Sample Answer for NUR-635 Topic 8 DQ 1 Included After Question
AJ is a student enrolled in the FNP program at Grand Canyon University. She is on her first clinical rotation, and she is asked to review a patient chart. AJ notices rheumatoid arthritis (RA) on a patient’s past medical history. AJ is not familiar with the treatment of RA, so her preceptor encourages her to do some research on the topic to gain a better understanding of RA. She is given the American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis to read.
Briefly describe the pathophysiology associated with rheumatoid arthritis. Based on the most current version of the American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis, use the following drug classes to complete the questions below:
Conventional DMARDs
Biologic DMARDs
Targeted synthetic DMARDs
Glucocorticoids
Identify a medication from one of the above drug classes, and briefly describe how the mechanism of action can treat rheumatoid arthritis. Determine monitoring, side effects, and drug-drug interactions associated with each medication. Based on the American College of Rheumatology, discuss the place in therapy for each medication class.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2
A Sample Answer For the Assignment: NUR-635 Topic 8 DQ 1
Title: NUR-635 Topic 8 DQ 1
Pathophysiology of Rheumatoid Arthritis (RA):
RA is an autoimmune disease characterized by chronic inflammation of the synovial lining of the joints. In RA, the immune system mistakenly attacks the synovium, leading to the formation of a hyperplastic synovial membrane. This results in the production of inflammatory cytokines, which, in turn, cause destruction of cartilage and bone in the affected joints, leading to symptoms such as pain, swelling, stiffness, and joint deformities (Chauhan, 2023).
Current Drug Classes for RA Treatment:
Conventional DMARDs (Disease-Modifying Antirheumatic Drugs):
- Medication Example: Methotrexate
- Mechanism of Action: Methotrexate inhibits immune cell proliferation, particularly lymphocytes, and reduces the production of inflammatory cytokines, thus suppressing the autoimmune response (Rosenthal, 2020).
- Monitoring: Patients on methotrexate require regular blood tests to monitor liver function, blood counts, and kidney function.
- Side Effects: Common side effects include nausea, liver toxicity, and bone marrow suppression.
- Place in Therapy: Methotrexate is often considered a first-line treatment for RA due to its efficacy and relatively favorable side effect profile.
Biologic DMARDs
- Medication Example: Adalimumab (a TNF-alpha inhibitor)
- Mechanism of Action: Adalimumab and other biologics target specific proteins or cells in the immune system to reduce inflammation. In this case, it inhibits TNF-alpha, a pro-inflammatory cytokine (Rosenthal, 2020).
- Monitoring: Regular monitoring for infections, including tuberculosis, is necessary as biologics can suppress the immune system.
- Side Effects: Common side effects include an increased risk of infections and injection site reactions.
- Place in Therapy: Biologics are often used when conventional DMARDs have not been effective or in more severe cases of RA.
Targeted Synthetic DMARDs:
- Medication Example: Tofacitinib
- Mechanism of Action: Tofacitinib is a Janus kinase (JAK) inhibitor that modulates the immune response by interfering with the signaling pathways of certain cytokines (Pang, 2022).
- Monitoring: Regular monitoring for side effects, including liver enzyme levels and blood counts, is required.
- Side Effects: Potential side effects include an increased risk of infections, liver problems, and changes in blood cell counts.
- Place in Therapy: Targeted synthetic DMARDs are often used in cases where other treatments have not been effective, similar to biologics.
Glucocorticoids:
- Medication Example: Prednisone
- Mechanism of Action: Glucocorticoids, such as prednisone, have anti-inflammatory and immunosuppressive effects, helping to reduce inflammation and pain in RA (Rosenthal, 2020).
- Monitoring: Patients on long-term glucocorticoid therapy may require monitoring for bone density and potential side effects.
- Side Effects: Long-term use can lead to numerous side effects, including weight gain, bone thinning, and an increased susceptibility to infections.
- Place in Therapy: Glucocorticoids are often used as a bridge therapy to manage acute symptoms of RA while waiting for other DMARDs to take effect or to control flares.
For the most current and specific information on the guidelines and medications for RA treatment, it is essential to refer to the most recent version of the American College of Rheumatology Guidelines (Singh, 2015) or consult with a healthcare professional.
Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.
Pang, M., Sun, Z., & Zhang, H. (2022). Biologic DMARDs and targeted synthetic DMARDs and the risk of all-cause mortality in rheumatoid arthritis: A systematic review and meta-analysis. Medicine, 101(32), e29838. https://doi.org/10.1097/MD.0000000000029838
Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016;68:1–26.
