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INTRODUCTION

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etodolac (ee-toe-doe-lak)

Lodine, Lodine XL

Classification

Therapeutic: antirheumatics, nonopioid analgesics

Pharmacologic: pyranocarboxylic acid

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Indications
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Osteoarthritis. Rheumatoid arthritis. Mild-to-moderate pain (not XL tablets).

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Action
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Inhibits prostaglandin synthesis. Also has uricosuric action. Therapeutic Effects: Suppression of inflammation. Decreased severity of pain.

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Adverse Reactions/Side Effects
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CNS: depression, dizziness, drowsiness, insomnia, malaise, nervousness, syncope, weakness. EENT: blurred vision, photophobia, tinnitus. Resp: asthma. CV: CHF, edema, hypertension, palpitations. GI: GI BLEEDING, dyspepsia, abdominal pain, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastritis, nausea, stomatitis, thirst, vomiting. GU: dysuria, renal failure, urinary frequency. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, ecchymoses, flushing, hyperpigmentation, pruritus, rashes, sweating. Hemat: anemia, prolonged bleeding time, thrombocytopenia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, ANGIOEDEMA, chills, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

  • Monitor signs of allergic reactions such as anaphylaxis and angioedema, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea), or skin reactions (rash, pruritus, urticaria, swelling in the face). Be especially alert for exfoliation, dermatitis, and other severe skin reactions that might indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). Notify physician immediately if these reactions occur.

  • Assess signs of congestive heart failure (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance). Report these signs to the physician immediately.

  • Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

  • Assess blood pressure (BP) periodically, and compare to normal values (See Appendix F). NSAIDs can increase BP and promote hypertension in certain patients.

  • Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Assess symptoms of bronchospasm and asthma, including wheezing, coughing, dyspnea, and tightness in chest. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

  • Monitor signs of kidney dysfunction such as painful urination or blood in the urine. Report signs of renal failure immediately, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma.

  • Monitor signs of thrombocytopenia (bruising, nose bleeds, and bleeding gums) or unusual weakness and fatigue that might be due to anemia. Notify physician if these signs occur.

  • Assess dizziness, drowsiness, and syncope that might affect gait, balance, and other functional activities (see Appendix C...

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