Auranofin

INTRODUCTION

Indications

Treatment of progressive rheumatoid arthritis resistant to conventional therapy.

Action

Inhibits inflammatory process. Modifies immune response (immunomodulating properties). Therapeutic Effects: Relief of pain and inflammation. Slowing of the disease process in rheumatoid arthritis.

Adverse Reactions/Side Effects

CNS: peripheral neuropathy. EENT: conjunctivitis, corneal gold deposition. GU: proteinuria, hematuria. Resp: bronchitis, pulmonary fibrosis, pneumonitis. CV: bradycardia. GI: GI BLEEDING, abdominal pain, cramping, diarrhea, gingivitis, glossitis, metallic taste, stomatitis, anorexia, difficulty swallowing, ↑ liver enzymes, dyspepsia, flatulence, nausea, vomiting. Derm: dermatitis, rash, alopecia, urticaria, photosensitivity reactions, pruritus. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, thrombocytopenia, anemia, eosinophilia, leukopenia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, ANGIOEDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions, including anaphylaxis and angioedema. Signs include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, burning/itching skin, swelling in the face). Notify physician immediately if these reactions occur.

• Monitor and report signs of agranulocytosis (fever, sore throat, mucosal lesions, infection), aplastic anemia (unusual fatigue, shortness of breath with exertion), thrombocytopenia (bruising, nose bleeds, bleeding gums), or other weakness or coagulation problems that might indicate other blood dyscrasias. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Assess any breathing problems or signs of pulmonary fibrosis, pneumonitis, or bronchitis such as dry cough, wheezing, rales, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

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

Interventions

• 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.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Instruct patient to also report other GI problems such as severe or prolonged diarrhea, nausea, vomiting, flatulence, indigestion, abdominal ...