Three things that I learned in this modules readings:

1. It is recommended to start all patients with rheumatoid arthritis (RA) on disease-

modifying antirheumatic drugs (DMARDs), medication therapy should be started early in

the disease process to decrease the progression of the disease.

2. Folic acid 1mg daily should be prescribed when taking DMARD medications, such as

Methotrexate, due to this medication being a folic acid antagonist.

3. Capsaicin is available as an over the counter topical analgesic for relief of neurogenic

pain. I was aware that this was an ingredient in peppers that causes a burning sensation,

but was not aware that it was in medicine form or that it was used to treat pain.

Two things that I will change the way I educate patients:

1. If taking antimalarial medications, such as hydroxychloroquine (Plaquenil), an eye exam

will be needed every 6-12 months.

2. Some of the frequently used over the counter medications, such as Excedrin migraine,

can cause a medication overuse headache. I will always ask about the frequency of use

of OTC medications and educate accordingly.

One question that I still have:

When prescribing corticosteroid joint injections, how judiciously should you use these

medications, and can practitioners administer these medications?

Cynthia,

I enjoyed reading your post. I was also unaware of the fact that colchicine has the potential to

cause diarrhea, and plan to add that to my education plan for patients in the future. I also
believe that preventative medicine and non-drug therapy is many times underutilized in the

medical profession.

In response to your question, How long should you give migraine therapy regimen before you

decide that it is not working? I did some reading and this is what I found, according to Mallick-

Searle (2016), It is essential to treat patients for an adequate amount of time (2 to 3 months)

before a change in treatment (p. 1052). I can only imagine, with the horrible and debilitating

pain of a migraine that has to seem like a lifetime with a regimen that you feel is not helping.

Also according to Mallick-Searle (2016), it is also an essential part of patient education of

migraine sufferers to ensure that they set realistic goals for their treatment, such as reduction in

frequency by 50%, and total elimination is not a realistic goal (p. 1052).

Mallick-Searle, T. (2016). Headaches. In T. M. Woo & M. L. Robinson (Eds.),

Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.), (pp. 1035-

1062). Philadelphia, PA: F. A. Davis Company.

Scott,

I enjoyed reading your post and you bring up a valid point. From previous inquiry about this

subject, it is to my understanding when treating infection, to treat empirically and if need be

change the treatment regimen. Like you, I feel uneasy about treating something that I am unsure

about. As I have heard many times from providers, as well as in class, if it looks like a duck,

and quacks like a duck, treat it like a duck. Unless insurance and cost is an issue, if uncertain,

one could always obtain bloodwork/ cultures, treat empirically until the lab results come back,

and change the treatment regimen as needed.

Also in response to Pennys response to your question, I find it so disturbing that healthcare

providers just write medications, even if the patient does not need them, in order to keep the

patient happy. In todays society, many (including myself) have been guilty of wanting a quick

fix for an illness with a prescription medication, when oftentimes a simple lifestyle modification

or change could be of benefit, without all of the additional side effects. I believe that patient

education is essential, and as future providers, we need to be proactive in assuring that our

patients understand all of the potential risks, as well as the benefits of medications and treatment

plans. How do you justify prescribing an antibiotic when the medication is not warranted for the

diagnosis? A question/thought that I have about that situation, how happy are those patients

going to be when they become tolerant to antibiotics or when the acquire a drug resistant bug

due to the overuse of unneeded antibiotics?