| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Gastrointestinal | |||
| Infliximab (Remicade)—IV 3 mg/kg up to 10 mg/kg | Autoimmune disorders (e.g., Crohn’s disease, ulcerative colitis, psoriatic arthritis) | Blocks the action of tumor necrosis factor-alpha, which attacks normal healthy parts of the body | Allergic reactions, bleeding problems |
| NURSING IMPLICATIONS: Infuse over 2 hr; use in-line filter. Medication to treat hypersensitivity should be available | |||
| Mesalamine (Asacol, Pentusa, Rowasa)—PO 800 mg 3 times/day for 6 wk | Ulcerative colitis | Local-acting anti-inflammatory in GI tract | Contraindicated if client has allergy to sulfonamides or salicylates; acceleration of symptoms; abdominal pain |
| NURSING IMPLICATIONS: Monitor for: abdominal pain, diarrhea, blood in stools, superinfection; if no improvement notify healthcare professional; may need diagnostic studies | |||
| Olsalazine (Dipentum)—PO 1 gm/day in 2 divided doses | See Mesalamine | See Mesalamine | See Mesalamine |
| NURSING IMPLICATIONS: See Mesalamine | |||
| Sulfasalazine (Azulfidine)—PO 3–4 gm/day in divided doses | See Mesalamine | See Mesalamine | See Mesalamine |
| NURSING IMPLICATIONS: See Mesalamine | |||
| Inhalants | |||
| Beclomethasone (Beclovent, Vanceril)—42–50 mcg/spray; 2 metered sprays 3–4 times/day | Emphysema | Glucocorticoid (inhalation) | Headache, hypersensitivity to fluorocarbon propellant; used with caution in diabetes or glaucoma |
| NURSING IMPLICATIONS: Do not exceed 1 mg/day | |||
| Flunisolide (AeroBid)—42–50 mcg/spray; 2 metered sprays 2–4 times/day | Emphysema | Potent locally acting anti-inflammatory and immune modifier | Headache, dysphonia; fungal infections; adrenal suppression with long-term use |
| NURSING IMPLICATIONS: Monitor respiratory status and lung sounds; assess clients changing from systemic to inhaled glucocorticoids for signs of adrenal insufficiency (anorexia, nausea, weakness, hypotension, hypoglycemia) | |||
| Triaminolone (Azmacort)—See Beclomethasone | Asthma | See Beclomethasone | See Beclomethasone |
| NURSING IMPLICATIONS: See Beclomethasone | |||
| Systemics | |||
| Cortisone acetate—PO, IM 20–100 mg daily in single or divided doses | Adrenocorticotropic hormone (ACTH) insufficiency; rheumatoid arthritis; allergies; ulcerative colitis; nephrosis | Anti-inflammatory effect of unknown action | Moon facies, hirsutism, thinning of skin, striae; hypertension; menstrual irregularities, delayed healing; psychoses |
 NURSING IMPLICATIONS: Give oral form pc, with snack at bedtime; give deep IM ( never deltoid); monitor vital signs; observe for behavior changes; skin care and activity to tolerance; diet—salt restricted, high protein, KCl supplement; protect from injury | |||
| Desoxycorticosterone acetate (hydrocortisone)—IM, IV 100–500 mg q2–6h; PO 3–5 mg 2–4 times daily | Addison’s disease; burns; surgical shock; adrenal surgery | Promotes reabsorption of sodium; restores plasma volume, BP, and electrolyte balance | Edema, hypertension, pulmonary congestion, hypokalemia |
| NURSING IMPLICATIONS: Salt restriction according to BP readings; monitor vital signs; weigh daily | |||
| Dexamethasone (Decadron)—PO 0.5–5.0 mg daily; IM, IV 4–20 mg daily | Addison’s disease; allergic reactions; leukemia; Hodgkin’s disease; iritis; dermatitis; rheumatoid arthritis Obstetric use: stimulate surfactant production in client with premature labor | Anti-inflammatory effect | See Cortisone acetate |
| NURSING IMPLICATIONS: Contraindicated in tuberculosis; see Cortisone acetate for nursing care | |||
| Methylprednisolone sodium (Solu-Medrol)—IV, IM 10–40 mg, slowly | Glucocorticoid, corticosteroid | See Dexamethasone | See Dexamethasone |
| NURSING IMPLICATIONS: See Dexamethasone | |||
| Prednisolone (Deltsone)—PO 5–60 mg/day single or divided doses | Multiple sclerosis | Suppress inflammation and normal immune response | Depression, euphoria; peptic ulceration; thromboembolism |
| NURSING IMPLICATIONS: Monitor for: Homans’ sign, abdominal pain, vomiting, tarry stools, mental status or mood changes | |||
| Prednisone—PO 2.5–15.0 mg daily | Rheumatoid arthritis; cancer therapy | Anti-inflammatory effect of unknown action | Insomnia and gastric distress |
| NURSING IMPLICATIONS: See Cortisone acetate | |||
| Rituximab (Rituxan)—IV 1,000-mg doses separated by 2 wk | Non-Hodgkin’s lymphoma; rheumatoid arthritis | Monoclonal antibody that interferes with growth and spread of certain B cells | Infusion reaction; tumor lysis syndrome, skin reaction, fever, headache, chills, sneezing |
| NURSING IMPLICATIONS: Give slowly IV. Avoid vaccines during treatment | |||