Immunomodulating Drugs Flashcards
Cytokines
Proteins, which aid cells, signal the immune response, and stimulate cells to move to the site of inflammation
Erythrocytes
Red blood cells, one of several formed elements in the blood
Erythropoiesis
Process of making RBCs
Folinic acid rescue
In chemo, the technique of administering leucovorin after a large dose of methotrexate, thereby allowing normal calls to survive aka leucovorin rescue
Hematopoiesis
Undifferentiated stem cells are stimulated to become specific blood cells
Intrinsic factor
Substance produced by the cells in the stomach and necessary for the absorption of vitamin B12
Iron deficient anemia
Condition resulting wen the body doesn’t have enough iron to meet its need for iron
Leukocytes
White blood cells (WBCs)
Macrocytic anemia
Anemia resulting from abnormal formation (enlargement) or erythrocytes
Megakaryocytes
Precursor cell to the platelets
Megaloblastic anemia
Anemia characterized by large, abnormal, immature erythrocytes circulating in the blood, results from folic acid deficiency
Thrombopoiesis
Formation of platelets (thrombocytes)
CSFs MOA
Glycoproteins that act on the hematopoietic cells used to stimulate proliferation, differentiation, and maturation of WBCs
CSFs use
Used to treat or prevent infection caused by chemo induced neutropenia during solid tumor treatment, neutropenia during bone marrow transplantation, production of stem cells for harvest before bone marrow transplant, neutropenia in those susceptible to symptomatic chronic infection
Filgrastim administrations
Started at least 24 hours after chemo and continued until ANC is at least 10,000. It isn’t recommended to use for more than 2 weeks, and should be stopped 1 day before the next chemo cycle
Pegfilgrastim administration
Given as a single dose between chemo cycles
Sargamostim use
Following BMT, following induction chemo used with leukemia, and stimulate stem cells for harvest
CSFs side effects
Bone pain, hypertension, nausea, vomiting, alopecia, hypersensitivity
Filgrastim precautions
Hypothyroidism,
CSFs precautions
Pregnancy (cat
C) and lactation
Pegfilgrasim precautions
Can cause a sickle cell crisis in those with the disease
CSFs interactions
Can stimulate cancer cell growth in cancer types that are stimulated by growth factors, and an even higher increase in neutrophil count can occur when taken with lithium
Hypersensitivity reactions from CSFs should be treated by
Antihistamines, steroids and bronchodilators
Oprelvekin MOA
Stimulates thrombopoiesis (precessions of making platelets)
Oprelvekin use
Prevent severe thrombocytopenia associated with chemo for solid tumor treatment, and reduces the need for several platelet transfusions, and ITP (acute or chronic bleeding disorder)
Oprelvekin administrations
Started at least 6 hours after a Chemo cycle, and drug is continued until platelet count reaches 50,000. Isn’t recommended for more than 21 days and is stopped 2 days before next chemo cycle
ITP signs
Signs of bleeding (purple areas on skin), and fatigue
How to treat ITP
Corticosteroids or removal of spleen
Eltrombopag use
ITP
Romiplostim use
ITP
Thrombopoietin side effects
Fluid retention, peripheral edema, dyspnea, syncope, fever, allergic reactions, tachycardia, palpitation, atrial fibrillation, arrhythmias resulting in stroke or pulmonary edema, capillary leak syndrome
Eltrombopag side effects
Can be toxic to the liver, LFTs are done prior to starting and every 2 weeks
Oprelvekin contraindications
Shouldn’t be used in people getting chemo that is very myelosuppressive
Thrombopoietin Drugs precautions
Renal failure, heart failure, or atrial arrhythmia, children under 12, pregnancy (cat C)
Eltrombopag discontinuation considerations
Platelet levels may decrease to lower than original diagnoses counts
Romiplostim discontinuation considerations
Platelet levels may decrease below original diagnosed counts
Ifosfamide interactions
Severe hypokalemia can occur with thrombopoietins
Oprelvekin contraindications
Lactation,
Oprelvekin pregnancy cat
C
Anemia in chronic kidney disease
Anemia resulting from a reduced production of erythropoietin, a hormone secreted by the kidneys that stimulates production of RBCs
Pernicious anemia
Anemia resulting from lack of secretion by the gastric mucosa of the intrinsic factor essential to the formation of RBCs and the absorption of vitamin
B12
Folic acid deficiency
Anemia occurring because of a dietary lack of folic acid, a component necessary in the formats of RBCs
Erythopoiesis stimulating agents (ESAs) MOA
Glycoproteins that stimulate and regulate the production of erythrocytes
ESAs use
Treat anemia associated with chronic kidney disease, chemo, zidovudine for HIV and post surgical blood replacement in place of allogeneic transfusions
Darbepoetin alfa use
Anemia associated with chronic kidney disease in people receiving dialysis and in those not receiving dialysis, and they elevate and maintain RBC levels and decrease need for transfusions
Methoxy polyethylene-epoetin B use
Anemia associated with chronic kidney disease in both people receiving and not receiving dialysis, and they also elevate and maintain RBC levels and decrease need for transfusions
ESAs side effects
Hypertension, headache, nausea, vomiting, diarrhea, rashes, fatigue, arthralgia and skin reaction at injection site
Epoetin Alfa side effects nature
Well tolerated when used to maintain hemoglobin levels no higher than 12
Darbepoetin Alfa side effects nature
Well tolerated when used to maintain hemoglobin levels no higher than 12
