DRUG THERAPY IN. Rheumatology Nursing. Second Edition. Edited by SARAH RYAN

Transcription

1 DRUG THERAPY IN Rheumatology Nursing Second Edition Edited by SARAH RYAN

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3 DRUG THERAPY IN Rheumatology Nursing

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5 DRUG THERAPY IN Rheumatology Nursing Second Edition Edited by SARAH RYAN

6 Copyright 2007 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England Telephone (for orders and customer service enquiries): Visit our Home Page on All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London W1T 4LP, UK, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to the Permissions Department, John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England, or ed to permreq@wiley.co.uk, or faxed to (+44) Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Other Wiley Editorial Offices John Wiley & Sons Inc., 111 River Street, Hoboken, NJ 07030, USA Jossey-Bass, 989 Market Street, San Francisco, CA , USA Wiley-VCH Verlag GmbH, Boschstr. 12, D Weinheim, Germany John Wiley & Sons Australia Ltd, 42 McDougall Street, Milton, Queensland 4064, Australia John Wiley & Sons (Asia) Pte Ltd, 2 Clementi Loop #02-01, Jin Xing Distripark, Singapore John Wiley & Sons Canada Ltd, 6045 Freemont Blvd, Mississauga, ONT, L5R 4J3 Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Anniversary Logo Design: Richard J.Pacifico Library of Congress Cataloging in Publication Data Drug therapy in rheumatology nursing / edited by Sarah Ryan. 2nd ed. p. ; cm. Rev. ed. of: Rheumatology / Jackie Hill and Sarah Ryan Includes bibliographical references. ISBN-13: (alk. paper) ISBN-10: (alk. paper) 1. Rheumatism Chemotherapy. 2. Rheumatism Nursing. I. Ryan, Sarah. II. Hill, Jacqueline, Rheumatology. [DNLM: 1. Rheumatic Diseases nursing. 2. Nursing Assessment. 3. Patient Education. 4. Rheumatic Diseases drug therapy. WE 544 D ] RC927.D dc British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN-13: (alk. paper) Typeset in 10/12pt Times by Integra Software Services Pvt. Ltd, Pondicherry, India Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production.

7 Contents List of Contributors List of Figures xv List of Tables xvii Preface xix xiii 1 Rheumatological Conditions 1 Janet Cushnaghan and Jackie McDowell 1.1 Introduction Features of rheumatic conditions 2 Pain 3 Stiffness 3 Swelling 3 Joint involvement 3 Function Epidemiology Anatomy and physiology of the musculoskeletal system 5 Muscle 5 Bone 5 Cartilage 6 Synovium 6 Ligaments and tendons 6 Tendon sheaths and bursae 6 Synovial joints 7 Physiology 7 Circulation 7 Lymphatics 7 Intra-articular pressure 8 Motion 8 Innervation 8 Temperature Anatomy and physiology of the musculoskeletal system in inflammatory arthritis 9 Immunopathogenetic mechanisms 9 Susceptibility 10 Synovitis 11

8 vi CONTENTS 1.6 An overview of the rheumatological conditions most commonly encountered in Western Europe 12 Rheumatoid arthritis 12 Juvenile idiopathic arthritis 19 Polymyalgia rheumatica 21 Inflammatory arthritis associated with spondylitis 22 Ankylosing spondylitis 22 Reiter s syndrome 23 Psoriatic arthritis 24 Septic arthritis 26 Reactive arthritis 28 Triggering factors 29 Osteoarthritis 30 Fibromyalgia syndrome 32 Connective tissue disease 34 Systemic lupus erythematosus 34 Scleroderma (systemic sclerosis) 36 Inflammatory muscle disease (polymyositis) The impact of rheumatological conditions on physical, psychological, social and occupational function 45 Personal impact of arthritis 47 Financial impact of arthritis 48 Impact on education 48 Impact on employment 49 The role of social support 50 Impact on family relationships 50 Depression 52 References 53 2 Drug Therapy 61 Sarah Ryan, Susan Oliver and Ann Brownfield 2.1 Pain 61 Physiology of pain 62 Pain receptors 63 The role of the brain 64 Physiological effects of acute pain Pharmacological interventions in rheumatology 65 Non-opioid analgesia 65 Compound analgesia 66 Opioids 66 Antidepressant drugs 71 Non-steroidal anti-inflammatory drugs 71

