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    Medications Used to Treat Lupus

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

    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.

    Types of Antimalarials

    The drugs most often prescribed are hydroxychloroquine sulfate (Plaquenil) and chloroquine (Aralen).

    Mechanism of Action and Use

    The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.

    Side/Adverse Effects

    Central Nervous System: Headache, nervousness, irritability, dizziness, and muscle weakness.

    Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps, and loss of appetite.

    Ophthalmologic: Visual disturbances and retinal changes manifested by blurring of vision and difficulty in focusing. A very serious potential side effect of antimalarial drugs is damage to the retina. Because of the relatively low doses used to treat SLE, the risk of retinal damage is small. However, patients should have a thorough eye examination before starting this treatment and every 6 months thereafter.

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