Celecoxib

INTRODUCTION

Indications

Relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and juvenile rheumatoid arthritis. Reduction of the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP), as an adjunct to usual care (endoscopic surveillance, surgery). Management of acute pain, including primary dysmenorrhea.

Action

Inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins. Has analgesic, anti-inflammatory, and antipyretic properties. Therapeutic Effects: Decreased pain and inflammation caused by arthritis or spondylitis. Decreased number of colorectal polyps. Decreased pain.

Adverse Reactions/Side Effects

CNS: dizziness, headache, insomnia. CV: edema. GI: GI BLEEDING, abdominal pain, diarrhea, dyspepsia, flatulence, nausea. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor rashes or other skin reactions (hives, itching, dermatitis, exfoliation). Notify physician immediately because certain skin reactions may indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).

• Watch for signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Although celecoxib may produce fewer GI side effects than other NSAIDs, some patients may still experience GI bleeding and other gastric problems (diarrhea, nausea, flatulence, heartburn). Report these signs to the physician immediately.

• Continually monitor for signs of MI (sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea) and stroke (sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances). Although rare, celecoxib has been associated with coronary and cerebral thrombosis. seek immediate medical assistance if patient develops these signs.

• Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to vasodilation or fluid retention.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain, improve function, and decrease the need for celecoxib and other analgesics.

• Because of the risk of MI and stroke, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Help patient explore other nonpharmacologic methods to reduce chronic pain (relaxation techniques, ...