9 CONTENTS 2.3 Disease Modifying Anti-rheumatic Drugs (DMARDs) 81 Use of DMARDs 81 Early treatment of RA 81 Combination therapy 82 Mode of action and pharmacokinetics of DMARDs 82 The anti-malarials 83 Sulfasalazine 85 D-penicillamine 85 Myocrisin 86 Auranofin 87 Methotrexate 87 Leflunomide 88 Azathioprine 88 Cyclophosphamide 89 Ciclosporin 89 Chlorambucil 90 Phenylbutazone 90 Dapsone 91 Minocycline 91 Mycophenolate Mofetil Biologic therapies 92 Introduction 92 Biologically engineered therapies (biologics) 93 Classifications biologic therapies 93 Mode of action general 94 Adverse reactions to biologic therapies 95 Biologic therapies treatment options 104 General issues related to the mode of action for all anti-tnf therapies 107 Side effects that should be considered for all anti-tnf 108 Pregnancy and breastfeeding 111 Immunization 112 Specific information on anti-tnf 112 Biologic therapies patient issues The use of steroids in the treatment of rheumatic disease 119 Glucocorticoids 120 The use of steroids in rheumatoid arthritis 120 Corticosteroid sparing agents 121 Adverse effects of corticosteroids 121 The use of corticosteroids in other rheumatological conditions 123 Bone mineral metabolism 124 Peptic ulceration 125 Atherosclerosis 125 Reducing the dose of corticosteroids 125 vii

10 viii Pulsed corticosteroids 125 Intramuscular corticosteroids 126 Intra-articular/soft tissue injections of corticosteroids Disorders of purine metabolism: gout 126 Hyperuricaemia Nurse prescribing 131 Who should prescribe? 132 Independent prescribing 132 Supplementary prescribing 133 Educational preparation 134 Professional responsibilities 134 Evaluation of prescribing Self-medication 136 The case for self-medication 136 Advantages of self-medication 137 Stages in the implementation of self-medication Complementary medicine 139 Diet 140 Massage 141 Aromatherapy 142 Reflexology 142 Acupuncture 142 Herbal medicine 142 Naturopathy 143 Holism Glucosamine Capsaicin 145 Conclusion 145 Appendix 2.A What happens next? 145 Appendix 2.B Guidelines for nurses on the use and administration of intra-articular injections 146 References 148 Appendix 2.C Patient group direction for the administration of methylprednisolone injection 40 mg/ml by intramuscular injection 148 Case scenarios 152 References 152 CONTENTS 3 The Role of the Nurse in Drug Therapy 163 Sarah Ryan and Margaret Ann Voyce 3.1 What is rheumatology nursing? 163 The nurse patient relationship 165

11 CONTENTS 3.2 Telephone advice lines The philosophy of rheumatology nursing The role of the nurse in drug therapy 168 Empowerment The commencement of DMARDs 169 Patient preparation 169 Monitoring clinics 170 Documentation 172 The use of protocols 172 Drug monitor clinic protocols Investigations 177 Haematological investigations 177 Biochemical investigations 181 Assessment of rheumatic disease activity Urine testing 184 Appearance 185 Odour 185 Measurement of specific gravity 185 Record keeping Drugs that require surveillance 187 Gold (myocrisin) therapy 187 Auranofin (ridula) therapy in RA 190 D-penicillamine (distamine) 191 Sulfasalazine en therapy (salazopyrin) 194 Methotrexate 196 Azathioprine (imuran) therapy 199 Cyclophosphamide (endoxana) therapy 201 Ciclosporin 203 Chlorambucil 205 Phenylbutazone (butacote) 206 Dapsone 207 Minocycline (minocin) 208 Leflunomide 208 Mycophenolate Mofetil Vaccination Pregnancy 212 Contraception The role of the community team in drug therapy 214 Minimizing confusion Community drug monitoring 216 Documentation 217 GPs concerns relating to practice-based monitoring 218 Patients experiences of drug monitoring Community clinics 218 ix

