Diflunisal

INTRODUCTION

Indications

Inflammatory disorders, including Rheumatoid arthritis, Osteoarthritis. Treatment of mild-to-moderate pain.

Action

Inhibits prostaglandin synthesis. Diflunisal is an NSAID chemically related to aspirin. Therapeutic Effects: Suppression of pain and inflammation.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, headache. EENT: tinnitus. CV: arrhythmias, ↑ in blood pressure, chest pain, edema. GI: GI BLEEDING, abdominal discomfort, nausea, constipation, diarrhea, dyspepsia, vomiting. GU: renal failure. Derm: rash. Hemat: blood dyscrasias, prolonged bleeding time. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, chills.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Notify physician if these signs occur.

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

• 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.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and decrease the need for diflunisal and other NSAIDs.

• Because of the risk of arrhythmias, ...