications ​ Temporary increase in blood glucose level Intra-articular Use in conjunction with ​ Local discomfort hyaluronans oral medications ​ Temporary increase in synovitis Topical NSAIDs Use as alternative to oral ​ Local skin irritation medications Topical capsaicin Use as alternative to oral ​ Local skin irritation medications ​ Goals of care include decreasing pain and improving or maintaining joint mobility while avoiding the toxic effects of pharmacological therapy ​ It is acceptable and safe to use acetaminophen, NSAIDs, and intra-articular medications in conjunction with each other ​ Patients should not use more than one NSAID because of increased risk of bleeding, development of gastric ulcers, and risk of renal damage Summarize the pathophysiology of the more common tissue disorders *osteoarthritis epidemiology* teaching and learning Epidemiology ​ Obesity is the single most modifiable risk factor ​ Obesity correlates most closely to the development of knee osteoarthritis ​ There have been links made between certain occupations and osteoarthritis (repetitive motions) ​ Aging is the most prevalent risk factors (however, osteoarthritis is not considered a normal part of aging) ​ Women are more affected; hands most prevalent Pathophysiology ​ When the cartilage is damaged from major trauma or repetitive microtrauma, osteophytes are formed by the body to attempt to repair the damage ​ Osteophytes are projections of new cartilage and bone growth that form along joint lines, contributing to pain in the joint and decreased range of motion ​ Osteophyte formations on the proximal interphalangeal joints and distal interphalangeal joints are referred to as Bouchard’s nodes and Heberden’s nodes aka hallmark signs Differentiate the abnormal assessments commonly seen in clients with connective tissue disorder to a normal adult assessment *comparing osteoarthritis vs rheumatoid table 20.2* teaching and learning Comparing Osteo vs RA Osteoarthritis Rheumatoid Arthritis Morning stiffness Less than 30 minutes More than 30 minutes Immune-mediated No yes Typical joint involvement ​ Large weight *bilateral inflammation bearing joints such ​ MCPs as hips and knees ​ PIPs ​ PIPs ​ MTPs ​ DIPs ​ Wrists ​ CMC ​ Elbows ​ First MTP ​ Ankles ​ Previously injured ​ Knees joints Symmetrical Joint Not Typical Very typical Involvement Systemic organ No Yes  involvement pain increases with activity Improves with rest lab testing no yes Differentiate the abnormal assessments commonly seen in clients with connective tissue disorder to a normal adult assessment *rheumatoid arthritis clinical manifestations* analysis ​ Common RA joint deformities ○​ swan-neck deformity caused by hyperextension of the proximal interphalangeal joints ○​ Boutonniere’s deformity caused by abnormal flexion of the proximal interphalangeal joints ○​ ulnar deviation caused by the lateral deviation of the phalanges ​ Rheumatoid nodules may be formed in subcutaneous tissue over bony prominences Evaluate the needs of clients with connective tissue disorders and/or their families for education needed to prevent and manage the disorder *Rheumatoid Arthritis Nursing Interventions* evaluation ​ Joint pain and mobility ○​ Joint pain and mobility are indicators of treatment efficacy and disease progression ○​ Came in diagnosed and gave treatment of acetaminophen and nsaids with education.. come back a couple of weeks later and evaluate for pain management and say wether its effective or not  ​ Temperature ○​ An increase in temperature is an indicator of infection ​ Laboratory testing ○​ CRP and ESR ​ Elevated values are indicative of inflammation ○​ Hemoglobin ​ A decreased value may indicate a GI bleed caused by NSAID use ○​ Serum albumin ​ Correlated with disease severity ○​ Platelet count ​ May be elevated in very active disease due to inflammation ○​ Liver and renal function ​ Elevated levels may be due to medications used to treat RA ​ Assess for pleural effusion, pericarditis, pleuritis, scleritis, episcleritis, and osteopenia ○​ May be present due to inflammatory changes outside of the joints Formulate a plan of care for a client with a connective tissue disorder *Rheumatoid Arthritis Treatment Nonpharmacological