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INTRODUCTION

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piroxicam (peer-ox-i-kam)

Apo-Piroxicam, Feldene, Novo-Pirocam, Nu-Pirox, PMS-Piroxicam

Classification

Therapeutic: antirheumatics, nonsteroidal anti-inflammatory agents

Pharmacologic: enolic acids (oxicams)

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Indications
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Management of inflammatory disorders, including Rheumatoid arthritis, Osteoarthritis. Unlabeled Use: Management of dysmenorrhea.

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Action
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Inhibits prostaglandin synthesis. Therapeutic Effects: Suppression of pain and inflammation.

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Adverse Reactions/Side Effects
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CNS: drowsiness, headache, dizziness. EENT: blurred vision, tinnitus. CV: edema. GI: DRUG-INDUCED HEPATITIS, GI BLEEDING, discomfort, dyspepsia, nausea, vomiting, anorexia, constipation, diarrhea, flatulence. GU: renal failure. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rashes. Hemat: blood dyscrasias, prolonged bleeding time. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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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.

  • Be alert for signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician immediately.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). 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 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 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.

  • Monitor unusual weakness and fatigue that might be due to anemia, or other symptoms such as fever, sore throat, mucosal lesions, or signs of infection that might be due to other blood dyscrasias. Notify physician if these signs occur.

  • 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.

  • Monitor signs of renal failure, 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. Report these signs immediately to the physician.

  • Assess dizziness and drowsiness 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.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need ...

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