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STUDY CARDS > Biological Response-Modifying and Antirheumatic Drugs > Flashcards

Biological Response-Modifying and Antirheumatic Drugs Flashcards

1
Q

Biological Response–Modifying

Alter the body’s response to diseases such as (four)

A

Alter the body’s response to diseases such as cancer and autoimmune, inflammatory, and infectious diseases

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2
Q

Biological Response–Modifying Drugs 2 types of medications

A

Hematopoietic drugs

Immunomodulating drugs
-Interferons (IFNs)
-Monoclonal antibodies (MABs)
-Interleukin (IL) receptor agonists and antagonists
-Miscellaneous drugs

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3
Q

Immunomodulating Drugs action

A

Medications that therapeutically alter a patient’s immune response to malignant tumour cells

Drugs that modify the body’s own immune response so that it can destroy various viruses and cancerous cells

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4
Q

Immunomodulating Drugs is also used for three other diseases

A

Fourth part of cancer therapy, in addition to:

-Surgery
-Chemotherapy
-Radiation

Also used for other diseases
-Autoimmune disease
-Inflammatory disease
-Infectious disease

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5
Q

Biological Response–Modifying Drugs: 6 Subclasses

A

Hematopoietic drugs
IFNs
MABs
IL receptor agonists and antagonists
Disease-modifying antirheumatic drugs
Miscellaneous drugs

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6
Q

Biological Response–Modifying Drugs:

Enhances two

Inhibits three

A

Enhancement of hematopoietic function

Enhancement or regulation of the host’s immune system defenses against the tumour

Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

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7
Q

Immune System

Two components of the immune system work together to recognize and destroy foreign particles and cells in the blood or other body tissues.

Types of cell in each

A

*Humoral immunity
–Mediated by B-cell functions (antibodies)

*Cell-mediated immunity
–Mediated by T-cell functions

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8
Q

Immune System

what attacks tumour antigens?

A

*Tumour antigens (chemical or tumour “markers”) label tumour cells as abnormal cells

*Antibodies attack tumour cells
–B lymphocytes (B cells) from the humoral immune system
–T lymphocytes (T cells) from the cell-mediated immune system

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9
Q

Humoral Immune System

Name of cell

Originates frrom?

When a foreign substance (antigen) is present, these turn into plasma cells, which in turn produce ______.

______ complex

_____ cells

A

B lymphocytes (B cells)
–Originate from bone marrow
–When a foreign substance (antigen) is present, these turn into plasma cells, which in turn produce antibodies.

Antibody–antigen complex

Memory cells

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10
Q

Antibodies are also known as

A

immunoglobulins

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11
Q

Monoclonal antibodies (MABs):

A

identical cells derived from a single cell

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12
Q

Five major types of naturally occurring immunoglobulins:

A

A, D, E, G, and M

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13
Q

T lymphocytes (T cells)

Originate from bone marrow but mature in the?

Three types, with different functions

A

Originate from bone marrow but mature in the thymus gland

Cytotoxic T cells
T-helper cells
T-suppressor cells

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14
Q

Cytotoxic T cells

A

directly kill their targets by causing cell lysis or rupture.

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15
Q

T-helper cells

A

direct the actions of many other components of the immune system.

control immune system
direct other immune cells

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16
Q

T-suppressor cells

A

limit or control the immune response.

opposite of T-helper cells
regulate immune response
allow tumours to grow

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17
Q

A healthy immune system has about

A

twice as many T-helper cells as T-suppressor cells at any one time.

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18
Q

Overactive T-suppressor cells may be responsible for clinically significant

A

cancer cases by permitting tumour growth beyond immune system control.

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19
Q

Other cells of the cell-mediated immune system help to destroy cancer cells.

A

Macrophages (derived from monocytes)

Natural killer (NK) cells (type of lymphocyte)

Polymorphonuclear leukocytes (neutrophils)

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20
Q

Therapeutic Effects of Biological Response–Modifying Drugs

A

Enhancement of hematopoietic function

Regulation or enhancement of the immune response, including cytotoxic or cytostatic activity against cancer cells

Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

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21
Q

Hematopoietic Drugs

action

produced by

A

Promote the synthesis of various types of major blood components

by promoting the growth or differentiation and the function of their precursor cells in the bone marrow.

Produced by recombinant deoxyribonucleic acid (DNA) technology

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22
Q

Hematopoietic Drugs Uses

Decrease the duration of?

Enable?

A

Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia

Enable higher doses of chemotherapy to be given

Other uses

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23
Q

Hematopoietic Drugs Categories

A

Erythropoietic drugs

Colony-stimulating factors

Platelet-promoting drug oprelvekin not available in Canada.

24
Q

Erythropoietic drug name

A

darbepoetin alfa

25
Q

Colony-stimulating factors

1 drug

Action

when to administer?