12 x 3.14 General practice Evaluation of community clinics 219 Potential problems with consultant-based community clinics Nurse-led community clinics New ways of utilizing outpatient appointments Drug therapy and osteoporosis 222 Classification of osteoporosis 222 Risk factors for osteoporosis fracture 223 Investigations for osteoporosis Hormone replacement therapy (HRT) Pain management Drugs to reduce fracture risk 225 Bisphosphonates 225 Etidronate 225 Alendronate Sodium (fosamax) Other drug treatments 226 Calcitonin 226 Calcium 226 Vitamin D 227 Calcitriol 227 Formation stimulating agents 227 Strontium ranelate (protelos) Prevention (lifestyle strategies) 228 Diet 228 Smoking 228 Alcohol 228 Exercise 228 Falls 228 Conclusion 229 Appendix 3.A 229 Appendix 3.B 232 References 235 CONTENTS 4 Patient Education and Adherence with Drug Therapy 243 Jackie Hill 4.1 Definitions of patient education Useful theories and models 244 Learned helplessness theory 245 Stress and coping theory 245 Health belief model 246 Self-efficacy theory 247

13 CONTENTS Changing self-efficacy 248 Mastery of skills 248 Modelling 249 Persuasion 250 Reinterpretation of physiological state Purpose of patient education Limitations of patient education Role of the nurse in patient education 252 Patient education and some fundamental aspects of nursing 252 Patient education and therapeutic nursing 252 Reciprocity 252 Professional closeness Planning a patient education programme 254 The learning environment 254 Demographic considerations 255 Disease duration 255 Age range 255 Diagnosis 256 Mixed educational ability 256 The type of programme Individual patient education 257 Preferences of drug therapy 257 Assess the patients knowledge of drugs 258 Establishing shared goals 259 Preferred method of information transfer 259 Contracting 260 The activity to be accomplished 260 The plan of action 260 Checking that the contract is realistic Teaching in groups Opportunity education The arthritis self-management programme What to teach 263 Teaching about drug therapy 264 What to include 265 Risks and adverse effects Teaching aids 267 Videos and CDs 270 Audiocassettes 270 Computer programs The optimum timing of patient education 271 Readiness for change 271 xi

14 xii 4.14 Patient education and adherence 272 Conclusion 273 Appendix 4.A Methotrexate information sheet 274 References 277 Index 283 CONTENTS

15 List of Contributors Ann Brownfield, RGN, MSc, BSc (Hons) Clinical Nurse Specialist, North and South Primary Care Trust, Haywood Hospital, Stoke on Trent Janet Cushnagan, MSc, MCSP MRC ERC, Southampton General Hospital, Southampton Jackie Hill, PhD, MPhil, RN, FRCN Arc senior lecturer in rheumatology nursing and Co-director ACUMeN, Chapel Allerton Hospital, Leeds Jackie A McDowell, BSc (Hons), RGN, NDN Clinical nurse specialist, Hereford Hospitals NHS Trust, Hereford Susan Oliver, MSc Nurse Consultant Rheumatology, Litchdon Medical Centre, Devon Sarah Ryan, RGN, PhD, MSc, FRCN Nurse Consultant Rheumatology, North and South Primary Care Trust, Haywood Hospital, Stoke on Trent Margaret Ann Voyce, SRN Rheumatology Nurse Practitioner, Rheumatology Department, Royal Cornwall Hospital, Truro