Penicillamine

INTRODUCTION

Indications

Progressive rheumatoid arthritis resistant to conventional therapy. Management of copper deposition in Wilson's disease. Management of recurrent cystine calculi. Unlabeled Use: Adjunct in the treatment of heavy metal poisoning.

Action

Antirheumatic effect, probably resulting from enhanced lymphocyte function. Chelates heavy metals, including copper, mercury, lead, and iron, into complexes that are excreted by the kidneys. Forms a soluble complex with cystine that is readily excreted by the kidneys. Therapeutic Effects: Decreased disease progression in rheumatoid arthritis. Decreased copper deposition in Wilson's disease. Decreased cystine renal calculi formation.

Adverse Reactions/Side Effects

EENT: blurred vision, eye pain. Resp: coughing, shortness of breath, wheezing. GI: altered taste, anorexia, cholestatic jaundice, diarrhea, drug-induced pancreatitis, dyspepsia, epigastric pain, hepatic dysfunction, nausea, oral ulceration, vomiting. GU: proteinuria. Derm: pemphigus, ecchymoses, hives, itching, rashes, wrinkling. Hemat: APLASTIC ANEMIA, anemia, eosinophilia, leukopenia, thrombocytopenia, thrombocytosis. MS: arthralgia, migratory polyarthritis. Neuro: myasthenia gravis syndrome. Misc: GOODPASTURE'S SYNDROME (GLOMERULONEPHRITIS AND INTRA-ALVEOLAR HEMORRHAGE), allergic reactions, fever, lymphadenopathy, systemic lupus erythematosus–like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor any unusual weakness and fatigue that might be due to aplastic anemia. Report signs of anemia or other blood dyscrasias such as leukopenia (fever, sore throat, signs of infection), or thrombocytopenia (bleeding gums, bruising, petechiae, blood in stools, urine, or emesis).

• Be alert for signs of Goopasture's syndrome, including renal dysfunction (hematuria, increased frequency, burning sensation while urinating, cloudy urine, decreased urine output, edema and hypertension due to fluid retention), pulmonary symptoms (dry cough, dyspnea, coughing up blood), and generalized weakness and fatigue. Notify physician immediately of these signs.

• 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.

• 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.

• Be alert for early signs of myasthenia gravis syndrome, such as drooping eyelids, facial muscle weakness, and difficulty swallowing and speaking. Report these signs to the physician immediately, and monitor other muscle groups for signs of unusual weakness and fatigue, especially after repeated contraction.

• Monitor signs of drug-induced lupus-like syndrome, including increased blood pressure, fever, joint pain, skin rashes, and redness/irritation of the eye (uveitis). Notify physician promptly if these signs appear.

Interventions

• If treating rheumatoid arthritis, 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 patients with arthritis explore other nonpharmacologic methods ...