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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
Q

Is there a cure for rheumatoid arthritis?

A

No cure.

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26
Q

Rheumatoid Arthritis: Treatment Goal

A

Reduce symptoms and prevent further damage to joints.

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27
Q

What are the pharmacological treatments for Rheumatoid Arthritis?

A
  • NSAIDs (early stages)
  • Corticosteroids (moderate stages)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
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28
Q

Disease Modifying Anti-rheumatic Arthritis Drugs

A

Provides anti-inflammatory and analgesic effects.

Can slow down the disease process.

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29
Q

Non-Pharmacologic Treatment for Rheumatoid Arthritis

A 
Physical therapy
Occupational therapy
Exercise
Diet
Stress reduction
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30
Q

Disease-Modifying Anti-rheumatic Arthritis Drugs include

A

Methotrexate
Leflunomide (Arava)
Etanercept (Enbrel)
Abatacept (Orencia)

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31
Q

Disease-Modifying Anti-rheumatic Arthritis Drugs: MOA

A

Vary per drug

Overall: inhibit movement of various cells (neutrophils, monocytes, and macrophages) into an inflamed, damaged area

32
Q

Disease-Modifying Anti-rheumatic Arthritis Drugs: Onset of Action

A

Slow—several weeks

First line therapy in most patients—slows progression of disease

33
Q

Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel)

A

Used to treat RA and psoriasis.

Patients must be screened for latex allergy (some dosage forms may contain latex)

34
Q

Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel) Onset of Action

A

1-2 weeks

35
Q

Disease-Modifying 
Antirheumatic Drugs: Etanercept (Enbrel) Contraindications

A

Contraindicated in presence of active infections.(Reactivation of hepatitis and TB have been reported)

36
Q

Disease-Modifying 
Antirheumatic Drugs: Abatacept (Orencia)

A

(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
Q

Multiple Sclerosis

A

Autoimmune response that causes:
Degeneration of CNS myelin
Scarring brain
Loss of axons

38
Q

Multiple Sclerosis: Pathophysiology

A
  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
Q

MS Symptoms

A 
Paresthesias of the face, trunk, or limbs
Weakness (all four limbs)
Impaired gait
Visual disturbances
Urinary incontinence
40
Q

How long do MS symptoms last?

A

A few days to weeks

Latent and exacerbated periods

41
Q

MS: Evaluation/Diagnosis

A

No single test available

Do criteria include: Hx and clinical exam, MRI, CSF findings

42
Q

MS: Treatment Goals

A

Prevent exacerbations
Prevent permanent Neurologic damage
Control symptoms

43
Q

MS: Pharmacologic Treatment includes

A

Corticosteroids
Immunosuppressants
Immune system modulators

Plasma exchange, stem cell therapy

44
Q

MS: Non-Pharmacologic Treatment

A

Regular exercise
Smoking cessation
Decrease stress, extreme fatigue
Decrease heat exposure

45
Q

Transplant Rejection

A

primary concern; occurs from an immune response targeted against the transplanted organ

46
Q

Graft Rejection Symptoms

A
  • 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
Q

Classes of Immunosuppressants to prevent organ rejection

A
  • Glucocorticoids
  • Calcineurin inhbitors
  • Antimetabolites
  • Biologics
48
Q

Glucocorticoids

A

inhibit all stages of T-cell activation and are used for induction, maintenance immunosuppression, and acute rejection

49
Q

Calcineurin inhibitors

A

inhibit the phosphate required for interleukin 2 production

50
Q

Antimetabolites

A

Inhibit cell proliferation

51
Q

Biologics

A

Inhibit cytotoxic T killer cell function

52
Q

Immunosuppressants include

A 
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
Q

Immunosuppressants: Therapeutic Use

A

Therapeutic use varies from drug to drug

Primarily indicated for the prevention of organ rejection

54
Q

What immunosuppressants are indicated for both prevention of rejection and treatment of organ rejection?

A

Muromonab-CD3 (Orthoclone)
Mycophenolate (Cellcept)
Tacrolimus (Prograf)

55
Q

Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax)

A

Monoclonal antibodies.

Used to prevent rejection of transplanted kidneys.

56
Q

Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax) are generally used as part of a

A

multidrug immunosuppressive regimen that includes cyclosporine and corticosteroids

57
Q

Immunosuppressants: Basiliximab (Simulect) and Daclizumab (Zenapax) has a tendency to

A

cause the allergy-like reaction known as cytokine release syndrome

58
Q

Cytokine Release Syndrome

A

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
Q

Basiliximab

A

black-box warning-potential for lymphoproliferative disorders and opportunistic infections and severe hypersensitivity reactions, including anaphylaxis

60
Q

Immunosuppressants: Cyclosporine (Sandimmune)

A

Calcineurin inhibitor
Prevention of organ rejection.
Several black box warnings.

61
Q

Immunosuppressants: Cyclosporine (Sandimmune) May be used for

A

other immunologic disorders like SLE, RA, IBS, psoriasis

62
Q

Several Black Box warnings for Cyclosporine

A

renal impairment (structural kidney damage), increased risk of serious and fatal infections, liver injury, seizures, encephalopathy, and skin cancer

63
Q

Nursing Management for Cyclosporine

A

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
Q

Immunosuppressants: Glatiramer acetate (Copaxone)

A

Works by blocking T-cell autoimmune activity against myelin protein

Reduces the frequency of the neuromuscular exacerbations associated with MS

65
Q

Immunosuppressants: Fingolimod (Gilenya)

A

Failed as an antirejection drug

Approved in 2010 for MS

Only oral drug for relapsing forms of MS

66
Q

Immunosuppressants: Fingolimod (Gilenya) Significant Adverse Effects

A

headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema

67
Q

Immunosuppressants: Fingolimod (Gilenya) Action

A

blocks T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with MS

68
Q

Immunosuppressants: Muromonab-CD3 (Orthoclone OKT3)

A 
Reversal and prevention of graft rejection
Monoclonal antibody (differs from human antibodies in that it comes from mice)
69
Q

Immunosuppressants: Muromonab-CD3 (Orthoclone OKT3) Action

A

specifically targets the binding sites on the T cells that recognize foreign invaders, such as a transplanted organ

70
Q

Immunosuppressants: Mycophenolate (CellCept) Indications

A

prevention of organ rejection as well as the treatment of organ rejection
Also used for treatment of SLE

71
Q

Immunosuppressants: Mycophenolate (CellCept): Black Box Warning

A

U.S. Food and Drug Administration black box warning for increased risk of congenital malformations and spontaneous abortions when used during pregnancy

72
Q

Immunosuppressants: Mycophenolate (CellCept): Side Effections

A 
hypertension
hypotension
peripheral edema
tachycardia
pain
headache
hyperglycemia
hyperlipidemia
electrolyte disturbances 
others
73
Q

Nursing Implications: Assessment

A

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
Q

Nursing Implications: Monitor

A

WBC counts throughout therapy; if the count drops below normal range, contact the prescriber

75
Q

Nursing Implications: Interactions

A

Grapefruit juice also interacts with some of these drugs

76
Q

Oral anti-fungal drugs are usually given with these drugs to treat

A

Oral candidiasis that may occur.

77
Q

Nursing Implications: Patient Teaching

A
  • 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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