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NURS 320 > Exam 2: Autoimmune Disorders And Immunosupressants > Flashcards

Exam 2: Autoimmune Disorders And Immunosupressants Flashcards

1
Q

Purpose of the Immune System

A

The purpose of the immune system is to distinguish self from non-self and to protect the body from foreign material (antigens), including cancer

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2
Q

Two Types of Immunity

A
  1. Humoral Immunity

2. Cellular Immunity

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3
Q

Humoral immunity is mediated by

A

B lymphocytes

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4
Q

Cellular immunity is mediated by

A

T lymphocytes

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5
Q

The immune system is responsible for

A
  • Participating in anaphylactic reactions
  • Rejection of kidney, liver and heart transplants.
  • Autoimmune diseases (the immune system attacks itself)
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6
Q

Immunosuppressants

A

Drugs that decrease or prevent an immune response, thus suppressing the immune system.
Used to prevent or treat rejection of transplanted organs

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7
Q

Immunosuppressants can be used to treat

A

rheaumatoid arthritis, systemic lupus, erythematosus, Crohn’s disease, multiple sclerosis, myasthenia gravis, psoriasis and others

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8
Q

Treatment w/ immunosuppressants usually lasts how long?

A

Lifelong

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9
Q

Immunosuppressants: MOA

A

All selectively suppress certain T-lymphocyte cells, thus preventing their involvement in the immune response

Results in a pharmacologically immunocompromised state

Each drug has a specific mechanisms of action

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10
Q

Systemic Lupus Erythematosus (SLE)

A

Most common autoimmune disorder
Characterized by antibodies: antibodies against self-antigens (nucleic acids).
Extremely difficult to diagnose

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11
Q

SLE: Pathophysiology

A
  • Autoantibodies react with the circulating antigen (nucleic acids, erythrocytes, phospholipids, lymphocytes, platelets, etc.)
  • Reaction forms circulating immune complexes.
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12
Q

Immune complexes can cause

A

Severe kidney inflammation.

Similar reaction/damage can occur in brain, heart, spleen, lung, GI tract, peritoneum and skin.

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13
Q

Symptoms of SLE result from

A

Type II and III hypersensitivity reactions .

May wax and wane: exacerbations of “flares”

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14
Q

SLE Clinical Manifestations

A

Arthralgias or arthritis (90% of patients)
Vasculitis and rash (70% -80%)
Renal disease (40%-50%)
Hematologic abnormalities (50%), especially anemia
Photosensitivity

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15
Q

Common Clinical Findings include

A

Simultaneous presence of at least 4 of these findings indicates the individual has SLE:
Facial rash confined to the cheeks
Discoid rash (raised patches, scaling)
Photosensitivity (skin rash as a result of sunlight exp.)
Oral or nasopharyngeal ulcers
Nonerosive arthritis of at least two peripheral joints
Serositis (pleurisy or pericarditis)
Renal Disorder (proteinuria)
Neurologic disorders (seizures or psychosis)
Hematologic disorders (anemia, leukopenia, thrombocytopenia)
Immunologic disorders
Presence of antinuclear antibody (ANA)

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16
Q

Diagnosis of SLE is based on

A
  • Positive ANA screening test (98%): high number of false positives
  • Positive ANA followed by one or more specific tests: Anti-Sm antibodies, Anti-double stranded DNA (anti-dsDNA) (Not all SLE patients will be positive for these tests d/t low sensitivity)
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17
Q

SLE-like symptoms can occur with

A

Prolonged use of certain drugs, thus medication history is essential for differential diagnosis.

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18
Q

Is there a cure for SLE?

A

NO CURE.

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19
Q

SLE fatalities results from

A

Infection
Organ failure
Cardiovascular Disease

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20
Q

Treatment for SLE

A

Goal: control symptoms and suppress the autoimmune response.
NSAIDs
Corticosteroids
Immunosuppressive drugs (mycophenolate, cyclosporine, azathioprine)
Antimalarial medication
Protection from UV light

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21
Q

Rheumatoid Arthritis

A

Autoimmune disorder.

Painful disease and often disabling.

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22
Q

Rheumatoid Arthritis can cause

A

Inflammation and tissue damage in joints.

Can also cause anemia; inflammation in lungs, eyes and pericardium; and subcutaneous nodules under the skin.

