Immunology

Question 1

main uses for immunosuppressant therapy

Answer 1

to counteract an inappropriate immune response like an autoimmune disorder

to block immune response when it is not wanted like in organ transplants or severe allergy treatment

Question 2

Desired effect of steroids in immunity

Answer 2

immune suppression; decreases number of EBC, T cells, and cytokines and suppresses phagocytosis

Question 3

steroid meds

Answer 3

-ones family
prednisone,hydrocortisone,methylprednisolone

Question 4

ADRs of steroids

Answer 4

systemic effects with high dose or long term therapy

Question 5

F/E effects of steroids

Answer 5

increase retention of Na+ and water, excretion of K+ and Ca+

Question 6

nervous system effects of steroids

Answer 6

decrease nerve excitability, slowed activity in cerebral cortex

Question 7

endocrine effects of steroids

Answer 7

suppression of cortisol releasing hormone from hypothalamus, suppress synthesis and release of ACTH from pituitary, suppress synthesis and release of natural cortisol from adrenal gland

Question 8

CHO metabolism effects of steroids

Answer 8

increase in gluconeogenesis and decrease cell use of glucose leading to HYPERGLYCEMIA

Question 9

protein metabolism effects of steroids

Answer 9

breakdown of protein resulting in MUSCLE WASTING and depletion of protein in all body cells; reduction in synthesis of new protein

Question 10

fat metabolism effects of steroids

Answer 10

breakdown of adipose tissue, oxidation of fatty acids, REDISTRIBUTE FAT/ Cushing’s syndrome (moon face and buffalo hump)

Question 11

nursing considerations in steroid therapy

Answer 11

DO NOT… abruptly stop therapy

DO… give according to circadian rhythm, give with food, protect patient from injury/infection, monitor blood glucose and fluid retention

Question 12

non-steroid immunosuppressants uses

Answer 12

organ transplant, 2nd agents in severe autoimmune diseases that are unresponsive to other therapy

Question 13

common ADR with non-steroid immunosuppressants

Answer 13

risk of serious infection

Question 14

types of non steroid immunosuppressants

Answer 14

calcineurin inhibitors and cytotoxic agents

Question 15

calcineurin inhibitors MOA

Answer 15

inhibit calcineurin (needed to produce IL 2, which is needed for production of T cells)

Question 16

ADR of calcineurin inhibitors

Answer 16

nephrotoxicity and increase infection risk; topical may be carcinogenic

Question 17

calcineurin inhibitor medications

Answer 17

cyclosporine and tacrolimus

Question 18

cytotoxic agent MOA

Answer 18

destroys B and T lymphocytes, kills all proliferating cells; most are non-sepcific

Question 19

cytotoxic agent ADRs

Answer 19

BONE MARROW SUPPRESSION, alopecia, GI dysfunction

Question 20

cytotoxic agent common medication

Answer 20

methotrexate

Question 21

purpose of biological response modifiers

Answer 21

therapeutic meds that will alter a pt’s immune response mainly to malignant cells

Question 22

types of biological response modifiers

Answer 22

hematopoietic agents, interferons, monoclonal antibodies, interleukins

Question 23

hematopoietic agent MOA

Answer 23

stimulate colony cells in bone marrow to restore blood components

Question 24

hematopoietic agent uses

Answer 24

treat bone marrow suppression in cancer patients, ESRD and severe immunocompromised

anemic pts = stimulate RBCs
neutropenic pts = stimulate WBCs
thrombocytopenic pts = stimulate platelets

Question 25

hematopoietic agent medications for anemia

Answer 25

epoetin, darbepoetin

Question 26

hematopoietic agent medications for neutropenia

Answer 26

filgrastim (stimulate neutrophils), sargramostim (stimulate granulocytes and macrophages)

Question 27

hematopoietic agent medications for thrombocytopenia

Answer 27

oprelvekin- promote platelets

Question 28

nursing considerations for hematopoietic agents

Answer 28

assess for S&S of anemia, neutropenia, and thrombocytopenia safety precautions (anemic = weak and dizzy, lead to falls; thrombocytopenic = bleed and bruise easy, protect from everything)

Question 29

interferon medications MOA

Answer 29

regulate immune functions, slows cell proliferation, and inhibits virus replication

Question 30

interferon med usage

Answer 30

chronic viral illnesses (Hep C, MS, cancer); often used in combo with antiviral

Question 31

monoclonal antibody MOA

Answer 31

block TNF or interleukins to inhibit joint destruction and inflammation

Question 32

monoclonal antibody uses

Answer 32

cancer treatment, progressive autoimmune disease (RA, Crohn's, ulcerative colitis)

Question 33

monoclonal antibody meds

Answer 33

-mab meds (adalimumab, trastuzamab)

Question 34

TNF Receptor Antagonist med types

Answer 34

etanercept- severe RA BCG vaccine- TB vaccine to treat bladder cancer Retinoid receptor agonist (bexarotene/tretinoin)- skin cancer and other types

Question 35

contraindication in TNF receptor antagonist

Answer 35

moderate to severe heart failure pts

Question 36

interleukins MOA

Answer 36

cytokines that exact MOA is unknown but enhance the signal to T cell growth and cytotoxic lymphocytes

Question 37

interleukins use

Answer 37

severe RA, cancer treatment (renal, malignant melanoma, and leukemia)

Question 38

interleukin meds for cancer treatment

Answer 38

aldesleukin (IL 2) and denileukin

Question 39

interleukin meds for RA and neonates

Answer 39

anakinra (IL 1 receptor antagonist)

Question 40

what are DMARDs

Answer 40

disease modifying antirheumatic drugs

Question 41

DMARD use

Answer 41

prevent progression of RA

Question 42

DMARD contraindication

Answer 42

pts with serious infections

Question 43

non biological DMARDs

Answer 43

methotrexate (RA and sickle cell anemia), hydroxychloroquine (slows immune response)

Question 44

biological DMARDs

Answer 44

given to pts that do not respond to methotrexate -mab drugs -tofacitinib may use for psoriasis, ulcerative colitis, etc

Question 45

methotrexate MOA

Answer 45

chemotherapy agent that decreases inflammation by increasing adenosine levels

Question 46

MTX ADRs

Answer 46

anemia and pulmonary fibrosis

Question 47

MTX is always taken with...?

Answer 47

1 mg folic acid qd

Question 48

hydroxychloroquine MOA

Answer 48

antimalarial agent that inhibits RF and early inflammatory cell response

Question 49

hydroxychloroquine ADRs

Answer 49

irreversible retinal damage and blindness

Question 50

sulfasalizine

Answer 50

reduces redness and inflammation; often used in combo with other treatments or steroids

Question 51

Janus Kinase Inhibitor

Answer 51

tofacitinib; last resort DMARD

Question 52

BBW on JAK Inhibitor

Answer 52

serious infection and malignancy; infections can lead to hospitalization or death