A

filgrastim

Granulocyte colony-stimulating factor

Stimulates precursor cells for the type of white blood cells known as granulocytes (including basophils, eosinophils, and neutrophils)

Administered before patient develops infection

26
Q

Filgrastim

Typically given as _____ 7-14 days

Do not start until ____ after chemo is completed

Sites

Discontinue after the ANC has reached?

Could start ____ days post chemo and last as long as ____ days

A

-Do not start until 24hrs after chemo is completed

-Keep refrigerated, take out minimum 30 minutes to warm up before use

-Use abdomen or back of arms for SC location

-Discontinue after the ANC has reached 1 x 10(9) / L

Note: Nadir is when the blood counts (mainly ANC and platelet counts) are at their lowest. Nadir could start 7-10 days post chemo and last as long as 28 days

27
Q

Hematopoietic Drugs:

Decrease the duration of chemotherapy-induced ______, ________, and _________.

Allow for ______ dosages of chemotherapy

Decrease bone marrow _____ _____ after bone marrow transplantation or irradiation

Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells, as well as ______ or _______infected cells

A

Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia

Allow for higher dosages of chemotherapy

Decrease bone marrow recovery time after bone marrow transplantation or irradiation

Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells, as well as virus- or fungus-infected cells

28
Q

Hematopoietic Drugs:Indications

A

Used for patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemotherapy

Decrease the duration of low neutrophil counts, thus reducing the incidence and duration of infections

Enhance the functioning of mature cells of the immune system, resulting in greater ability to kill cancer cells as well as virus- and fungus-infected cells

Enhance red blood cell and platelet counts in patients with bone marrow suppression resulting from chemotherapy

Allow higher doses of chemotherapy, resulting in the destruction of a greater number of cancer cells

29
Q

Hematopoietic Drugs:Adverse Effects

A

Usually mild

Most common include:
Fever
Muscle aches
Bone pain
Flushing

30
Q

Interferons three basic properties

Are used to treat _____ and _____

A

Proteins with three basic properties

-Antiviral
-Antitumour
-Immunomodulating

Used to treat certain viral infections and cancer

Interferon (IFN)-α, -ß, and -γ

31
Q

Interferons action

A

Recombinantly manufactured substances that are identical to the IFN cytokines that are naturally present in the human body

-Protect human cells from virus attack
-Prevent cancer cells from dividing and replicating
-Increase the activity of other immune system cells, such as macrophages, neutrophils, and NK cells

32
Q

Interferons:Effects on the Immune System

Restores?

Can be helpful in which disorder? because?

A

Antiviral/Antitumor/Immune Modulator/Suppress

Restore the immune system’s function if it is impaired

Augment the immune system’s ability to function as the body’s defense

Inhibit the immune system from working

Helpful in autoimmune disorders

33
Q

Interferons: Indications (three)

A

Viral infections
—Genital warts, hepatitis – alfa interferons (anti-viral action)

Cancer
—Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi’s sarcoma, malignant melanoma – alfa interferons (anti-tumor action)

Autoimmune disorders
—Multiple sclerosis – beta interferons (immune modulating/immune-suppressive)

34
Q

Interferons: Adverse Effects

A

Flulike effects
—Fever, chills, headache, myalgia

Dose-limiting adverse effect is fatigue.

Other adverse effects
-Anorexia
-Dizziness
-Nausea
-Vomiting
-Diarrhea

35
Q

Interferons: Products

A

IFN-α products: “leukocyte IFNs”—produced from human leukocytes

IFN alfa-2b (Intron-A®) – wider uses listed

peginterferon alfa-2a (Pegasys®) – chronic Help C

IFN-ß products - – RRMS *allergy to human albumin
-IFN β-1a (Avonex®, Rebif®)
-IFN β-1b (Betaseron®, Extavia®)

IFN-γ (Gamma) products are not available in Canada.

36
Q

Monoclonal Antibodies

Treats (four)

Contraindicated for (2)

A

For treatment of cancer, rheumatoid arthritis (RA), multiple sclerosis, and organ transplantation

Specifically target cancer cells and have minimal effect on healthy cells

Fewer adverse effects than traditional antineoplastic medications

Contraindicated for active TB and other infections

37
Q

Monoclonals: Anti TNF Property

Tumor necrosis factor(TNF)

A

is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. It is produced chiefly by activated macrophages, although itCANbe produced by other cell types as well.

38
Q

Monoclonals: Anti TNF Property

TNF inhibitors

A

are drugs that help stop inflammation. They’re used to treat diseases like rheumatoid arthritis (RA), juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, ulcerative colitis (UC), and Crohn’s disease. They’re also called TNF blockers, biologic therapies, oranti-TNF drugs.

