Azathioprine

INTRODUCTION

Indications

Prevention of renal transplant rejection (with corticosteroids, local radiation, or other cytotoxic agents). Treatment of severe, active, erosive rheumatoid arthritis unresponsive to more conventional therapy. Unlabeled Use: Management of Crohn's disease.

Action

Antagonizes purine metabolism with subsequent inhibition of DNA and RNA synthesis. Therapeutic Effects: Suppression of cell-mediated immunity and altered antibody formation.

Adverse Reactions/Side Effects

EENT: retinopathy. Resp: pulmonary edema. GI: anorexia, hepatotoxicity, nausea, vomiting, diarrhea, mucositis, pancreatitis. Derm: alopecia, rash. Hemat: anemia, leukopenia, pancytopenia, thrombocytopenia. MS: arthralgia. Misc: SERUM SICKNESS, chills, fever, Raynaud's phenomenon.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, especially signs of serum sickness such as muscle aches, joint pains, fever, and skin rash. Notify physician or nursing staff immediately if these reactions occur.

• Watch for and report signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Assess any breathing problems or signs of pulmonary edema such as rales/crackles 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.

• If treating rheumatoid arthritis, periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

• Assess any new or increased joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by arthritis or anatomic and biomechanical problems.

• Monitor signs of Raynaud's phenomenon as indicated by decreased circulation to the fingers and toes resulting in pain, numbness, swelling, and color changes in the affected digits. Report these signs to the physician, and educate patient about how to avoid the onset of symptoms (keep hands warm, avoid caffeine, stress, and other triggers).

• If treating inflammatory bowel diseases, monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether 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 patient explore other nonpharmacologic methods to reduce chronic arthritis pain such as relaxation techniques, exercise, counseling, and so forth.

Patient/Client-Related Instruction

• Instruct patient to report signs of retinopathy such as blurred vision, loss of vision, and spots ...