Therapy* implementation ​ Education is very important in the management of Rheumatoid Arthritis ​ Patients must understand their disease and the measures they can take to help manage the disease ​ Range- of- motion exercises promote joint mobility, reduce stiffness, and improve muscle strength ​ Aerobic exercise promotes cardiac health– low impact ​ Physical and occupational therapies may be necessary to teach patients appropriate exercises, teach patients how to protect their joints, evaluate the need for assistive devices, and teach proper use of the devices  ​ Proper nutrition is important to maintain good health, prevent obesity, and decrease the risk of heart disease ​ It is important for patients to take rest periods to manage fatigue and joint pain Differentiate the abnormal assessments commonly seen in clients with connective tissue disorder to a normal adult assessment *systematic scleroderma- limited vs diffuse table 20.5* assessment Systematic Scleroderma Limited Diffuse Insidious onset (gradual) Rapid onset Involves skin of extremities distal to Involves skin of extremities and trunk elbows and knees aka fingers/toes Less likely internal organ involvement Affects internal organs (around 2 years of and with late onset onset) Raynaud’s phenomenon precedes Raynaud’s phenomenon may occur (before) disease’s diagnosis by years concurrently or after diagnosis ​ Usual onset is 30-50.. But in women it ranges from 15-40 years old ​ Raynaud’s phenomenon causes permanent tissue damage and loss of digits due to chronic ischemia (vasoconstriction of the small vessels) in the hands when exposure to cold Judge the appropriateness and safety of the more common medications used for the treatment of connective tissue disorders *lupus/safety alert- methotrexate safety warning pg 390* evaluation ​ Patient on methotrexate must be monitored closely for hepatic toxicity while the dose is being escalated and periodically while on maintenance dose ​ Take folic acid daily to prevent side effects such as oral ulcers ​ Avoid alcohol while taking this medication because of the risk of hepatotoxicity  ​ Counsel female patients on proper birth control methods because of the significant risk of teratogenicity (the capability of producing fetal malformation) ​ Patients with renal insufficiency require lower doses of methotrexate Judge the appropriateness and safety of the more common medications used for the treatment of connective tissue disorders *SLE pharmacological therapy* analysis ​ Interventions are based on disease manifestations ​ Antimalarial medications such as hydroxychloroquine (Plaquenil) are frequently used ​ Nonsteroidal anti-inflammatory medications such as ibuprofen are useful in treating: ○​ Arthralgias ○​ Myalgias ○​ Headaches ○​ Fever ​ Glucocorticoids may be necessary to suppress inflammation in joints, kidneys and other organ systems ​ Immunosuppressive agents such as methotrexate may be necessary to treat joint inflammation, which does not respond to NSAIDs or steroids ○​ Glucocorticoids and immunosuppressive agents may be used in combination with hydroxychloroquine (antimalarial); to treat more serious clinical manifestations ​ Belimumab (Benlysta) is a biological response modifier; first new approved treatment in 40 years ​ Rule of thumb- depending on severity of symptoms 1.​ Start- Analgesics 2.​ NSAIDS 3.​ Steroids 4.​ Glucocorticoids/immunosuppressants 5.​ End- biologics Evaluate the needs of clients with connective tissue disorders and/ or their families for education needed to prevent and manage the disorder *gout/nursing interventions* teaching and learning Nursing Interventions ​ Monitor uric acid level ○​ Hyperuricemia promotes crystal formation ​ Assess for presence of tophi- lumps or hard nodules under the skin around joints ○​ The presence of tophi is indicative of advanced gout ​ Assess for red, swollen, and painful joints ○​ Red, swollen and painful joints indicate an acute gout flare ​ Assess pain levels ○​ Evaluating pain helps determine the occurrence of a flare and the efficacy of treatment Teaching ​ Avoid alcoholic beverages, especially beer ​ Take uric acid-lowering agents as directed ​ Report gout flares promptly ​ Proper nutrition– no seafood or steak