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Pharmacology Test 2 > Immune Modulators > Flashcards

Immune Modulators Flashcards

1
Q

Immune Modulators: Across the lifespan

A

Children: Higher dose immune suppressant; monitor infection, GI, renal, hematological, CNS effects
Adults: NO P/L

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2
Q

Immune Stimulators / Names

A

Interferons: Interferon Alfa-2b
Interleukin: aldesleukin, oprelvekin
Colony-Stimulating Factors: filgrastim, sargramostim

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3
Q

Interferon Actions

A

Prevent virus particles from replicating inside other cells
Stimulate interferon receptor sites on non-invaded cells to produce antiviral proteins
Inhibit tumor growth and replication

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4
Q

Interferon Contraindication and Caution

A

Allergy/Pregnancy/Lactation

Cardiac disease / CNS dysfunction / myelosuppression

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5
Q

Myelosuppression

A

A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets

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6
Q

Interferon: ADE

A

Flu like most common

Lethargy, myalgia, arthralgia, anorexia, nausea, HA, dizziness, bone marrow suppression

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7
Q

Interferon Alfa - 2a Indications

A

Harry cell leukemia, aids related kaposi sarcoma, chronic hep b / c, intralesional treatment of condylomata acuminate in 18 y/o, malignant melanomas, follicular lymphoma,

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8
Q

Interleukins

A

Chemicals produced by T cells to communicate between leukocytes (increase lymphocytes, platelets, cytokines) (increase natural killer)

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9
Q

Interleukin: types of preparations

A

Aldesleukin
- Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria

Oprelvekin
- A newer agent produced by DNA technology

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10
Q

Intertleukin Action

A

Actions
Increase the number of natural killer cells and lymphocytes
Activates cellular immunity and inhibits tumor growth

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11
Q

Aldesleukin: Indications

A

Specific renal carcinomas; possible treatment of AIDS and AIDS-related disorders

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12
Q

Oprelvekin: Indication

A

Prevention of severe thrombocytopenia after myelosuppressive chemotherapy

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13
Q

Interleukin: Contraindication / Caution / ADE

A

Contraindications
Known allergy, pregnancy, and lactation
Cautions
Renal, liver, or cardiovascular impairment
Adverse Effects
Lethargy, myalgia, arthralgia, fatigue, fever, respiratory difficulties, depression with suicidal ideation
Flu like most common
know respiratory difficulties and depression

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14
Q

Colony-Stimulating Factors: Names

A

Filgrastim

sargramostim

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15
Q

Colony-Stimulating Factors: Contraindications

A

Contraindications - Allergy to any component of the drug, pregnancy, lactation, renal or hepatic disease, radiation and chemotherapy

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16
Q

Colony-Stimulating Factors: ADE

A

Adverse Effects- GI related, headache, fatigue, generalized weakness, alopecia and dermatitis, and generalized pain and bone pain

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17
Q

Colony-Stimulating Factors: Drug drug

A

Drug-Drug interactions-increase in the myeloproliferative effects when combined with lithium or corticosteroids

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18
Q

Colony-Stimulating Factors: Indication

A

Indication- Can be used to reduce the incidence of infection in patients with bone marrow suppression, to decrease the neutropenia associated with bone marrow transplants and chemotherapy, and to help in the treatment of various blood-related cancers.

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19
Q

Colony-Stimulating Factors

A

Increase the production of neutrophils in the bone marrow with little effect on other hematopoietic cells

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20
Q

Nursing Considerations for Immune Stimulants

A

Assessment
History and physical exam
Assess for contraindications and cautions: Known allergies, pregnancy or lactation, history of hepatic, renal, or cardiac disease; bone marrow depression; leukemic states; and CNS disorders
Skin lesions, weight, monitor temperature, check heart rate and rhythm and blood pressure, orientation and reflexes
Obtain a baseline ECG
Monitor the results of laboratory tests

