Ridaura

auranofin

(au-rane-oh-fin) ,

Ridaura

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (anti-inflammatory activity)

ROUTE	ONSET	PEAK	DURATION
PO	3–6 mo	unknown	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• peripheral neuropathy

Ear, Eye, Nose, Throat

• conjunctivitis
• corneal gold deposition

Genitourinary

• proteinuria,
• hematuria

Respiratory

• bronchitis
• pulmonary fibrosis
• pneumonitis

Cardiovascular

• bradycardia

Gastrointestinal

• gi bleeding (life-threatening)
• abdominal pain (most frequent)
• cramping (most frequent)
• diarrhea (most frequent)
• gingivitis
• glossitis
• metallic taste
• stomatitis (most frequent)
• anorexia
• difficulty swallowing
• ↑ liver enzymes
• dyspepsia
• flatulence
• nausea
• vomiting

Dermatologic

• dermatitis (most frequent)
• rash (most frequent)
• alopecia
• urticaria
• photosensitivity reactions
• pruritus (most frequent)

Hematologic

• agranulocytosis (life-threatening)
• aplastic anemia (life-threatening)
• thrombocytopenia
• anemia
• eosinophilia
• leukopenia

Miscellaneous

• allergic reactions, including anaphylaxis (life-threatening)
• angioedema (life-threatening)

Interactions

Drug-Drug interaction

Bone marrow toxicity may be additive with other myelosuppressive agents (antineoplastics, radiation therapy, azathioprine ) or high doses of corticosteroids.Concurrent use with penicillamine ↑ the risk of adverse hematologic or renal reactions.May ↑ blood levels of phenytoin.

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess range of motion and degree of swelling and pain in affected joints before and periodically throughout therapy.
• Lab Test Considerations: Monitor renal, hepatic, and hematologic function and urinalysis before and monthly during therapy. May cause thrombocytopenia, leukopenia, and anemia. May also cause ↑ liver enzymes, proteinuria, and hematuria.
Rapid decrease in hemoglobin, WBC <4000/mm³, granulocytes <1500/mm³, or platelets <150,000/mm³, albuminuria, hematuria, rash, dermatitis, pruritus, skin eruption, stomatitis, persistent diarrhea, jaundice, or petechiae may indicate gold toxicity. Withhold therapy until toxicity has been ruled out. If signs of overdose occur, corticosteroids are usually used to reverse effects. A chelating agent, dimercaprol (BAL), may be given to enhance gold excretion when corticosteroids are ineffective.

Potential Nursing Diagnoses

Impaired physical mobility (Indications)
Diarrhea (Side Effects)

Implementation

• Oral: Administer with meals to minimize gastric irritation.

Patient/Family Teaching

• Instruct patient to take medication exactly as directed; do not skip or double doses. Take missed dose as soon as possible except if next dose is almost due.
• Concurrent therapy with salicylates or other NSAIDs or corticosteroids is usually necessary, especially during the first few months of gold therapy. Patients should continue physical therapy and ensure adequate rest. Explain that joint damage will not be reversed; the goal is to slow or stop the disease process.
• Emphasize the importance of good oral hygiene to reduce stomatitis.
• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
• Instruct patient to report symptoms of leukopenia (fever, sore throat, signs of infection); thrombocytopenia (bleeding gums; bruising; petechiae; blood in stools, urine, or emesis); or gold toxicity immediately. Diarrhea may be resolved by decreasing the dose.
• Emphasize the importance of regular visits to health care professional to monitor progress and evaluate blood and urine tests for side effects.
• Discuss the need for contraception while receiving this medication. Advise female patients to notify health care professional promptly if pregnancy is suspected.

Evaluation/Desired Outcomes

• Decrease in swelling, pain, and stiffness of joints.
  • Increase in mobility. Continuous therapy for 3–6 mo may be required before therapeutic effects are seen.