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Pharmacology Exam #2 > Immune Modulators > Flashcards

Immune Modulators Flashcards

1
Q

What are Immune Modulators?

A

Agents that either stimulate OR suppress the immune system

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2
Q

What are Immune Stimulants?

A

Agents that help ENERGIZE the immune system when it needs help fighting a specific pathogen

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3
Q

What are Immune Suppressants?

A

Agents that BLOCK the normal effects of the immune system for things like organ transplantation and autoimmune disorders

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4
Q

Lifespan considerations of Immune Modulators
In Children

A
  • Use with CAUTION
  • Monitor closely for infection, GI, renal, hematological or CNS effects
  • Immune suppressants are needed in HIGHER doses than in adults
  • Protect against infection and injury
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5
Q

Lifespan considerations of Immune Modulators
In Adults

A
  • Teach proper injection technique
  • Avoid infection and injury
  • Contraindicated in pregnancy and lactation
  • Some drugs may impair fertility in both men and women
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6
Q

Lifespan considerations of Immune Modulators
In Older Adults

A
  • Aging immune system is less efficient and less responsive - more susceptible to drug effects
  • Monitor renal and liver function to determine dosage
  • More susceptible to infection - teach to avoid infection and injury
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7
Q

What are the different classes of Immune Stimulants?

A
  • Interferons (naturally released from human cells in response to viral invasion, stimulate T Cells and phagocytes, fight tumors)
  • Interleukins (communicate between lymphocytes, stimulate cellular immunity via NK cells, inhibit tumor growth, increase # of platelets)
  • Colony-Stimulating Factors (stimulate bone marrow to produce more WBCs, reduces neutropenia, fights some blood cancers)
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8
Q

Interferons
Drug Name

A

Interferon alfa-2b

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9
Q

Interferons
Mechanism of Action

A
  • Prevents virus particles from replicating inside other cells
  • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
  • Inhibits tumor growth and replication
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10
Q

Interferons
Indications

A
  • Various cancers (leukemias, sarcoma, melanoma, follicular lymphoma)
  • Hepatitis B & C
  • Multiple Sclerosis
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11
Q

Interferons
Contraindications

A

Absolute:
* Allergy
* Pregnancy

Caution:
* Lactation
* Cardiac disease
* Myelosuppression
* Central Nervous System dysfunction (Alzheimer’s Disease, ALS, etc.)

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12
Q

Interferons
Adverse Effects

A
  • Flu-like symptoms due to the inflammatory response
  • Lethargy
  • Myalgia (muscle pain)
  • Arthralgia (joint pain/stiffness)
  • Anorexia (loss of appetite)
  • Nausea
  • Headache
  • Dizziness
  • Bone Marrow Depression
  • Suicide Ideation
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13
Q

Interferons
Drug Interactions

A

NONE known

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14
Q

Interleukins
Mechanism of Action

A
  • Increase the number of Natural Killer (NK) cells and lymphocytes
  • Activate cellular immunity
  • Inhibit tumor growth
  • Increase circulating platelets
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15
Q

Interleukins
Indications

A
  • Aldesleukin: specific renal carcinomas; possible treatment of AIDS and AIDS related disorders
  • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy (platelets)
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16
Q

Interleukins
Drug Names

A

Aldesleukin

Oprelvekin

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17
Q

Interleukins
Contraindications

A

Absolute:
* Allergy
* Pregnancy

Cautions:
* Renal impairment
* Liver Impairment
* Cardiovascular impairment

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18
Q

Interleukins
Adverse Effects

A
  • Lethargy
  • Myalgia (muscle pain)
  • Arthralgia (joint pain/stiffness)
  • Fatigue
  • Fever
  • Respiratory difficulties
  • Depression with SI

(Flu-like symptoms)

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19
Q

Colony-Stimulating Factors
Drug Names

A

Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)

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20
Q

Colony-Stimulating Factors
Mechanism of Action

A

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

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21
Q

Colony-Stimulating Factors
Indications

A
  • Reduce the incidence of infection in pts with bone marrow suppression
  • Decrease neutropenia associated with chemotherapy and bone marrow transplants
  • Treat some blood-related cancers

(NOT for bone marrow cancers or Sickle-Cell Anemia as it would multiply the damaged/diseased cells)

22
Q

Colony-Stimulating Factors
Contraindications

A

Absolute:
* Allergy to any products made with E. coli
* Ongoing chemo or radiation (for use POST-treatment)

Cautions:
* Pregnancy
* Lactation

23
Q

Colony-Stimulating Factors
Adverse Effects

A
  • 🤢 GI effects: Nausea & diarrhea
  • 🧠 CNS effects: headache, fatigue, generalized weakness
  • Dermatologic: alopecia, dermatitis
  • Generalized pain
  • Bone Pain
  • Splenomegaly (enlarged spleen)
  • Leukocytosis
24
Q

Immune Stimulants
Assessment

A

History:
* Assess for contraindications and cautions

Physical:
* Skin - lesions
* Weight
* Temperature
* Heart rate and rhythm
* Blood pressure
* Orientation and reflexes

Labs:
* ECG
* Renal & liver function tests
* CBC

25
Q

Immune Stimulants
Nursing Diagnoses

A
  • Impaired comfort r/t CNS, GI, and flu-like effects
  • Risk of Malnutrition (r/t flu-like effects)
  • Acute or chronic fear or anxiety (r/t diagnosis and drug therapy)
  • Knowledge deficit
26
Q

Immune Stimulants
Implementation/Patient Teaching

A
  • Monitor baseline labs and periodically during therapy
  • Proper administration if injections are required
  • Monitor for severe reactions
  • Comfort measures for flu-like symptoms
  • Ensure pt is well hydrated
  • Barrier contraception to prevent pregnancy

(from personal experience - administer antihistamine such as claritin BEFORE colony stimulating factors to prevent/decrease bone pain)

27
Q

What are the different classes of Immune Suppressants?

