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Medications Used to Treat Lupus

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) continued...

Types of NSAIDs

There are as many as 70 NSAIDs on the market, and new ones are constantly becoming available. Some can be purchased as over-the-counter preparations, whereas larger doses of those drugs or other preparations are available only by prescription. For example, prescriptions are required for diclofenac sodium (Voltaren), indomethacin (Indocin), diflunisal (Dolobid), and nabumetone (Relafen).

Mechanism of Action and Use

The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating joint pain and swelling and muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.

Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching the patient to a different NSAID should produce the desired effects. Patients should use only one NSAID at any given time.

Side/Adverse Effects

Gastrointestinal: Dyspepsia, heartburn, epigastric distress, and nausea; less frequently, vomiting, anorexia, abdominal pain, GI bleeding, and mucosal lesions. Misoprostol (Cytotec), a synthetic prostaglandin that inhibits gastric acid secretion, may be given to prevent GI intolerance. It prevents gastric ulcers and their associated GI bleeding in patients receiving NSAIDs.

Genitourinary: Fluid retention, reduction in creatinine clearance, and acute tubular necrosis with renal failure.

Hepatic: Acute reversible hepatotoxicity.

Cardiovascular: Hypertension and moderate to severe noncardiogenic pulmonary edema.

Hematologic: Altered hemostasis through effects on platelet function.

Other: Skin eruption, sensitivity reactions, tinnitus, and hearing loss.

Pregnancy and Lactation

NSAIDs should be avoided during the first trimester and just before delivery; they may be used cautiously at other times during pregnancy. NSAIDs appear in breast milk and should be used cautiously by breastfeeding mothers.

Considerations for Health Professionals

Assessment

History: Allergy to salicylates, other NSAIDs, cardiovascular dysfunction, hypertension, peptic ulcer, GI bleeding or other bleeding disorders, impaired hepatic or renal function, pregnancy, and lactation.

Laboratory data: Hepatic and renal studies, CBC, clotting times, urinalysis, serum electrolytes, and stool for guaiac.

Physical: All body systems to determine baseline data and alterations in function, skin color, lesions, edema, hearing, orientation, reflexes, temperature, pulse, respirations, and blood pressure.

Evaluation

Therapeutic response, including decreased inflammation and adverse effects.

Administration

With food or milk (to decrease gastric irritation).

Antimalarials

This group of drugs was first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators discovered antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use of antimalarials showed that they are effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever. They have also been shown to be effective in the treatment of DLE. Antimalarials are not used to manage more serious, systemic forms of SLE that affect the organs. It may be weeks or months before the patient notices that these drugs are controlling disease symptoms.

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