Question

A nurse is teaching about a new prescription for infliximab to a client who has rheumatoid arthritis. Which of the following information should the nurse include in the teaching?
a. “You will receive a Mantoux test before the initial medication dose.”
b. “You might experience diarrhea during the first 2 weeks of treatment.”
c. “You will receive the medication every week for 6 weeks.”
d. “You should receive the intranasal influenza vaccine.”

Answer 1

Answer: Opcion A. "You will receive a Mantoux test before the initial medication dose"

Explanation: The INFLIXIMAB is one of the medications used for treating Rheumatoid arthritis, among other inflammatory diseases as psoriasic arthritis,  ankylosing spondylitis, Crohn's disease. It is used when the regular treatment has not worked. It helps to reduce pain and joint inflammation.

The mechanism of action of the INFLIXIMAB is to reduce a substance called TNFα (Tumor Necrosis Factor α) responsible for the inflammatory response that helps the body against an antigen. Because this medication reduces this body defense, it is important for the health providers to know in advance if there is a condition or disease in the immune system, cancer, or something that per se, could predispose to infections.

The Mantoux test is a tuberculin skin test that is used to know if a person has an infection with Mycobacterium tuberculosis, the bacteria responsible of causing Tuberculosis. In the test, a tuberculin protein called PPD is used to be injected into the skin, specifically in the forearm. If the person is infected with the bacteria, it is expected that between 48 and 72 hours, the health professional would see an induration in the site of injection.

If someone has a positive tuberculin test, then it would not be possible to administer INFLIXIMAB.

Opcion B. Incorrect. There is no description of diarrhea as an adverse event for using this medication. The adverse effects could be headache, stomach ache, cough or skin allergy. Also, for the suppression of part of the immune system, it is recommended to be aware of symptoms of infection as fever, sweats, muscle pain.

Opcion C. Incorrect. The usual dose of INFLIXIMAB in the treatment of Rheumatoid Arthritis for adults is, an inicial dose, then a second dose 2 weeks later; then, a third dose 4 weeks later, and finally one dose every 8 weeks.

Opcion D. Incorrect. The intranasal influenza vaccine is a "live attenuated" vaccine. If it is administered in a person using INFLIXIMAB, he/she could develop a severe infection by Influenza.