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23
Q

Rheumatoid Arthritis: Clinical Manifestations

A
  • Pain and Stiffness in joints particularly in the wrists, hands, elbows, shoulders, knees, and ankles.
  • Reduced ROM
  • Affects both sides equally.
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24
Q

Rheumatoid Arthritis: Diagnosis

A

Primarily off of symptoms

Blood test for rheumatoid factor.

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25
Is there a cure for rheumatoid arthritis?
No cure.
26
Rheumatoid Arthritis: Treatment Goal
Reduce symptoms and prevent further damage to joints.
27
What are the pharmacological treatments for Rheumatoid Arthritis?
- NSAIDs (early stages) - Corticosteroids (moderate stages) - Disease-modifying anti-rheumatic drugs (DMARDs)
28
Disease Modifying Anti-rheumatic Arthritis Drugs
Provides anti-inflammatory and analgesic effects. | Can slow down the disease process.
29
Non-Pharmacologic Treatment for Rheumatoid Arthritis
``` Physical therapy Occupational therapy Exercise Diet Stress reduction ```
30
Disease-Modifying Anti-rheumatic Arthritis Drugs include
Methotrexate Leflunomide (Arava) Etanercept (Enbrel) Abatacept (Orencia)
31
Disease-Modifying Anti-rheumatic Arthritis Drugs: MOA
Vary per drug | Overall: inhibit movement of various cells (neutrophils, monocytes, and macrophages) into an inflamed, damaged area
32
Disease-Modifying Anti-rheumatic Arthritis Drugs: Onset of Action
Slow—several weeks | First line therapy in most patients—slows progression of disease
33
Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel)
Used to treat RA and psoriasis. | Patients must be screened for latex allergy (some dosage forms may contain latex)
34
Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel) Onset of Action
1-2 weeks
35
Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel) Contraindications
Contraindicated in presence of active infections.(Reactivation of hepatitis and TB have been reported)
36
Disease-Modifying 
Antirheumatic Drugs: Abatacept (Orencia)
(NOT ON STUDY GUIDE) 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 vaccines
37
Multiple Sclerosis
Autoimmune response that causes: Degeneration of CNS myelin Scarring brain Loss of axons
38
Multiple Sclerosis: Pathophysiology
1. Autoreactive T and B cells cross the blood-brain barrier and recognize myelin and oligodendrocyte autoantigens 2. Triggers inflammation and loss of oligodendrocytes (myelin producing cells) 3. Activation of brain macrophages contribute to inflammation and injury with plaque formation and axonal degeneration 4. Loss of myelin disrupts nerve conduction and death of neurons and brain atrophy
39
MS Symptoms
``` Paresthesias of the face, trunk, or limbs Weakness (all four limbs) Impaired gait Visual disturbances Urinary incontinence ```
40
How long do MS symptoms last?
A few days to weeks | Latent and exacerbated periods
41
MS: Evaluation/Diagnosis
No single test available | Do criteria include: Hx and clinical exam, MRI, CSF findings
42
MS: Treatment Goals
Prevent exacerbations Prevent permanent Neurologic damage Control symptoms
43
MS: Pharmacologic Treatment includes
Corticosteroids Immunosuppressants Immune system modulators Plasma exchange, stem cell therapy
44
MS: Non-Pharmacologic Treatment
Regular exercise Smoking cessation Decrease stress, extreme fatigue Decrease heat exposure
45
Transplant Rejection
primary concern; occurs from an immune response targeted against the transplanted organ
46
Graft Rejection Symptoms
- The organ’s function may start to decrease. - General discomfort, uneasiness, or ill feeling. - Pain or swelling in the area of the organ (rare) and fever (rare). - Flu-like symptoms, including chills, body aches, nausea, cough, and SOB
47
Classes of Immunosuppressants to prevent organ rejection
- Glucocorticoids - Calcineurin inhbitors - Antimetabolites - Biologics
48
Glucocorticoids
inhibit all stages of T-cell activation and are used for induction, maintenance immunosuppression, and acute rejection
49
Calcineurin inhibitors
inhibit the phosphate required for interleukin 2 production
50
Antimetabolites
Inhibit cell proliferation
51
Biologics
Inhibit cytotoxic T killer cell function
52
Immunosuppressants include
``` cyclosporine (Sandimmune) azathioprine (Imuran) muromonab-CD3 (Orthoclone) daclizumab (Zenapax) sirolimus (Rapamune) basiliximab (Simulect) glatiramer acetate (Copaxone) tacrolimus (Prograf) mycophenolate mofetil (CellCept) fingolimod (Gilenya), approved for MS in 2010 ```
