Immunomodulating Drugs Flashcards
Immunomodulating Drugs
Medications that therapeutically alter a patient’s immune response to malignant tumor cells
Hematopoietic Drugs
Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia
Allows for higher doses of chemotherapy
Filgrastim (Neupogen)
Hematopoietic drug
Granulocyte colony-stimulating factor
Stimulates precursor cells to turn into granulocytes such as basophils, eosinophils, and neutrophils
Oprelvekin (Neumega)
Hematopoietic drug
Enhances synthesis of platelets
Indicated for the prevention of chemotherapy-induced thrombocytopenia and avoidance of the need for platelet transfusions
Adverse Effects of Hematopoietic Drugs
Fever, muscle aches, bone pain, flushing
Interferons
Restore the immune system’s function if it is impaired
Augment the immune system’s ability to function as the body’s defense
Inhibit the immune system from working
HELPFUL IN AUTOIMMUNE DISEASES
Indications for Interferons
Genital warts, hepatitis
Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi’s sarcoma, malignant melanoma
Multiple sclerosis
Adverse Effects of Interferons
Fever, chills, headache, myalgia, anorexia, dizziness, nausea, vomiting, diarrhea
Dose-limiting adverse effect is fatigue
Monoclonal Antibodies
Treatment of cancer, rheumatoid arthritis, multiple sclerosis, and organ transplantation
Specifically target cancer cells and have minimal effect on healthy cells
Fewer adverse effects that traditional antineoplastic medications
Rheumatoid Arthritis
Autoimmune disorder causing inflammation and tissue damage in joints
TREATMENT: RELIEVE SYMPTOMS, MAINTAIN JOINT FUNCTION, MIIMIZE SYSTEMIC INVOLVEMENT, DELAY PROGRESSION OF DISEASE, NONDRUG MEASURES
Treatment consists of NSAIDs and DMARDs
Examples of Monoclonal Antibodies
ADALIMUMAB (HUMIRA) AND INFLIXIMAB (REMICADE)
Disease-Modifying Antirheumatic Drugs
Modify the disease of rheumatoid arthritis
Exhibit antiinflammatory, antiarthritic, and immunomodulating effects
Inhibit the movement of various cells into an inflamed, damaged area
Slow onset of action of several weeks
Nonbiologic Disease-Modifying Antirheumatic Drug
METHOTREXATE
Biologic Disease-Modifying Antirheumatic Drugs
ETANERCEPT-ENBREL AND ABATACEPT-ORENCIA
Eternercept (Enbrel)
Used to treat rheumatoid arthritis and psoriasis
Patients must be screened for latex allergy
1-2 weeks onset of action
Contraindicated in presence of active infections
Abatacept (Orencia)
Used to treat rheumatoid arthritis
Caution if the patient has a history of recurrent infections or COPD
Patients must be up to date in immunizations
May increase risk of infections associated with live vaccines or decrease response to vaccines
Nursing Implications of Immunomodulating Drugs
TEACH PATIENT TO IMMEDIATELY REPORT SIGNS OF INFECTION (SORE THROAT, DIARRHEA, VOMITING, FEVER OF 100.5 DEGREES FAHRENHEIT OR HIGHER)
Immunosuppressants
Drugs that decrease or prevent an immune response
Used to prevent or treat rejection of transplanted organs
Used in rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, multiple sclerosis, myasthenia gravis, and psoriasis
Transplants
IMMUNOSUPPRESSANTS ARE USED TO INHIBIT THE IMMUNE SYSTEM AND PREVENT ORGAN REJECTION
TRANSPLANT PATIENTS ARE ON IMMUNOSUPPRESSANT THERAPY FOR THE DURATION OF THEIR LIFETIME
Major Classes of Immunosuppressants
Glucocorticoids (inhibit T-cell activation)
Calcineurin inhibitors (inhibit phosphate)
Antimetabolites (inhibit cell proliferation)
Biologics (inhibit cytotoxic T cell functions)
Cyclosporine (Sandimmune)
Prevention of organ rejection
May be used for other autoimmune disorders
Black box warnings: renal impairment, increased risk of fatal infections, liver injury, seizures, encephalopathy, and skin cancer
Azathiprine (Imuran)
Prophylaxis of organ rejection concurrently with other immunosuppressant drugs
Adverse effects include lymphoma and other malignancies as well as hepatosplenic T-cell lymphoma
Tacrolimus (Prograf)
Used for the prevention of liver transplant rejection
Other uses are unlabeled uses
Nursing Implications
Monitor WBC counts throughout therapy, and if WBC counts drop below normal range, contact prescriber
GRAPEFRUIT JUICE INTERACTS WITH THESE DRUGS
ASSESS THE ORAL CAVITY OFTEN FOR WHITE PATCHES ON THE TONGUE, MUCOUS MEMBRANES, AND ORAL PHARYNX
MIX ORAL CYCLOSPORINE IN A GLASS CONTAINER
INFORM PATIENTS THAT LIFELONG THERAPY WITH IMMUNOSUPPRESSANTS IS INDICATED WITH ORGAN TRANSPLANTATION
