Nabumetone

INTRODUCTION

Indications

Symptomatic management of rheumatoid arthritis and osteoarthritis.

Action

Inhibits prostaglandin synthesis. Therapeutic Effects: Suppression of pain and inflammation.

Adverse Reactions/Side Effects

CNS: agitation, anxiety, confusion, depression, dizziness, drowsiness, fatigue, headache, insomnia, malaise, weakness. EENT: abnormal vision, tinnitus. Resp: dyspnea, hypersensitivity pneumonitis. CV: edema, fluid retention, vasculitis. GI: GI BLEEDING, abdominal pain, diarrhea, abnormal liver function tests, anorexia, constipation, dry mouth, dyspepsia, flatulence, gastritis, gastroenteritis, increased appetite, nausea, stomatitis, vomiting. GU: albuminuria, azotemia, interstitial nephritis. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, increased sweating, photosensitivity, pruritus, rash. Hemat: prolonged bleeding time. Metab: weight gain. Neuro: paresthesia, tremor. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, ANGIONEUROTIC EDEMA.

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 or angioneurotic edema, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Be especially alert for exfoliation, dermatitis, and other severe skin reactions that might indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). 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.

• Be alert for signs of difficult, labored breathing (dyspnea) or other signs of pneumonitis such as cough, shortness of breath, fever, and abnormal breath sounds (rales; See Appendix K). Report these signs to the physician.

• Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.

• 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 interstitial nephritis (blood in urine, decreased urine output, weight gain from fluid retention) or signs of increased nitrogenous compounds in the blood (azotemia) such as confusion, decreased alertness, tachycardia, pallor, fatigue, dry mouth, thirst, and decreased/absent urine production. Notify physician of these signs.

• Assess any tremors or signs of paresthesia (numbness, tingling). Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Be alert for signs of vasculitis, including fatigue, weakness, muscle pain, joint pain, fever, loss of appetite, and weight loss. Report these signs to the physician.

• Assess dizziness and drowsiness that might affect ...