Biologic Response-Modifying and Antirheumatic Drugs Flashcards
Aldesleukin (IL-2)
Chemical Classification
Interleukin-2, human recombinant (cytokine)
Aldesleukin (IL-2)
Mechanism of Action
Enhancement of lymphocyte mitogenesis and stimulation of IL-2-dependent cell lines; enhancement of lymphocyte cytotoxicity; induction of killer cell activity; induction of inteferon-gamma production; results in activation of cellular immunity, production of cytokines, and inhibition of tumor growth
Aldesleukin (IL-2)
Uses
Metastatic renal cell carcinoma in adults; melanoma (metastatic)
Aldesleukin (IL-2)
Contraindications
Hypersensitivity, abnormal thallium stress test or pulmonary function tests, organ allografts, angina, cardiac tamponade, MI, GI bleeding/perforation, psychosis, renal failure, pulmonary insufficiency, seizures, ventricular tachycardia
Cardiac/Pulmonary disease, coma
Aldesleukin (IL-2)
Side Effects
CNS: mental status changes, dizziness, sensory dysfunction, syncope, motor dysfunction, Fever, Chills, headache, impaired memory, depression, sleep disturbances, hallucinations, rigors, neuropathy
CV: Hypotension, sinus tachycardia, dysrhythmias, bradycardia, PVCs, PACs, myocardial ischemia, MYOCARDIAL INFARCTION, CARDIAC ARREST, CAPILLARY LEAK SYNDROME, CVA
EENT: reversible visual changes
GI: Nausea, Vomiting, Diarrhea, Stomatitis, Anorexia, GI bleeding, dyspepsia, constipation, INTESTINAL PERFORATION/ileus, jaundice, ascites
GU: OLIGURIA/ANURIA, PROTEINURIA, HEMATURIA, dysuria, RENAL FAILURE
HEMA: Anemia, THROMBOCYTOPENIA, LEUKOPENIA, COAGULATION DISORDERS, LEUKOCYTOSIS, EOSINOPHILIA
INTEG: Pruritus, Erythema, Rash, dry skin, EXFOLIATIVE DERMATITIS, purpura, petechiae, urticaria
MS: arthralgia, myalgia
RESP: pulmonary congestion, Dyspnea, PULMONARY EDEMA, RESPIRATORY FAILURE, APNEA, tachypnea, pleural effusion, wheezing
SYST: infection
Aldesleukin (IL-2)
Nursing Considerations
ASSESS:
- CBC, differential, platelet count weekly; may withhold product if WBC is 2L or >/=75% before therapy; monitor temp q4hr, pulse oximetry, dyspnea, crackles, ABGs; watch for respiratory failure, intubate if necessary
- Stress thallium study before therapy; document normal ejection fraction, unimpaired wall motion
- Bleeding: hematuria, guaiac, bruising petechiae
- Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
- Local irritation, pain, burning at inj site
- GI symptoms: frequency of stools, cramping; acidosis, signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
PERFORM/PROVIDE:
- Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
- Increased fluid when able to reduce renal problems
Filgrastim (Neupogen)
Functional Classification
Biologic modifier
Filgrastim (Neupogen)
Chemical Classification
Granulocyte colony-stimulating factor
Filgrastim (Neupogen)
Mechanism of Action
Stimulates proliferation and differentiation of neutrophils
Filgrastim (Neupogen)
Uses
To decrease infection in patients receiving antineoplastics are myelosuppressive; to increase WBC in patients with product-induced neutropenia; bone marrow transplantation
Filgrastim (Neupogen)
Contraindications
Hypersensitivity to proteins of Escherichia coli
Filgrastim (Neupogen)
Side Effects
CNS: fever, headache
GI: Nausea, vomiting, diarrhea, mucositis, anorexia
HEMA: THROMBOCYTOPENIA, excessive leukocytosis
INTEG: alopecia, exacerbation of skin conditions, urticaria, cutaneous vasculitis
MS: osteoporosis, skeletal pain
OTHER: chest pain, hypotension
RESP: ACUTE RESPIRATORY DISTRESS SYNDROME, wheezing, ALVEOLAR HEMORRHAGE
Filgrastim (Neupogen)
Nursing Considerations
ASSESS:
- Blood studies: CBC, platelet count before treatment and twice weekly; neutrophil counts may be increased for 2 days after therapy
- BP, respirations, pulse before and during therapy
- Bone pain; give mild analgesics
- CBC with differential, platelets
Interferon alfa-2b
Functional Classification
Antineoplastic-miscellaneous