A
  • Immune modulators (Apremilast)
  • T and B cell suppressors
  • Interleukin Receptor Antagonists (Anakinra)
  • Monoclonal Antibodies
28
Q

Immune Modulator: Apremilast
Mechanism of Action

A
  • Blocks the release of proinflammatory cytokines and increases the secretion of ANTI-inflammatory cytokines from monocytes –> DECREASING overall immune activity
  • Has varying effects on cell proliferation
29
Q

Immune Modulator: Apremilast
Indication

A

Psoriatic Arthritis

30
Q

Immune Modulator: Apremilast
Contraindications

A

Pregnancy

31
Q

Immune Modulator: Apremilast
Adverse Effects
AND
Drug Interactions

A

UNKNOWN

Relatively new drug class

32
Q

T- and B-Cell Suppressors
Mechanism of Action

A
  • Block antibody production by B cells
  • Inhibit suppressor and helper T cells
  • Modify the release of interleukins and T cell growth factor
33
Q

T- and B-Cell Suppressors
Indications

A
  • Cyclosporine: Suppression of rejection in variety of transplants; rheumatoid arthritis; psoriasis
  • Mycophenolate: Prevention of rejection after renal or heart transplants in adults
  • Tacrolimus: Prevention of rejection after heart or liver transplant
34
Q

T- and B-Cell Suppressors
Contraindications

A

Absolute:
* Allergy
* Pregnancy
* Lactation

Cautions:
* Renal or hepatic impairment

35
Q

T- and B-Cell Suppressors
Adverse Effects

A
  • Increased risk of infection
  • Increased risk of development of neoplasms (tumors)
  • Hepatotoxicity
  • Renal dysfunction or toxicity
  • 🫁 Pulmonary edema
  • 🤢 GI upset
  • 🧠 Headache
  • 💓 Hypertension
  • Cyclosporine: Hirsutism and gum overgrowth
36
Q

T- and B-Cell Suppressors
Drug Interactions

A

Drugs that are hepatotoxic or nephrotoxic

37
Q

Interleukin Receptor Antagonists
Drug Name

A

Anakinra

38
Q

Interleukin Receptor Antagonists: Anakinra
Mechanism of Action

A
  • Blocks the activity of interleukins that are released in an inflammatory or immune response

(Interleukin-1 are thought to be responsible for the degradation of cartilage)

39
Q

Interleukin Receptor Antagonists: Anakinra
Indication

A

Rheumatoid arthritis

(when other traditional treatments haven’t worked)

40
Q

Interleukin Receptor Antagonists: Anakinra
Contraindications

A

Absolute:
* Allergy to products made with E. coli.
* Allergy to Anakinra

Caution:
* Pregnancy & lactation
* Renal impairment
* Immunosuppression
* Any active infection

41
Q

Interleukin Receptor Antagonists: Anakinra
Adverse Effects

A

🧠 Headache
👃 Sinusitis
🤢 Nausea
💩 Diarrhea

42
Q

Interleukin Receptor Antagonists: Anakinra
Drug Interactions

A
  • Etanercept (TNF blocker) may cause severe and even life-threatening infections.
43
Q

Monoclonal Antibodies
Mechanism of Action

A
  • Antibodies that attach to SPECIFIC antigen receptors (designed to respond to very specific situations)
  • Binds to T cells, disabling them, and acting as an immune suppressor
  • Decrease inflammatory response
44
Q

Monoclonal antibodies
Indications

A
  • Cancers
  • Arthritis
  • Crohn’s Disease
  • Ulcerative colitis
  • Multiple Sclerosis (MS)
45
Q

Monoclonal Antibodies
Drug Names

A

Adalimumab
Certolizumab
Golimumab
Infliximab

46
Q

Monoclonal Antibodies
Contraindications

A

Absolute:
* Allergy
* Fluid Overload (exacerbated)
* Pregnancy & Lactation

Cautions:
* Fever (r/t infection)
(okay to give if fever is related to disease process)

47
Q

Monoclonal Antibodies
Adverse Effects

A
  • Acute pulmonary edema (caused by Cytokine Release Syndrome CRS = leads to shock)
  • Fluid retention
  • Flu-like symptoms
48
Q

Monoclonal Antibodies
Drug Interactions

A

Other immune suppressants => severe suppression can lead to sepsis

49
Q

Immune Suppressants
Nursing Diagnoses

A
  • Impaired Comfort (r/t CNS, GI, and flu-like effects)
  • Risk of infection (r/t immune suppression)
  • Risk of malnutrition (r/t nausea & vomiting)
  • Knowledge deficit
50
Q

Immune Suppressants
Assessment

A

History:
* Assess for contraindications & cautions

Physical:
* Weight
* Monitor for fluid retention
* Temperature
* Pulse and BP
* Orientation & reflexes
* Check for coughing ➡️ sign of pulmonary edema - quick intervention needed

Labs:
* Baseline ECG
* Renal & Liver Function Tests
* CBC

51
Q

Immune Suppressants
Implementation/Patient Teaching

A
  • Monitor baseline and then periodic labs during treatment
  • Administer drug as indicated; teach proper administration
  • Protect pt from infection
  • Strict aseptic technique
  • Comfort measures for flu-like symptoms
  • Monitor nutritional status
  • Small frequent meals for GI upset
  • Barrier contraception to prevent pregnancy
  • Alternative to breastmilk

Pharmacology Exam #2 (14 decks)

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