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21
Q

Nursing Considerations for Immune Stimulants: Diagnosis

A

Nursing Diagnoses
Acute pain related to CNS, GI, and flu-like effects
Imbalanced nutrition: Less than body requirements related to flu-like effects
Anxiety related to diagnosis and drug therapy
Deficient knowledge regarding drug therapy

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22
Q

Immune stimulants: Implementation

A

Implementation
Arrange for laboratory tests before and periodically during therapy
Administer drug as indicated; instruct the patient and a significant other if injections are required
Monitor for severe reactions
Instruct female patients in the use of barrier contraceptives to avoid pregnancy
Provide patient teaching

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23
Q

Immune Stimulaters: Evaluation

A

Evaluation
Monitor patient response to the drug (improvement in condition being treated)
Monitor for adverse effects (flu-like symptoms, GI upset, CNS changes, bone marrow depression)
Evaluate the effectiveness of the teaching plan
Monitor the compliance with the regimen

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24
Q

Recap Immune Stimulants

A

Immune stimulants assist the immune system to fight specific pathogens or cancer cells; in doing so, they cause flu-like symptoms (lethargy, muscle and joint aches and pains, anorexia, nausea).
Interferons are used to treat various cancers and warts.
Interleukins stimulate cellular immunity and inhibit tumor growth.
Colony-stimulating factors increase the production of white blood cells by working in the bone marrow.

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25
Q

Immune Suppressors: Types

A

Immune modulators
T and B cell suppressors
Interleukin receptor antagonists
Monoclonal antibodies

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26
Q

Immune Modulators: Names

A

Apremilast

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27
Q

Immune Modulators: Action

A

Block the release of various cytokines involved in the inflammatory response and activation of lymphocytes, decreasing immune activity

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28
Q

Immune Modulators: Action

A

Action- Inhibit the secretion of proinflammatory cytokines and increase the secretion of anti-inflammatory cytokines from monocytes and have varying effects on cell proliferation.

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29
Q

Immune Modulators Contraindications

A

Contraindications- Pregnancy, lactation and severe liver impairment

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30
Q

Immune Modulators: ADE and DD Interactions

A

Adverse effects- unknown

Drug-drug interactions- unknown

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31
Q

T- and B-Cell Suppressors: Names

A 
Cyclosporine: 
Azathioprine: 
Glatiramer:
Mycophenolate: 
Tacrolimus
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32
Q

Cyclosporine

A

Suppression of rejection in variety of transplants; rheumatoid arthritis, psoriasis

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33
Q

Azathioprine

A

Prevention of rejection in renal hemotransplants; treatment of rheumatoid arthritis

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34
Q

Glatiramer

A

Reduction of number of relapses in multiple sclerosis in adults

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35
Q

Mycophenolate

A

Prevention of rejection after renal or heart transplant in adults

36
Q

Tacrolimus

A

Prevention of rejection after heart or liver transplant

37
Q

T- and B-Cell Suppressors: Actions

A

Actions- Block antibody production by B cells, inhibit suppressor and helper T cells, and modify the release of interleukins and of T cell growth factor

38
Q

T- and B-Cell Suppressors: Contraindications

A

Contraindications- Known allergy, pregnancy, lactation, and hepatic disease

39
Q

T- and B- cell suppressor: ADE

A

Adverse effects- Increased risk for infection and for the development of neoplasms due to their blocking effect on the immune system as well as hepatotoxicity, renal toxicity, renal dysfunction, and pulmonary edema.

40
Q

T- and B- cell suppressor: DD Interaction

A

Drug-Drug Interactions- Increased risk of toxicity if these drugs are combined with other drugs that are hepatotoxic or nephrotoxic.

