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INTRODUCTION

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etanercept (ee-tan-er-sept)

Enbrel

Classification

Therapeutic: antirheumatics (disease-modifying antirheumatic drugs, DMARDs)

Pharmacologic: anti-TNF agents

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Indications
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To decrease progression, signs and symptoms of rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, psoriatic arthritis. or plaque psoriasis when response has been inadequate to other disease-modifying agents. May be used with other agents.

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Action
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Binds to tumor necrosis factor (TNF), making it inactive. TNF is a mediator of inflammatory response. Therapeutic Effects: Decreased inflammation and slowed progression of arthritis, spondylitis, or psoriasis.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness, weakness. EENT: rhinitis, pharyngitis, sinusitis. Resp: upper respiratory tract infection, cough, respiratory disorder. GI: abdominal pain, dyspepsia. Derm: rash. Hemat: pancytopenia. Local: injection site reactions. Misc: INFECTIONS, ↑ risk of malignancies.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for any signs of infection, including upper respiratory tract infections. Signs of respiratory infection include cough, fever, nasal congestion, sneezing, runny nose, and sore throat. Report these signs to the physician immediately.

  • Monitor and report signs of red and white blood cell deficiencies (pancytopenia), including leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemias. Periodic blood tests may be needed to monitor WBC and RBC counts.

  • Assess dizziness or weakness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • If treating arthritic conditions, periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

  • If treating psoriasis, monitor skin responses to help document whether drug therapy is successful in resolving this condition.

  • Assess the subcutaneous injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

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Interventions
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  • If treating arthritic conditions, implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of antirheumatic drug therapy.

  • Help patients with arthritis explore other nonpharmacologic methods to reduce chronic arthritis pain, such as relaxation techniques, exercise, counseling, and so forth.

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons who have contagious diseases.

  • Instruct patient to report other troublesome side effects, including severe or prolonged headache, upper respiratory tract inflammation/irritation, or GI problems (abdominal pain, indigestion).

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Pharmacokinetics
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Absorption: 60% absorbed after SC administration.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: 115 hr (range 98–300 hr).

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