Interferon alfa-2b
Chemical Classification
Protein product
Interferon alfa-2b
Mechanism of Action
Antiviral action inhibits viral replication by reprogramming virus; antitumor action suppresses cell proliferation; immunomodulating action phagocytizes target cells; may also inhibit virus replication in virus-infested cells
Interferon alfa-2b
Uses
Hairy-cell leukemia in persons>18yr; condylomata acuminata; chronic hepatitis C, hepatitis B; malignant melanoma; non-hodgkin’s lymphoma
Interferon alfa-2b
Contraindications
hypersensitivity
Interferon alfa-2b
Side Effects
CNS: Dizziness, Confusion, Numbness, Paresthesias, hallucinations, SEIZURES, COMA, amnesia, anxiety, mood changes, depression, somnolence, paranoia, irritability, hostility, encephalopathy
CV: Edema, Hypotension, hypertension, chest pain, palpitations, dysrhythmias, CHF, MI, CVA, tachycardia, syncope
GI: Weight Loss, Taste Changes, nausea, anorexia, diarrhea, xerostomia
GU: Impotence
HEMA: NEUTROPENIA, THROMBOCYTOPENIA
INTEG: Rash, Dry, Skin, Itching, Alopecia, flushing, photosensitivity, SERIOUS SKIN INFECTION
MISC: Flulike Syndrome, Fever, Fatigue, Myalgias, Headache, Chills, optic neuritis, ANAPHYLAXIS, ANGIOEDEMA
Interferon alfa-2b
Nursing Considerations
ASSESS:
- Symptoms of infection; chills, fever, headache may be masked by product fever
- CNS reaction: LOC, mental status, dizziness, confusion, paresthesia, slurred speech, anxiety, depression, paranoia, hallucinations, suicidal thoughts
- Cardiac status: lung sounds; ECG before and during treatment, especially in those with cardiac disease; MI, CHF, CVA, hypo/hypertension may occur; LFTs, thyroid function tests
- Bone marrow depression: bruising, bleeding, blood in stools, urine, sputum, emesis
- CBC with differential before and during treatment, nadirs of leukopenia/thrombocytopenia occur after 18-19 days (alfa-2a); recovery after 3-4wk; if granulocytes <30,000/mm2 discontinue product
PERFORM/PROVIDE:
-Increased fluid intake to 2-3L/day
Interferon beta-1b
Functional Classification
Multiple sclerosis agent, immune modifier
Interferon beta-1b
Chemical Classification
Interferon, Escherichia coli derivative
Interferon beta-1b
Mechanism of Action
Antiviral, immunoregulatory; action not clearly understood; biologic response-modifying properties mediated through specific receptors on cells, inducing expression of interferon-induced gene products
Interferon beta-1b
Uses
Ambulatory patients with relapsing or remitting MS
Interferon beta-1b
Contraindications
Hypersensitivity to natural or recombinant interferon-beta or human albumin, hamster protein, rotovirus vaccine
Interferon beta-1b
Side Effects
CNS: Headache, Fever, Pain, Chills, Mental Changes, Depression, hypertonia, SUICIDE ATTEMPTS, SEIZURES
CV: Migraine, Palpitations, Hypertension, tachycardia, peripheral vascular disorders
EENT: Conjunctivitis, blurred vision
GI: Diarrhea, Constipation, Vomiting, Abdominal Pan
GU: Dysmenorrhea, Irregular Menses, Metrorrhagia, cystitis, breast pain
HEMA: DECREASED LYMPHOCYTES, ANC, WBC; Lymphadenopathy, anemia
INTEG: Sweating, Inj Site Reaction
MS: Myalgia, MYASTHENIA
RESP: Sinusitis, dyspnea
Interferon beta-1b
Nursing Considerations
ASSESS:
- Blood, hepatic studies: CBC, differential, platelet counts, BUN, creatinine ALT, urinalysis; if absolute neutrophil count <750/mm3 or if AST/ALT is 10x normal, discontinue products
- CNS symptoms: headache, fatigue, depression
- GI status: diarrhea or constipation, vomiting, abdominal pain
- Cardiac status: increased BP, tachycardia
- Mental Status: Depression, depersonalization, suicidal thoughts, insomnia
- Multiple sclerosis symptoms
Rituximab
Functional Classification
Antineoplastic-miscellaneous; DMARDs
Rituximab
Chemical Classification
Murine/human monoclonal antibody
Rituximab
Mechanism of Action
Directed against the CD20 antigen that is found on malignant B lymphocytes; CD20 regulates a portion of cell-cycle initiation/differentiation
