Immune Modulators Flashcards
What are Immune Modulators?
Agents that either stimulate OR suppress the immune system
What are Immune Stimulants?
Agents that help ENERGIZE the immune system when it needs help fighting a specific pathogen
What are Immune Suppressants?
Agents that BLOCK the normal effects of the immune system for things like organ transplantation and autoimmune disorders
Lifespan considerations of Immune Modulators
In Children
- 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
Lifespan considerations of Immune Modulators
In Adults
- Teach proper injection technique
- Avoid infection and injury
- Contraindicated in pregnancy and lactation
- Some drugs may impair fertility in both men and women
Lifespan considerations of Immune Modulators
In Older Adults
- 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
What are the different classes of Immune Stimulants?
- 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)
Interferons
Drug Name
Interferon alfa-2b
Interferons
Mechanism of Action
- Prevents virus particles from replicating inside other cells
- Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
- Inhibits tumor growth and replication
Interferons
Indications
- Various cancers (leukemias, sarcoma, melanoma, follicular lymphoma)
- Hepatitis B & C
- Multiple Sclerosis
Interferons
Contraindications
Absolute:
* Allergy
* Pregnancy
Caution:
* Lactation
* Cardiac disease
* Myelosuppression
* Central Nervous System dysfunction (Alzheimer’s Disease, ALS, etc.)
Interferons
Adverse Effects
- 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
Interferons
Drug Interactions
NONE known
Interleukins
Mechanism of Action
- Increase the number of Natural Killer (NK) cells and lymphocytes
- Activate cellular immunity
- Inhibit tumor growth
- Increase circulating platelets
Interleukins
Indications
- Aldesleukin: specific renal carcinomas; possible treatment of AIDS and AIDS related disorders
- Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy (platelets)
Interleukins
Drug Names
Aldesleukin
Oprelvekin
Interleukins
Contraindications
Absolute:
* Allergy
* Pregnancy
Cautions:
* Renal impairment
* Liver Impairment
* Cardiovascular impairment
Interleukins
Adverse Effects
- Lethargy
- Myalgia (muscle pain)
- Arthralgia (joint pain/stiffness)
- Fatigue
- Fever
- Respiratory difficulties
- Depression with SI
(Flu-like symptoms)
Colony-Stimulating Factors
Drug Names
Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)
Colony-Stimulating Factors
Mechanism of Action
Increases the production of neutrophils in the bone marrow with little effect on other hematopoietic cells
Colony-Stimulating Factors
Indications
- 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)
Colony-Stimulating Factors
Contraindications
Absolute:
* Allergy to any products made with E. coli
* Ongoing chemo or radiation (for use POST-treatment)
Cautions:
* Pregnancy
* Lactation
Colony-Stimulating Factors
Adverse Effects
- 🤢 GI effects: Nausea & diarrhea
- 🧠 CNS effects: headache, fatigue, generalized weakness
- Dermatologic: alopecia, dermatitis
- Generalized pain
- Bone Pain
- Splenomegaly (enlarged spleen)
- Leukocytosis
Immune Stimulants
Assessment
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
Immune Stimulants
Nursing Diagnoses
- 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
Immune Stimulants
Implementation/Patient Teaching
- 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)
What are the different classes of Immune Suppressants?
- Immune modulators (Apremilast)
- T and B cell suppressors
- Interleukin Receptor Antagonists (Anakinra)
- Monoclonal Antibodies
Immune Modulator: Apremilast
Mechanism of Action
- 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
Immune Modulator: Apremilast
Indication
Psoriatic Arthritis
Immune Modulator: Apremilast
Contraindications
Pregnancy
Immune Modulator: Apremilast
Adverse Effects
AND
Drug Interactions
UNKNOWN
Relatively new drug class
T- and B-Cell Suppressors
Mechanism of Action
- Block antibody production by B cells
- Inhibit suppressor and helper T cells
- Modify the release of interleukins and T cell growth factor
T- and B-Cell Suppressors
Indications
- 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
T- and B-Cell Suppressors
Contraindications
Absolute:
* Allergy
* Pregnancy
* Lactation
Cautions:
* Renal or hepatic impairment
T- and B-Cell Suppressors
Adverse Effects
- 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
T- and B-Cell Suppressors
Drug Interactions
Drugs that are hepatotoxic or nephrotoxic
Interleukin Receptor Antagonists
Drug Name
Anakinra
Interleukin Receptor Antagonists: Anakinra
Mechanism of Action
- 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)
Interleukin Receptor Antagonists: Anakinra
Indication
Rheumatoid arthritis
(when other traditional treatments haven’t worked)
Interleukin Receptor Antagonists: Anakinra
Contraindications
Absolute:
* Allergy to products made with E. coli.
* Allergy to Anakinra
Caution:
* Pregnancy & lactation
* Renal impairment
* Immunosuppression
* Any active infection
Interleukin Receptor Antagonists: Anakinra
Adverse Effects
🧠 Headache
👃 Sinusitis
🤢 Nausea
💩 Diarrhea
Interleukin Receptor Antagonists: Anakinra
Drug Interactions
- Etanercept (TNF blocker) may cause severe and even life-threatening infections.
Monoclonal Antibodies
Mechanism of Action
- 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
Monoclonal antibodies
Indications
- Cancers
- Arthritis
- Crohn’s Disease
- Ulcerative colitis
- Multiple Sclerosis (MS)
Monoclonal Antibodies
Drug Names
Adalimumab
Certolizumab
Golimumab
Infliximab
Monoclonal Antibodies
Contraindications
Absolute:
* Allergy
* Fluid Overload (exacerbated)
* Pregnancy & Lactation
Cautions:
* Fever (r/t infection)
(okay to give if fever is related to disease process)
Monoclonal Antibodies
Adverse Effects
- Acute pulmonary edema (caused by Cytokine Release Syndrome CRS = leads to shock)
- Fluid retention
- Flu-like symptoms
Monoclonal Antibodies
Drug Interactions
Other immune suppressants => severe suppression can lead to sepsis
Immune Suppressants
Nursing Diagnoses
- 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
Immune Suppressants
Assessment
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
Immune Suppressants
Implementation/Patient Teaching
- 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
