Antirheumatics sulfasalazine

Sulfasalazine use is often limited by adverse effects. Antirheumatic effects should be seen in 2 months. 

Sulfasalazine (Azulfidine, Azulfidine EN) [Anti-inflammatory/ Antirheumatic (DMARD)/Sulfonamide] Uses Ulcerative colitis, RA, juvenile RA, active Crohn Dz, ankylosing spondylitis, psoriasis Action Sulfonamide actions unclear Dose Adults. Initial, 1 g PO tid-qid T to a max of 8 g/d in 3 -5- doses maint 500 mg PO qid Feds. Initial 40-60 mg/kg/24 h PO -s- q4-6h maint 20-30 mg/kg/24 h PO q6h RA >6 y 30-50 mg/kg/d in 2 doses, start w/ 1/4-1/3 maint dose, T wkly until dose reached at 1 mo, 2 g/d max -i in renal failure... 

Sulfasalazine, a prodrug, is cleaved by bacteria in the colon into sulfapyridine and 5-aminosalicylic acid. It is believed that the sul-fapyridine moiety is responsible for the agent s antirheumatic properties, although the exact mechanism of action is not known. Once the colonic bacteria have cleaved sulfasalazine, sulfapyridine and 5-aminosalicylic acid are absorbed rapidly from the gastrointestinal tract. Sulfapyridine distributes rapidly throughout the body, but higher concentrations are found in certain tissues such as serous fluid, liver, and intestines. Both sulfasalazine and its metabolites are excreted in the urine. Antirheumatic effects should be seen within 2 months. 

Slow-acting antirheumatic drugs Methotrexate Hydroxychloroquine, sulfasalazine Infliximab, etanercept, leflunomide, penicillamine, gold... 

Older disease-modifying antirheumatic drugs (DMARDs) used frequently in rheumatoid arthritis include hydroxychloroquine, methotrexate, steroids, and sulfasalazine. Gold salts and penicillamine may be effective but cause severe toxicity (see Chapter 36). 

Which assessment data would the nurse expect for the client with rheumatoid arthritis who is taking sulfasalazine (Azulfidine), an antirheumatic medication ... 

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