Rheumatologic Disorders

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Systemic Lupus Erythematosus
1.Admit to:
2.Diagnosis: Systemic Lupus Erythematosus
3.Condition:
4.Vital Signs: tid
5.Allergies:
6.Activity: Up as tolerated with bathroom privileges
7.Nursing:
8.Diet: No added salt, low psoralen diet.
9. Special Medications:
-Ibuprofen (Motrin) 400 mg PO qid (max 2.4 g/d) OR
-Indomethacin (Indocin) 25-50 mg tid-qid.
-Hydroxychloroquine (Plaquenil) 200-600 mg/d PO
-Prednisone 60-100 mg PO qd. Maintenance 10-20
mg PO qd or 20-40 mg PO qOD OR
-Methylprednisolone (pulse therapy) 500 mg IV over
30 min q12h for 3-5d, then prednisone 50 mg PO
qd.
-Betamethasone dipropionate (Diprolene) 0.05%
ointment applied bid.
10. Extras: CXR PA, LAT, ECG. Rheumatology consult.
11. Labs: CBC, platelets, SMA 7&12, INR/PTT, ESR,
complement CH-50, C3, C4, C-reactive protein, LE
prep, Coombs test, VDRL, rheumatoid factor, ANA,
DNA binding, lupus anticoagulant, anticardiolipin,
antinuclear cytoplasmic antibody. UA.
Acute Gout Attack
1.Admit to:
2.Diagnosis: Acute gout attack
3.Condition:
4.Vital Signs: tid
5.Activity: Bed rest with bedside commode
6.Nursing: Keep foot elevated; support sheets over
foot; guaiac stools.
7.Diet: Low purine diet.
8.Special Medications:
-Ibuprofen (Motrin) 800 mg, then 400-800 mg PO q4-
6h OR
-Diclofenac (Voltaren) 25-75 mg tid-qid with food OR
-Indomethacin (Indocin) 50 mg PO q6h for 2d, then
50 mg tid for 2 days, then 25 mg PO tid OR
-Ketorolac (Toradol) 30-60 mg IV/IM, then 15-30 mg
IV/IM q6h or 10 mg PO tid-qid OR
-Naproxen sodium (Anaprox, Anaprox-DS) 550 mg
PO bid OR
-Methylprednisolone (SoluMedrol) 125 mg IV x 1 dose
THEN
-Prednisone 60 mg PO qd for 5 days, followed by
tapering.
-Colchicine 2 tablets (0.5 mg or 0.6 mg), followed by 1
tablet q1h until relief, max dose of 9.6 mg/24h.
Maintenance colchicine: 0.5-0.6 mg PO qd-bid.
Hypouricemic Therapy:
-Probenecid (Benemid), 250 mg bid. Increase the
dosage to 500 mg bid after 1 week, then increase
by 500-mg increments every 4 weeks until the uric
acid level is below 6.5 mg/dL. Max dose 2 g/d.
Contraindicated during acute attack.
-Allopurinol (Zyloprim) 300 mg PO qd, may increase
by 100-300 mg q2weeks. Usually initiated after the
acute attack.
9. Symptomatic Medications:
-Famotidine (Pepcid) 20 mg IV/PO q12h.
-Meperidine (Demerol) 50-100 mg IM/IV q4-6h prn
pain OR
-Hydrocodone/acetaminophen (Vicodin), 1-2 tab q4-
6h PO prn pain.
-Docusate sodium (Colace) 100 mg PO qhs.
-Acetaminophen (Tylenol) 325-650 mg PO q4-6h prn
headache.
-Zolpidem (Ambien) 5-10 mg qhs prn insomnia.
10. Labs: CBC, SMA 7, uric acid. UA with micro.
Synovial fluid for light and polarizing micrography for
crystals; C&S, Gram stain, glucose, protein, cell count.
X-ray views of joint. 24-hour urine for uric acid.