Meloxicam

INTRODUCTION

Indications

Relief of signs and symptoms of osteoarthritis and rheumatoid arthritis (including juvenile rheumatoid arthritis).

Action

Inhibits prostaglandin synthesis, probably by inhibiting the enzyme cyclooxygenase. Therapeutic Effects: Decreased pain and inflammation associated with osteoarthritis. Also decreases fever.

Adverse Reactions/Side Effects

CV: edema. GI: GI BLEEDING, abnormal liver function tests, diarrhea, dyspepsia, nausea. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, pruritus. Hemat: anemia, leukopenia, thrombocytopenia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Monitor rashes or other skin reactions (itching, hives, acne, abnormal sweating, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

• 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.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). NSAIDs can increase BP and promote hypertension in certain patients.

• 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.

Interventions

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

• If treating arthritic conditions, recommend orthotic and assistive devices as needed to reduce pain, improve function, and augment the effects of drug therapy.

• Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

Patient/Client-Related Instruction

• Advise patient that analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

• Inform patient that NSAIDs may impair bone and cartilage healing. Advise patient to consult physician about NSAID use, especially after fractures, spinal fusion, and other bone surgeries.

• Caution patient about the use of over-the-counter products that contain NSAIDs or acetaminophen while taking prescription doses of meloxicam. Use of multiple NSAIDs increases the risk of toxicity and overdose.

• Advise patient about the risks of gastric irritation. Instruct patient to notify physician of GI reactions such as severe or prolonged nausea, diarrhea, and indigestion.

• Advise patient ...