Rituximab
Uses
Non-Hodgkin’s lymphoma (CD20 positive, B-cell), bulky disease (tumors>10cm), rheumatoid arthritis, Wegener’s granulomatosis, microscopic polyangitis
Rituximab
Contraindications
Hypersensitivity, murine proteins
Rituximab
Side Effects
CNS: LIFE-THREATENING BRAIN INFECTION (PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY)
CV: CARDIAC DYSRHYTHMIAS, HEART FAILURE, HYPERTENSION, MI, SUPRAVENTRICULAR TACHYCARDIA, angina
GI: Nausea, Vomiting, Anorexia, GI OBSTRUCTION/PERFORATION
GU: RENAL FAILURE
HEMA: LEUKOPENIA, NEUTROPENIA, THROMBOCYTOPENIA, anemia
INTEG: Irritation At Site, Rash, FATAL MUCOCUTANEOUS INFECTIONS (RARE)
MISC: Fever, chills, asthenia, Headache, ANGIOEDEMA, hypotension, myalgia, BRONCHOSPASM, ARDS
SYST: TOXIC EPIDERMAL NECROLYSIS, TUMOR LYSIS SYNDROME, STEVENS-JOHNSON SYNDROME, EXFOLIATIVE DERMATITIS
Rituximab
Nursing Considerations
ASSESS:
- FATAL INF REACTION: hypoxia, pulmonary infiltrates, ARDS, MI, ventricular fibrillation, cardiogenic shock; most fatal reactions occur with 1st inf; potentially fatal
- SEVERE MUCOCUTANEOUS REACTIONS: Stevens-Johnson syndrome, lichenoid dermatitis, toxic epidermal lysis; occur 1-13wk after product given
- TUMOR LYSIS SYNDROME: acute renal failure requiring hemodialysis, hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia
- MULTIFOCAL LEUKOENCEPHALOPATHY: confusion, dizziness, lethargy, hemiparesis; monitor periodically
- CBC, differential, platelet count weekly; withhold product if WBC is <100,000/mm3; notify prescriber of results; product should be discontinued
- ECG, serum creatinine/BUN, electrolytes, uric acid
- GI symptoms: frequency of stools
- DEHYDRATION: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
Sargramostim (Leukine)
Functional Classification
Biologic Modifier
Sargramostim (Leukine)
Chemical Classification
Granulocyte macrophage colony-stimulating factor (GM-CSF)
Sargramostim (Leukine)
Mechanism of Action
Stimulates proliferation and differentiation of hematopoietic progenitor cells (granulocytes, macrophages
Sargramostim (Leukine)
Uses
Acceleration of myeloid recovery in patients with non-Hodgkin’s lymphoma, acute lymphoblastic leukemia, acute myelogenous leukemia, autologous bone marrow transplantation in Hodgkin’s disease; bone marrow transplantation failure or engraftment delay, mobilization and transplant of peripheral blood progenitor cells (PBPCs)
Sargramostim (Leukine)
Contraindications
Neonates; hypersensitivity to GM-CSF, benzyl alcohol, yeast products; excessive leukemic myeloid blast in bone marrow, peripheral blood
Sargramostim (Leukine)
Side Effects
CNS: fever, malaise, CNS disorder, weakness, chills, dizziness, syncope, headache
CV: TRANSIENT SUPRAVENTRICULAR TACHYCARDIA, peripheral edema, PERICARDIAL EFFUSION, hypotension, tachycardia
GI: nausea, vomiting, diarrhea, anorexia, GI HEMORRHAGE, stomatitis, LIVER DAMAGE, hyperbilirubinemia
GU: urinary tract disorder, abnormal kidney function
HEMA: BLOOD DYSCRASIAS, HEMORRHAGE
INTEG: alopecia, rash, peripheral edema
MS: bone pain, myalgia
RESP: dyspnea
Sargramostim (Leukine)
Nursing Considerations
ASSESS:
- Blood studies: CBC, differential count before treatment, 2x weekly; leukocytosis may occur (WBC >50,000 cells/mm3, ANC >20,000 cells/mm3), platelets; if ANC >20,000/mm3 or 10,000/mm3 after nadir has occurred or platelets >500,000/mm3, reduce dose by 1/2 or discontinue; if blast cells occur, discontinue
- Renal, hepatic studies before treatment: BUN, creatinine, urinalysis; AST, ALT, alk phos; 2x weekly monitoring is needed in renal/hepatic disease
- HYPERSENSITIVITY, rashes, local inj site reactions; usually transient
- Body weight, hydration status; increased fluid retention in cardiac disease; pulmonary function
- Myalgia, arthralgia in legs, feet; use analgesics
Aldesleukin (IL-2)
Functional Classification
Antineoplastic-miscellaneous
