Sulfasalazine

INTRODUCTION

Indications

Inflammatory bowel diseases, including Ulcerative colitis, Proctitis, Proctosigmoiditis. Rheumatoid arthritis unresponsive or intolerant to salicylates and/or NSAIDs.

Action

Locally acting anti-inflammatory action in the colon, where activity is probably a result of inhibition of prostaglandin synthesis. Therapeutic Effects: Reduction in the symptoms of inflammatory bowel disease.

Adverse Reactions/Side Effects

CNS: headache. Resp: pneumonitis. GI: anorexia, diarrhea, nausea, vomiting, drug-induced hepatitis. GU: crystalluria, oligospermia, orange-yellow discoloration of urine. Derm: rashes, exfoliative dermatitis, photosensitivity, yellow discoloration. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, blood dyscrasias, eosinophilia, megaloblastic anemia, thrombocytopenia. Neuro: peripheral neuropathy. Misc: hypersensitivity reactions, including SERUM SICKNESS AND STEVENS-JOHNSON SYNDROME, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report signs of agranulocytosis (fever, sore throat, mucosal lesions, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or any unusual weakness and fatigue that might be due to aplastic anemia or other anemias. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Monitor signs of hypersensitivity reactions, especially signs of serum sickness (muscle aches, joint pains, fever, skin rash) or Stevens-Johnson syndrome (hives, acne, abnormal sweating, exfoliation). Notify physician immediately if these reactions occur.

• If treating rheumatoid arthritis, periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

• Assess any breathing problems or signs of pneumonitis such as dry cough, wheezing, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Be alert for signs of peripheral neuromyopathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• If treating inflammatory bowel diseases, monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful.

Interventions

• Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of anti-rheumatic drug therapy.

• Help patient explore other nonpharmacologic methods to reduce chronic arthritis pain, such as relaxation techniques, exercise, counseling, and so forth.

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, and loss of appetite. Instruct patient to report severe or prolonged GI ...