Immunology Flashcards
main uses for immunosuppressant therapy
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
Desired effect of steroids in immunity
immune suppression; decreases number of EBC, T cells, and cytokines and suppresses phagocytosis
steroid meds
-ones family
prednisone,hydrocortisone,methylprednisolone
ADRs of steroids
systemic effects with high dose or long term therapy
F/E effects of steroids
increase retention of Na+ and water, excretion of K+ and Ca+
nervous system effects of steroids
decrease nerve excitability, slowed activity in cerebral cortex
endocrine effects of steroids
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
CHO metabolism effects of steroids
increase in gluconeogenesis and decrease cell use of glucose leading to HYPERGLYCEMIA
protein metabolism effects of steroids
breakdown of protein resulting in MUSCLE WASTING and depletion of protein in all body cells; reduction in synthesis of new protein
fat metabolism effects of steroids
breakdown of adipose tissue, oxidation of fatty acids, REDISTRIBUTE FAT/ Cushing’s syndrome (moon face and buffalo hump)
nursing considerations in steroid therapy
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
non-steroid immunosuppressants uses
organ transplant, 2nd agents in severe autoimmune diseases that are unresponsive to other therapy
common ADR with non-steroid immunosuppressants
risk of serious infection
types of non steroid immunosuppressants
calcineurin inhibitors and cytotoxic agents
calcineurin inhibitors MOA
inhibit calcineurin (needed to produce IL 2, which is needed for production of T cells)
ADR of calcineurin inhibitors
nephrotoxicity and increase infection risk; topical may be carcinogenic
calcineurin inhibitor medications
cyclosporine and tacrolimus
cytotoxic agent MOA
destroys B and T lymphocytes, kills all proliferating cells; most are non-sepcific
cytotoxic agent ADRs
BONE MARROW SUPPRESSION, alopecia, GI dysfunction
cytotoxic agent common medication
methotrexate
purpose of biological response modifiers
therapeutic meds that will alter a pt’s immune response mainly to malignant cells
types of biological response modifiers
hematopoietic agents, interferons, monoclonal antibodies, interleukins
hematopoietic agent MOA
stimulate colony cells in bone marrow to restore blood components
hematopoietic agent uses
treat bone marrow suppression in cancer patients, ESRD and severe immunocompromised
anemic pts = stimulate RBCs
neutropenic pts = stimulate WBCs
thrombocytopenic pts = stimulate platelets
hematopoietic agent medications for anemia
epoetin, darbepoetin
hematopoietic agent medications for neutropenia
filgrastim (stimulate neutrophils), sargramostim (stimulate granulocytes and macrophages)
hematopoietic agent medications for thrombocytopenia
oprelvekin- promote platelets
nursing considerations for hematopoietic agents
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)
interferon medications MOA
regulate immune functions, slows cell proliferation, and inhibits virus replication
interferon med usage
chronic viral illnesses (Hep C, MS, cancer); often used in combo with antiviral
monoclonal antibody MOA
block TNF or interleukins to inhibit joint destruction and inflammation
monoclonal antibody uses
cancer treatment, progressive autoimmune disease (RA, Crohn’s, ulcerative colitis)
monoclonal antibody meds
-mab meds (adalimumab, trastuzamab)
TNF Receptor Antagonist med types
etanercept- severe RA
BCG vaccine- TB vaccine to treat bladder cancer
Retinoid receptor agonist (bexarotene/tretinoin)- skin cancer and other types
contraindication in TNF receptor antagonist
moderate to severe heart failure pts
interleukins MOA
cytokines that exact MOA is unknown but enhance the signal to T cell growth and cytotoxic lymphocytes
interleukins use
severe RA, cancer treatment (renal, malignant melanoma, and leukemia)
interleukin meds for cancer treatment
aldesleukin (IL 2) and denileukin
interleukin meds for RA and neonates
anakinra (IL 1 receptor antagonist)
what are DMARDs
disease modifying antirheumatic drugs
DMARD use
prevent progression of RA
DMARD contraindication
pts with serious infections
non biological DMARDs
methotrexate (RA and sickle cell anemia), hydroxychloroquine (slows immune response)
biological DMARDs
given to pts that do not respond to methotrexate
-mab drugs
-tofacitinib
may use for psoriasis, ulcerative colitis, etc
methotrexate MOA
chemotherapy agent that decreases inflammation by increasing adenosine levels
MTX ADRs
anemia and pulmonary fibrosis
MTX is always taken with…?
1 mg folic acid qd
hydroxychloroquine MOA
antimalarial agent that inhibits RF and early inflammatory cell response
hydroxychloroquine ADRs
irreversible retinal damage and blindness
sulfasalizine
reduces redness and inflammation; often used in combo with other treatments or steroids
Janus Kinase Inhibitor
tofacitinib; last resort DMARD
BBW on JAK Inhibitor
serious infection and malignancy; infections can lead to hospitalization or death
