Biological Response-Modifying and Antirheumatic Drugs Flashcards
Biological Response–Modifying
Alter the body’s response to diseases such as (four)
Alter the body’s response to diseases such as cancer and autoimmune, inflammatory, and infectious diseases
Biological Response–Modifying Drugs 2 types of medications
Hematopoietic drugs
Immunomodulating drugs
-Interferons (IFNs)
-Monoclonal antibodies (MABs)
-Interleukin (IL) receptor agonists and antagonists
-Miscellaneous drugs
Immunomodulating Drugs action
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
Immunomodulating Drugs is also used for three other diseases
Fourth part of cancer therapy, in addition to:
-Surgery
-Chemotherapy
-Radiation
Also used for other diseases
-Autoimmune disease
-Inflammatory disease
-Infectious disease
Biological Response–Modifying Drugs: 6 Subclasses
Hematopoietic drugs
IFNs
MABs
IL receptor agonists and antagonists
Disease-modifying antirheumatic drugs
Miscellaneous drugs
Biological Response–Modifying Drugs:
Enhances two
Inhibits three
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
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
*Humoral immunity
–Mediated by B-cell functions (antibodies)
*Cell-mediated immunity
–Mediated by T-cell functions
Immune System
what attacks tumour antigens?
*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
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
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
Antibodies are also known as
immunoglobulins
Monoclonal antibodies (MABs):
identical cells derived from a single cell
Five major types of naturally occurring immunoglobulins:
A, D, E, G, and M
T lymphocytes (T cells)
Originate from bone marrow but mature in the?
Three types, with different functions
Originate from bone marrow but mature in the thymus gland
Cytotoxic T cells
T-helper cells
T-suppressor cells
Cytotoxic T cells
directly kill their targets by causing cell lysis or rupture.
T-helper cells
direct the actions of many other components of the immune system.
control immune system
direct other immune cells
T-suppressor cells
limit or control the immune response.
opposite of T-helper cells
regulate immune response
allow tumours to grow
A healthy immune system has about
twice as many T-helper cells as T-suppressor cells at any one time.
Overactive T-suppressor cells may be responsible for clinically significant
cancer cases by permitting tumour growth beyond immune system control.
Other cells of the cell-mediated immune system help to destroy cancer cells.
Macrophages (derived from monocytes)
Natural killer (NK) cells (type of lymphocyte)
Polymorphonuclear leukocytes (neutrophils)
Therapeutic Effects of Biological Response–Modifying Drugs
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
Hematopoietic Drugs
action
produced by
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
Hematopoietic Drugs Uses
Decrease the duration of?
Enable?
Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia
Enable higher doses of chemotherapy to be given
Other uses
Hematopoietic Drugs Categories
Erythropoietic drugs
Colony-stimulating factors
Platelet-promoting drug oprelvekin not available in Canada.
Erythropoietic drug name
darbepoetin alfa
Colony-stimulating factors
1 drug
Action
when to administer?
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
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
-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
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
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
Hematopoietic Drugs:Indications
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
Hematopoietic Drugs:Adverse Effects
Usually mild
Most common include:
Fever
Muscle aches
Bone pain
Flushing
Interferons three basic properties
Are used to treat _____ and _____
Proteins with three basic properties
-Antiviral
-Antitumour
-Immunomodulating
Used to treat certain viral infections and cancer
Interferon (IFN)-α, -ß, and -γ
Interferons action
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
Interferons:Effects on the Immune System
Restores?
Can be helpful in which disorder? because?
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
Interferons: Indications (three)
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)
Interferons: Adverse Effects
Flulike effects
—Fever, chills, headache, myalgia
Dose-limiting adverse effect is fatigue.
Other adverse effects
-Anorexia
-Dizziness
-Nausea
-Vomiting
-Diarrhea
Interferons: Products
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.
Monoclonal Antibodies
Treats (four)
Contraindicated for (2)
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
Monoclonals: Anti TNF Property
Tumor necrosis factor(TNF)
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.
Monoclonals: Anti TNF Property
TNF inhibitors
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.
Monoclonal Antibodies four drug names
Adalimumab (RA)
infliximab (RA, Crohn’s)
Rituximab (NHL)
Natiluzumab (MS)
Rituximab (Rituxan)
*Associated with allergic response; premedicate with diphenhydramine and acetaminophen
Interleukins
action
classified as?
drug classification and name
Natural part of the immune system: classified as lymphokines
Beneficial antitumour action
Interleukin (IL) receptor agonists
–aldesleukin
Interleukins
Antitumour action:
IL-2 derivative aldesleukin:
Aldesleukin:
Lymphokine-activated killer cells:
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
Capillary Leak Syndrome
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
aldesleukin (Proleukin)
Treatment of?
Contraindicated in?
ROUTE
Treatment of metastatic renal cell carcinoma and metastatic melanoma
Contraindicated in those with organ transplants
Available only for injection
Rheumatoid Arthritis
Describe:
Diagnosis:
Treatment: TWO
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)
Osteoarthritis
Caused?
Symptoms? TWO
Age-related degeneration of joint tissues
Pain and reduced function
Not an auto-immune related condition
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
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
Nonbiological Disease-Modifying Antirheumatic Drug names (two)
methotrexate
leflunomide
Methotrexate
Frequency
AEs
How to lessen AEs
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
Biological Disease-Modifying Antirheumatic Drug names
adalimumab
etanercept
infliximab
abatacept
etanercept (Enbrel®)
Treats?
Important consideration
contraindication? because?
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
abatacept (Orencia®)
Treats?
Caution?
Important consideration?
may increase
may decrease
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
Nursing Implications
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
Teach patients to report signs of infection immediately.
Sore throat
Diarrhea
Vomiting
Fever of 38.1°C or higher
Watching for febrile neutropenia; needs urgent treatment and monitoring
Monitor therapeutic responses.
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
