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Non-opioid analgesic
Hem: leukopenia, neutropenia, thrombocytopenia; GI: N/V, abd pain, hepatotoxicity; GU: renal failure

Do not exceed 4 grams/day
caution w/ pts w/ anemia, hepatic dz, renal dz, and elderly

Hem: bood dyscrasias; GI: N/V, abd pain, anorexia; GU: dysuriahematuria, oliguria: Neuro: dizzyness, drowsiness

Administer wf to decrease GI SE butĀ best taken on empty stomach
Contra. for those w/ hypersensitivity, asthma, severe remal dz, severe hepatic dz
May cause water retention, edema
Cox-1 and Cox-2 inhibitors: Celebrex, Bextra

Hem: blood dyscrasias; GI: N/V, abd pain, anorexia; GU dysuria, hematuria, oliguria; Neuro: dizziness, drowsiness; Cardiac: chest pain, MI

Slows the progression of the disease before it worsens.

GI: mild stomach discomfort; Neuro: Light-headedness, HA; eyes **Retinal Damage**

Take w/ light snack; eye exam q 6-12 mos

DMARD/ GI anti-inflammatory
Hem: leukocytopenia, neutropenia, thrombocytopenia; Integument: Stevenson-Johnson syndrome; GU: renal failure, toxic nephrosis

**Take w/ full glass of water to prevent crystalluria; cannot be given to those w/ sulfa allergy; incr. effects of oralĀ anticoag meds; decreases iron/folic acid absorption
(Rheumatrex, MTX)

DMARD: antineoplastic
Hem: leukopenia, low platelets, elevated LFT's, elevated creatinine

Need folic and vit b supplements; report toxic effects which include mouth sores and acute dyspnea

site rxns--treated w/ ice and hydrocortisone cream

**Given subQ 1-2 x wkly; methotrexate tried first (can be used in combo w/methotrexate); teaching include how to give subq inj

Infusion rxns: chest discomfort, tachycardia, SOB, lightheadedness

Mehtotrexate tried first (can b used in combo); acetaminophen and benadryl given prior to infusion and if rxn occurs

Site rxns occur mor often w/this med than other BRM's - same treatment w/site rxns

Make sure pt rotates sites; pt teaching includes how to give subq inj

Skeletal M. rlaaxant
Neuro: Drowsiness*, may inpair mental and physical abilities; GI: upset, dry mouth
**Toxic signs: GI: N/V/D, weakness...toxicity-->death, agranulocytosis

*IV (necrosing agent), or PO - treat acute attacks, reduce incidence of attacks, abort impending attack; take wf, drink pleanty of fluids; **teaching re: SE
(Anti-arthritic, NSAID)
N/V, constipation, dizziness, drowsiness; characteristic SE: **Severe frontal HA**, bleeding

Geri pts at higher risk for adverse rxns: dizziness, bleeding; those w/ asthma, asa allergy at higher risk for rxn; monitor I & O
Predisone or Prednisolone
Hyperglycemia, incr appetite, insomnia, anxiety, HTN, fluid retention, electrolyte imbalance

**short-term "burst" therapy preferred**; taper off med; take wf
Allopurinol/ Zyloprim
*Reduces blood levels of uric acid*; hypersensitivity syndrome: rash, fever, eosinophilia-->CAUTION! **Drug of choice for primary hyperuricemia**

Monitor I & O; drink fluids; monitor glucose levels (decrease) in diabetics, **monitor LFT's (increase) CBC, Diff (supression); **may take after meals or milk to decrease GI sx
Probenecid (Benuryl)
*inhibits reabsorption of uric acid in renal tubules*; mild GI SE; Contra w/ asa and other salicylates

Monitor I & O; * may take w/meals or milk to decrease GI sx; **Do not take w/ asa containing products (Decreases effects of med)**
Alendronate (Fosamax)

GI upset, abdpain, gastroesophageal relux, **esphagitis**, HA

**Take w/8 oz of water 30 min before eating or drinking; sit or stand for 30 min after taking ( do not lie down until after eating)**
Risedronate (Actonel) Biphosphate
Arthralgia, GI disturbances, HA, abd pain, rash edema, chest pain, bone pain, dizziness, leg cramps, infection

Drug is more tolerable for pts with GI problems than Fosamax
Ralosifene (Evista)

hot flashes, leg cramps

Contra in pregnancy and history of thromboembolic events

med is stopped 72 hrs before surgery or prolonged immobilization
Calcitonin (Micalcin)

rhinitis, GI upset, back pain, facial flushing (w/ inj)

Perform periodic nasal exams to check for ulceration, stop if nasal ulceration occurs; *switch nostrils daily* (document alternating nostrils); inj recommended QHS b/c of possible facial flushing and nausea
Carbidopa/ Levadopa (Sinemet)

**Used to treat tremor and rigidity

N/V, postural hypotension, cardiac dysrhythmias, involuntary movements
Trihexyphenidyl (Artane)
Benztropine (Cogentin)

**helps mostly w/tremor; good for first 3-5 years

Depression may mask confusion, insomnia, dry mouth, hallucinations, dizziness, tachyarrhythmias

contra w/pts w/depression or cardiac diagnoses
Bromocritptine mesylate (Parlodel)
Pergolide (Permax)

Dopamine Agonists
Decr. tremor and improves posture

Nausea, hallucinations, confusion, hypotension (particularly at the beginning of treatment), dizziness; also can cause some cardiac SE: palpitations, angina

Contra w/pts w/ signs of hypotension
Selegilene (Eldepryl)

Slow the breakdown of levo-

Insomnia, confusion, hallucinations, nausea, and orthostatic hypotension

Avoid foods w/tyromine (aged/smoked foods) red wine, beer

Contra w/ problems w/BP
Entacapone (Comtan)

prevents breakdown of levadopa

othrostatic hypotension, diarrhea, hallucinations, dyskinesia, rhabdomyolysis
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