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