39
Q

Monoclonal Antibodies four drug names

A

Adalimumab (RA)

infliximab (RA, Crohn’s)

Rituximab (NHL)

Natiluzumab (MS)

40
Q

Rituximab (Rituxan)

A

*Associated with allergic response; premedicate with diphenhydramine and acetaminophen

41
Q

Interleukins

action

classified as?

drug classification and name

A

Natural part of the immune system: classified as lymphokines

Beneficial antitumour action

Interleukin (IL) receptor agonists
–aldesleukin

42
Q

Interleukins

Antitumour action:

IL-2 derivative aldesleukin:

Aldesleukin:

Lymphokine-activated killer cells:

A

Antitumour action: IL-2 is produced by activated T cells in response to macrophage- “processed” antigens and secreted IL-1.

IL-2 derivative aldesleukin: stimulates or restores immune response

Aldesleukin: binds to receptor sites on T cells, which stimulates the T cells to multiply

Lymphokine-activated killer cells: recognize and destroy only cancer cells and ignore normal cells

43
Q

Capillary Leak Syndrome

A

Severe toxicity of aldesleukin therapy

Capillaries lose ability to retain vital colloids in the blood; these substances are “leaked” into the surrounding tissues.

Result: massive fluid retention
-Respiratory distress
-Heart failure
-Myocardial infarction
-Dysrhythmias

Reversible after IL therapy is discontinued

44
Q

aldesleukin (Proleukin)

Treatment of?

Contraindicated in?

ROUTE

A

Treatment of metastatic renal cell carcinoma and metastatic melanoma

Contraindicated in those with organ transplants

Available only for injection

45
Q

Rheumatoid Arthritis

Describe:

Diagnosis:

Treatment: TWO

A

Autoimmune disorder causing inflammation and tissue damage in joints

Diagnosis primarily symptomatic

Treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs)

46
Q

Osteoarthritis

Caused?

Symptoms? TWO

A

Age-related degeneration of joint tissues

Pain and reduced function

Not an auto-immune related condition

47
Q

Disease-Modifying Antirheumatic Drugs

Modify the disease of ______

Three effects?

Inhibit the movement of various cells into an inflamed, damaged area, such as a _____

________ onset of action of several weeks versus _____ to ______ for NSAIDs

Also referred to as __________ antirheumatic drugs

A

Modify the disease of RA

Exhibit anti-inflammatory, antiarthritic, and immunomodulating effects

Inhibit the movement of various cells into an inflamed, damaged area, such as a joint

Slow onset of action of several weeks versus minutes to hours for NSAIDs

Also referred to as slow-acting antirheumatic drugs

48
Q

Nonbiological Disease-Modifying Antirheumatic Drug names (two)

A

methotrexate

leflunomide

49
Q

Methotrexate

Frequency

AEs

How to lessen AEs

A

First line therapy recommended by Canadian Rheumatology Association usually in a combo of two

Given PER WEEKLY not daily basis (oral most common)

Lower doses than for cancer (7.5mg – 20 mg/wk)

Bone marrow suppression is most common adverse effect; stomatitis may also occur fairly commonly

Folic acid supplement taken concurrently to lessen adverse effects

Onset of action 3-6weeks, half-life 3-10 hours

50
Q

Biological Disease-Modifying Antirheumatic Drug names

A

adalimumab

etanercept

infliximab

abatacept

51
Q

etanercept (Enbrel®)

Treats?

Important consideration

contraindication? because?

A

Used to treat rheumatoid arthritis (including juvenile rheumatoid arthritis) and moderate to severe chronic plaque psoriasis

Patients must be screened for latex allergy (some dosage forms may contain latex).
Onset of action: 1 to 2 weeks

Contraindicated in presence of active infections
–Reactivation of hepatitis and tuberculosis has been reported

52
Q

abatacept (Orencia®)

Treats?

Caution?

Important consideration?

may increase

may decrease

A

Used to treat RA

Caution if the patient has a history of recurrent infections or chronic obstructive pulmonary disease

Patients must be up to date on immunizations before starting therapy.

May increase risk of infections associated with live vaccines

May decrease response to dead or live vaccines

53
Q

Nursing Implications

A

Assess for allergies, specifically allergies to egg proteins and IgG.

Assess for conditions that may be contraindications.

Assess baseline blood counts; perform cardiac, kidney, and liver studies.

Assess for presence of infection.

Follow specific guidelines for preparation and administration of drugs.

Monitor the patient’s response during therapy.

With some BRMs, treatment with opioids, antihistamines or anti-inflammatory drugs may be required for management of bone pain and chills.

Aniemetics used for nausea and vomiting

54
Q

Teach patients to report signs of infection immediately.

A

Sore throat
Diarrhea
Vomiting
Fever of 38.1°C or higher

Watching for febrile neutropenia; needs urgent treatment and monitoring

55
Q

Monitor therapeutic responses.

A

Decrease in growth of lesion or mass

Improved blood counts
Absence of infection, anemia, and hemorrhage

Observe for and monitor adverse effects.

Remember we are looking for signs of immune system triggered or immune system suppressed

STUDY CARDS (17 decks)

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