McKenna's Pharmacology for Nursing, 2e

C H A P T E R 1 6  Anti-inflammatory, antiarthritis and related agents 253

TABLE 16.3

DRUGS IN FOCUS Antiarthritis agents

Drug name

Dosage/route

Usual indications

Gold compounds

Adult: 6 mg/day PO; monitor geriatric people carefully Paediatric: 0.1–0.15 mg/kg per day PO Adult: 10 mg IM, then 25 mg IM every other week; use caution in geriatric people Paediatric: 10 mg IM, then 1 mg/kg IM every other week

Oral agent for long-term therapy of rheumatic disorders

auranofin (Ridaura)

sodium aurothiomalate (Myocrisin)

Injected drug for early treatment of rheumatic disorders

Other antiarthritis drugs anakinra (Kineret)

Adult: 100 mg/day SC

Reduction of signs and symptoms of rheumatoid arthritis in people ≥18 years if one or more other arthritis agents have failed Reduction of signs and symptoms of severe rheumatoid arthritis in people whose disease is unresponsive to other therapy; prevention of damage early in the disease; ankylosing spondylosis; psoriatic arthritis Relief of pain in the knees of people with arthritis whose disease is unresponsive to conventional treatment Treatment of active rheumatoid arthritis, to relieve signs and symptoms and to slow the progression of disease in adults Treatment of severe, active rheumatoid arthritis in adults whose disease is unresponsive to conventional therapy Relief of pain in the knees of people with arthritis whose disease is unresponsive to conventional treatment

etanercept (Enbrel)

Adult: 25 mg SC two times per week or 50 mg SC once a week Paediatric (4–17 years): 0.4 mg/kg SC two times per week with 72–96 hours between doses; not recommended for children <4 years 2 mL once a week for 3 weeks injected into the affected knee

hyaluronidase (Hyalase)

leflunomide (Arava)

100 mg PO daily for 3 days, then 20 mg PO daily

penicillamine

250 mg/day PO for 1 month, increasing to dose of 1500 mg/day PO

(D-Penamine)

sodium hyaluronate (Fermathron)

20 mg once a week for 5 weeks injected into affected knee

Clinically important drug–drug interactions These drugs should not be combined with penicillamine, antimalarials, cytotoxic drugs or immunosuppressive agents other than low-dose corticosteroids because of the potential for severe toxicity. Prototype summary: Auranofin Indications: Treatment of selected cases of adult and juvenile rheumatoid arthritis, most effective early in disease. Actions: Although the mechanism of action has not been fully elucidated, auranofin exhibits a variety of anti-inflammatory, antiarthritic and immunoregulatory activities. These properties include: stimulation of cell-mediated immunity, suppression of immunoglobulin synthesis and antibody-dependent cytotoxicity, suppression of the respiratory burst/superoxide radicals, inhibition

D isease - modifying antirheumatic drugs Other antiarthritis drugs, called disease-modifying antirheumatic drugs (DMARDs), are available for treating arthritis and aggressively affect the process of neutrophil release of lysosomal enzymes and secretion of inflammatory eicosanoids, inhibition of platelet aggregation, serotonin production and protein kinase C activity. Pharmacokinetics: Route Onset Peak Oral Rapid 2 hours T 1/2 : 10 to 30 days; excreted mainly in faeces and some in urine. Adverse effects: Dermatitis, nausea, diarrhoea, anaemia, membranous glomerulonephritis and nephrotic syndrome.