41
Q

Interleukin Receptor Antagonist: Name

A

Anakinra

42
Q

Interleukin Receptor Antagonist: Action

A

Works to block the activity of the interleukins that are released in an inflammatory or immune response

43
Q

Interleukin Receptor Antagonist: Action / Indication

A

Actions
Used to treat rheumatoid arthritis
Block activity of interleukin-1

44
Q

Interleukin Receptor Antagonist: Contraindications

A

Contraindications-
Known allergy to Escherichia coli–produced products or to anakinra, pregnancy, lactation, renal impairment and immunosuppression or any active infection

45
Q

Interleukin Receptor Antagonist: ADE

A

Adverse Effects

Headache, sinusitis, nausea, diarrhea are the most common

46
Q

Interleukin Receptor Antagonist: Drug drug interaction

A

Drug-Drug Interactions- Etanercept may cause severe and even life-threatening infections

47
Q

Monoclonal Antibodies (-mab): Names

A

Adalimumab, certolizumab, golimumab, and infliximab are most common

48
Q

Monoclonal Antibodies (-mab): Action

A

It reacts as an antibody to human T cells, disabling the T cells and acting as an immune suppressor

49
Q

Monoclonal Antibodies (-mab): actions

A

Actions- Antibodies that attach to specific receptors

50
Q

Monoclonal Antibodies: Contraindications

A

Contraindications- Known allergy and fluid overload and fever as well as pregnancy and lactation

51
Q

Monoclonal Antibodies: Contraindications

A

Contraindications- Known allergy and fluid overload and fever as well as pregnancy and lactation

52
Q

Monoclonal Antibodies: Drug drug interactions

A

Drug-Drug Interactions- Severe immune suppression can occur with the use of other suppressants

53
Q

Monoclonal antibody: Assessment

A

Assessment
History and physical exam
Assess for contraindications and cautions
Obtain weight, temperature, pulse and blood pressure, orientation and reflexes
Obtain a baseline ECG
Monitor the results of laboratory tests

54
Q

Immune suppressants: Diagnosis

A

Nursing Diagnoses
Acute pain related to CNS, GI, and flu-like effects
Risk for infection related to immune suppression
Imbalanced nutrition: Less than body requirements, related to nausea and vomiting
Deficient knowledge regarding drug therapy

55
Q

Monoclonal antibodies: Implementation

A

Implementation
Arrange for laboratory tests before and periodically during therapy
Administer the drug as indicated; instruct the patient and a significant other if injections are required
Protect the patient from exposure to infections and maintain a strict aseptic technique for any invasive procedures
Monitor nutritional status during therapy; provide small, frequent meals, mouth care, and nutritional consultation
Instruct females in use of barrier contraceptives
Suggest another method of feeding the baby
Provide thorough patient teaching

56
Q

Immune Suppressants: Evaluation

A

Evaluation
Monitor patient response to the drug (prevention of transplant rejection, improvement in autoimmune disease or cancer, prevention of RSV disease, improvement in signs and symptoms of Crohn disease or rheumatoid arthritis)
Monitor for adverse effects (flu-like symptoms, GI upset, increased infections, neoplasms, fluid overload)
Evaluate the effectiveness of the teaching plan
Monitor the compliance to the regimen

57
Q

Recap Immune Suppressants

A

Immune suppressants are used to depress the immune system when needed to prevent transplant rejection or severe tissue damage associated with autoimmune disease.
Increased susceptibility to infection and increased risk of neoplasm are potentially dangerous effects associated with the use of immune suppressants. Patients need to be protected from infection, injury, and invasive procedures.

58
Q

Interferon Alfa-2b: Actions and ADE

A

Actions: inhibits the growth of tumor cells and enhances the immune response
Adverse Effects: dizziness, confusion, rash, dry skin, anorexia, nausea, bone marrow suppression, flu-like syndrome
most common are flu like symptoms and then bone marrow suppression which is more serious ADE

59
Q

Interferon Alfa-2b: Indications

A

used for variety of cancer treatments
IM SUb Q IV
- Indication: Hairy cell leukemia, malignant melanoma, AIDS-related Kaposi sarcoma, chronic hepatitis B and C, follicular lymphoma, intralesional treatment of condylomata acuminate in patients 18 years of age or older

60
Q

Aldesleukin: Indications

A

Indications: metastatic renal cell carcinoma in adults, treatment of metastatic melanomas
A cancer treatment

