Hydroxychloroquine

INTRODUCTION

Indications

Suppression/chemoprophylaxis of malaria. Treatment of severe rheumatoid arthritis/systemic lupus erythematosus.

Action

Inhibits protein synthesis in susceptible organisms by inhibiting DNA and RNA polymerase. Therapeutic Effects: Death of plasmodia responsible for causing malaria. Also has anti-inflammatory properties.

Adverse Reactions/Side Effects

CNS: SEIZURES, aggressiveness, anxiety, apathy, confusion, fatigue, headache, irritability, personality changes, psychoses. EENT: keratopathy, ototoxicity, retinopathy, tinnitus, visual disturbances. CV: ECG changes, hypotension. GI: abdominal cramps, anorexia, diarrhea, epigastric discomfort, nausea, vomiting, hepatic failure. Derm: bleaching of hair, alopecia, hyperpigmentation, photosensitivity, Stevens-Johnson syndrome. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. Neuro: neuromyopathy, peripheral neuritis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Monitor signs of agranulocytosis and leukopenia (fever, sore throat, mucosal lesions, signs of infection, bruising), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to aplastic anemia. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Monitor rashes or other skin reactions (pruritus, urticaria, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome).

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

• Be alert for signs of peripheral neuromyopathy and neuritis (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.

• 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 blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Monitor changes in personality, mood, and behavior, including aggressiveness, anxiety, confusion, irritability, and psychosis. Notify physician if these changes become problematic.

• If treating malaria, monitor any changes in symptoms (decreased fever, chills, sweating) to help document whether antimalarial drug therapy is successful.

Interventions

• Because of the risk of ECG changes and hypotension, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve ...