National Nursing Ebook Continuing Education Summaries

227 Nursing Assessment, Management and Treatment of Autoimmune Diseases

Treatment Lupus is a chronic condition that needs ongoing management. The overall goals of treatment are to promote remission of symptoms and limit the damage that the disease does to patients’ organs (Cleve- land Clinic, 2021). | NURSING CONSIDERATION Lupus is an unpredictable disease that can change with time. This means that treatment interventions may need to be changed to meet the current state of the disease (Cleveland Clinic, 2021). Medications are the foundation of treat - ment for lupus. Medications most often prescribed to treat lupus include the fol- lowing (Cleveland Clinic, 2021; Mayo Clinic, 2021a; Rebar et al., 2019): ● Corticosteroids : Corticosteroids such as prednisone are prescribed to reduce the inflammatory process. Steroid creams can be applied directly to rashes. Steroid pills in low doses may be effective for patients with mild to moderate forms of the disease. High doses of steroids such as methylprednisolone (Medrol) are frequently used to control serious disease involving the kidneys and brain and other internal organs. Unfortunately, high doses of steroids often produce side effects. Side effects include weight gain, bruising easily, hypertension, diabetes, and bone diseases such as osteoporosis.

| NURSING CONSIDERATION

Initial prednisone doses of 60 mg or more are typical. Noticeable improve- ment of the patient’s condition is usu- ally apparent within 48 hours. After symptoms are controlled, the dosage is tapered gradually and then discon- tinued (Rebar et al., 2019). ● Hydroxychloroquine (Plaquenil) : Hydroxychloroquine is an antimalarial drug that has been prescribed to help keep lupus-related skin and joint disease under control. It has also been found to be effective in the treatment of fatigue and mouth sores. ● Azathioprine (Imuran) : An immunosuppressant, azathioprine (originally used to prevent transplanted organ rejection) is generally used to treat the more serious aspects of the disease. ● Methotrexate (Rheumatrex) : Methotrexate is an antineoplastic drug used to suppress the immune system. It has been found to be helpful in the treatment of lupus-related skin disease, arthritis, and other forms of the disease that are not life- threatening. This medication is used for patients who have not responded to drugs such as hydroxychloroquine or low doses of prednisone. ● Cyclophosphamide (Cytoxan) and mycophenolate mofetil (CellCept) : These are antineoplastic drugs that significantly reduce immune system activity. They are used to treat more severe forms of lupus, particularly if there is kidney involvement. ● Belimumab (Benlysta) : Belimumab is a monoclonal antibody used to reduce the activity of lymphocytes,

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