61
Q

Aldesleukin: Actions

A

Actions: activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines

62
Q

Aldesleukin: ADE

A

ADE: mental status changes, dizziness, hypotension, since tachycardia, arrhythmias, pruritus, nausea, vomiting, diarrhea, anorexia, gastrointestinal bleed, bone marrow suppression, respiratory difficulties, fever, chills, pain
Still need to be aware of the rare ADE because they’re serious

63
Q

Filgrastim: Indications

A

Indications: reduce the incidence of infection and reduction in time to neutrophil recovery with myelosuppressive chemo, leukemia, bone marrow transplants

64
Q

Filgrastim: Indications

A

used in patients who are neutropenic from myelosuppresive chemo, leukemia, or bone marrow transplant

65
Q

Filgrastim: Actions

A

Actions: Increase production of neutrophils in the bone marrow

66
Q

Filgrastim: ADE

A

ADE: HA, fatigue, alopecia, rash n/v, diarrhea, stomatitis, anorexia, bone pain, cough, generalized pain (bone pain)

67
Q

Cyclosporine: Indications

A

Indications: Prophylaxis for organ rejection in kidney, liver, and heart transplant (used with corticosteroids); treatment of chronic rejection in patients previously treated with immune suppressants; treatment of RA and recalcitrant psoriasis

68
Q

Cyclosporine: Actions

A
  • Actions: reversibly inhibits immunocompetent lymphocytes, inhibits T helper cells and T suppressor cells, lymphokine production, and release of interleukin-2 and T cell growth factor
69
Q

Cyclosporine: ADE

A

ADE: Tremor, hypertension, gum hyperplasia, renal dysfunction, diarrhea, hirsutism, acne, bone marrow suppression, interleukin receptor agonist
- risk of infection from bone marrow suppression

70
Q

Bevacizumab: Indications

A

Indication: treatment of metastatic colorectal cancer, non-squamous cell non-small cell lung cancer, glioblastoma, renal cell carcinoma, cervical cancer, ovarian cancer

71
Q

Bevacizumab: Actions

A

Actions: monoclonal antibody that binds to and inhibits vascular endothelial growth factor leading to decreased angiogenesis and cell proliferation

72
Q

Bevacizumab: ADE

A

ADE: HA, back pain, hypertension, GI perforation, hemorrhage, surgery and wound complications (delayed healing), thrombotic events
flu like symptoms most common - risk for infection is most serious

73
Q

Immune suppressants: T and B cell Patient Teaching

A

to prevent organ rejection, patients need to take these drugs lifelong

74
Q

ADE to monitor: nursing considerations: Immune suppressants

A

increased infection, neoplasms, fluid overload

75
Q

Pulmonary Edema as an ADE

A

T and B cell suppressors

Monoclonal Antibody

76
Q

Flu like symptoms as ADE

A

Interferons
Interleukins
Colony stimulating
Monoclonal antibody

77
Q

Interleukins: actions

A

Stimulate cellular immunity and inhibit tumor growth - a great cancer treatment

78
Q

Interferons: general treatment of

A

Treat various cancers and warts

79
Q

Colony-Stimulating Factors

A

Increase production of WBC by working in bone marrow

80
Q

Has to do with transplants

A

Colony Stimulating Factors: Filgrastim - reduce infection and neutropenia after bone marrow transplants
T and B cell Suppressors - prevent rejection of organ transplants

81
Q

Neutrophils

A

Colony-Stimulating Factors

82
Q

Inhibit Cytokines - helps with inflammation

A

Immune modulators: inhibit pro-inflammatory cytokines, increase secretion of anti-inflammatory cytokines

83
Q

Bone marrow transplants
Chemo
Blood cancers

A

Colony stimulating factors

84
Q

Reduce incidence of infection

A

Colony-stimulating factors

85
Q

Risk of infection as ADE

A

T and B cell Suppressants (suppress many parts of immune system including bone marrow suppression)

Interleukin Receptor Antagonist (acute infection and immune suppression as contraindications)

Monoclonal Antibodies

Risk for infection as nursing diagnosis for immune suppressants

Immune modulators ADE unknown

Pharmacology Test 2 (3 decks)

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