53
Immunosuppressants: Therapeutic Use
Therapeutic use varies from drug to drug Primarily indicated for the prevention of organ rejection
54
What immunosuppressants are indicated for both prevention of rejection and treatment of organ rejection?
Muromonab-CD3 (Orthoclone) Mycophenolate (Cellcept) Tacrolimus (Prograf)
55
Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax)
Monoclonal antibodies. | Used to prevent rejection of transplanted kidneys.
56
Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax) are generally used as part of a
multidrug immunosuppressive regimen that includes cyclosporine and corticosteroids
57
Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax) has a tendency to
cause the allergy-like reaction known as cytokine release syndrome
58
Cytokine Release Syndrome
can be severe and even involve anaphylaxis. Patients are often premedicated with corticosteroids (e.g., intravenous [IV] methylprednisolone) in an effort to avoid or alleviate this problem
59
Basiliximab
black-box warning-potential for lymphoproliferative disorders and opportunistic infections and severe hypersensitivity reactions, including anaphylaxis
60
Immunosuppressants: Cyclosporine (Sandimmune)
Calcineurin inhibitor Prevention of organ rejection. Several black box warnings.
61
Immunosuppressants: Cyclosporine (Sandimmune) May be used for
other immunologic disorders like SLE, RA, IBS, psoriasis
62
Several Black Box warnings for Cyclosporine
renal impairment (structural kidney damage), increased risk of serious and fatal infections, liver injury, seizures, encephalopathy, and skin cancer
63
Nursing Management for Cyclosporine
Narrow therapeutic range, lab draws necessary Mix oral cyclosporine solution in a glass container Do not use Styrofoam containers because the drug adheres to the inside wall of the container
64
Immunosuppressants: Glatiramer acetate (Copaxone)
Works by blocking T-cell autoimmune activity against myelin protein Reduces the frequency of the neuromuscular exacerbations associated with MS
65
Immunosuppressants: Fingolimod (Gilenya)
Failed as an antirejection drug Approved in 2010 for MS Only oral drug for relapsing forms of MS
66
Immunosuppressants: Fingolimod (Gilenya) Significant Adverse Effects
headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema
67
Immunosuppressants: Fingolimod (Gilenya) Action
blocks T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with MS
68
Immunosuppressants: Muromonab-CD3 (Orthoclone OKT3)
``` Reversal and prevention of graft rejection Monoclonal antibody (differs from human antibodies in that it comes from mice) ```
69
Immunosuppressants: Muromonab-CD3 (Orthoclone OKT3) Action
specifically targets the binding sites on the T cells that recognize foreign invaders, such as a transplanted organ
70
Immunosuppressants: Mycophenolate (CellCept) Indications
prevention of organ rejection as well as the treatment of organ rejection Also used for treatment of SLE
71
Immunosuppressants: Mycophenolate (CellCept): Black Box Warning
U.S. Food and Drug Administration black box warning for increased risk of congenital malformations and spontaneous abortions when used during pregnancy
72
Immunosuppressants: Mycophenolate (CellCept): Side Effections
``` hypertension hypotension peripheral edema tachycardia pain headache hyperglycemia hyperlipidemia electrolyte disturbances others ```
73
Nursing Implications: Assessment
Perform a thorough assessment before administering immunosuppressants Renal, liver, and cardiovascular function studies Central nervous system baseline function Respiratory assessment Baseline vital signs Baseline laboratory studies, including hemoglobin, hematocrit, white blood cell (WBC) count, and platelet count
74
Nursing Implications: Monitor
WBC counts throughout therapy; if the count drops below normal range, contact the prescriber
75
Nursing Implications: Interactions
Grapefruit juice also interacts with some of these drugs
76
Oral anti-fungal drugs are usually given with these drugs to treat
Oral candidiasis that may occur.
77
Nursing Implications: Patient Teaching
- Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation. - Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection (i.e Avoid crowds and avoid people with colds or other infections) - Inform patients to immediately report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection.

NURS 320 (28 decks)

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