Auranofin (Ridaura) is prescribed for a client with rheumatoid arthritis, and the nurse monitors the client for signs of an adverse effect related to the medication. Which of the following indicates an adverse effect?
A. Nausea
B. Diarrhea
C. Anorexia
D. Proteinuria
Correct Answer: D. Proteinuria
Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side effects of the medication.
Option A: Auranofin is used, with rest and nondrug therapy, to treat rheumatoid arthritis. It improves arthritis symptoms including painful or tender and swollen joints and morning stiffness. Auranofin comes as a capsule to take by mouth. It usually is taken once or twice a day. It must be taken on a regular schedule, as prescribed by the doctor, to be effective. The full effect of this drug usually is not felt for 3-4 months; in some people, it may take up to 6 months.
Option B: Auranofin may cause an upset stomach. Take auranofin after meals or a light snack. It may act as an inhibitor of kappa B kinase and thioredoxin reductase which would lead to a decreased immune response and decreased free radical production, respectively. In patients with inflammatory arthritis, such as adult and juvenile rheumatoid arthritis, gold salts can decrease the inflammation of the joint lining. This effect can prevent the destruction of bone and cartilage.
Option C: Plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing and sunscreen. Auranofin may make your skin more sensitive to sunlight. The main mechanism of action of auranofin is through the inhibition of reduction/oxidation (redox) enzymes such as thioredoxin reductase (TrxR). The thiol ligand contained in auranofin has a high affinity for thiol and selenol groups, to which it forms stable, and irreversible, adducts. Redox enzymes such as TrxR are essential to many cellular processes, particularly in maintaining the intracellular levels of reactive oxygen species (ROS).