Methoxy polyethylene side effects nature
Well tolerated when used to maintain hemoglobin levels no higher than 12
Epoetim Alfa contraindications
Uncontrolled hypertension, those needing an emergency transfusion, and those with an allergy to human albumin
Darbepoetin Alfa contraindications
Uncontrolled hypertension
ESAs risks
Polycythemia (am overload of RBCs in the circulation) can occur if hemoglobin isn’t monitored
What can polycythemia result in
Increased mortality, serious cardio or thromboembolic events, and possible tumor progression in cancer patients
Epoetin Alfa precautions
Hypertension, Hearst disease, HF, history of seizures, pregnancy (cat C), and lactation
Darbepoetin Alfa precautions
Hypertension, heart disease, HF, history of seizures, pregnancy (cat C), and lactation
Iron preparations MOA
Elevating the serum iron concentration, which replenishes hemoglobin and depleted iron stores
Iron administration
Usually oral, best absorbed on an empty stomach
Iron preparations side effects
GI irritation, nausea, vomiting, constipation, diarrhea, darker stools, headache, backache, allergic reactions
Parenteral iron side effectiveness
Soreness and inflammation
IM iron side effects
Sterile abscesses at IM site, brown discoloration of skin
IV iron side effects
Phlebitis at the injection site
Iron contraindications
Hemochromatosis or hemolytic anemia,
Iron precautions
Aspirin allergy
Iron interactions
Decreased Gi absorption of the antibiotic, decreased absorption of levothyroxine, decreased effect of levodopa and methyldopa absorbed acid (vitamin C) increased iron absorption
Folic acid use
Treating megaloblastic anemias caused by a deficiency of folic acid, can decrease risk of neural tube defects (given to pregnancy and lactating women)
What to do if patient with folic acid deficiency can’t take oral meds
Leuvcovorin
Folic acid side effects
Few side effects, but parenteral administration can rarely cause an allergic reaction
Folic acid contraindications
Pernicious anemia or other anemia where vitamin B12 is deficient
Folic acid pregnancy cat
A
Leucovorin contraindications
Pernicious anemia or other anemias where vitamin B12 is deficient
F9ic acid interactions
Increases in seizure activity with hydantoins, signs of folate deficiency with sulfasalazine
Vitamin B12 uses
For patients with a vitamin B12 deficiency which is seen in people with a strict vegetarian lifestyle, total gastrectomy or subtotal gastric resection, intestinal diseases (ulcerative colitis or sprue), gastric carcinoma, congenital decrease in the number of gastric cells that secrete intrinsic factor, and is also used to perform the schilling test, which is used to diagnose pernicious anemia
Vitamin B12 side effects
Mild diarrhea and itching, and signs that signal a marked increase in RBC production
Marked increase in RBC production side effects
Acne, peripheral vascular thrombosis, HF, and pulmonary edema
Vitamin B12 contraindications
Allergy to cyanocobalamin
Vitamin B12 oral pregnancy cat
A
Vitamin B12 parenteral pregnancy cat
C
Vitamin B12 precautions
Pregnancy, pulmonary disease and anemia
Vitamin B12 interactions
Alcohol, neomycin, and colchicine decrease oral vitamin B12 absorption
Immunosuppressive Drugs MOA
Reduces the strength of the body’s own immune system
Immunosuppressive Drugs use
Psoriasis, multiple sclerosis, crohn disease, or ulcerative colitis or rheumatoid arthritis, and as anti rejection drugs
Drugs used to suppress immunity include
Corticosteroids, calcineurin inhibitors, mTOR inhibitors, IMDH inhibitors, biologics, and monoclonal antibodies
Anti-organ rejection agents ex
Azathioprine, basiliximab, belatacept, cyclosporine, mycophenolate mofetil, sirolimus, tacrolimus,
Immunosuppressive agents for crohn disease and ulcerative colitis ex
Adalimumab, certolizumab pegol, golimumab, infliximab, vedolizumab
Immunosuppressive Drugs for hepatitis C ex
Peginterferon Alfa-2B, interferon alfacon-1
Immunosuppressive Drugs for hepatitis B ex
Peginterferon Alfa-2a, peginterferon Alfa-2b
Immunosuppressive Drugs for multiple sclerosis ex
Adalimumab, dimethyl fumarate, fingolimod, glatiramer, interferon beta-1A, peginterferon beta-1A, interferon beta-1B, natalizumab, teriflunomide,
Immunosuppressive drugs for plaque psoriasis ex
Adalimumab, alefacept, apremilast, cyclosporine, efalizumab, etanercept, golimumab, infliximab, secukinumab, ustekinumab
Rheumatoid arthritis immunosuppressive drugs ex
Abatacept, adalimumab, anakinra, azathioprine, canakinumab, certolizumab pegrol, cyclosporine, etanercept, golimumab, infliximab, rilonacept, tocilizumab
Immunosuppressive Drugs side effects
Headache, chills, and fever, itching, dizziness, and myalgias
Calcineurin inhibitors side effects
Gum hyperplasia, hair growth, tremors
Monoclonal antibodies side effects
Nauseated, or GI distress, acute infusion reactions (typically 1st dose and within 30 mins)
Immunosuppressive agents contraindications
Live virus vaccines,
People on monoclonal antibodies should be monitored for
Neutropenia
IMDH inhibitors interactions
Severe decreases in WBCs, RBCs and platelets are seen with ACE inhibitors
Calcineurin inhibitors interactions
Increased risk of arrhythmia with antiarrhythmics,
People on calcineurin inhibitors should be monitored for
Blood urea nitrogen levels should be monitored because calcineurin inhibitors are nephrotoxic
Immunosuppressants interactions
Grapefruit and other citrus
Increased hemoglobin can cause an increased risk of
Myocardial infarction and stroke
Iron anaphylactic reactions signs
Dyspnea, urticaria, rashes, itching and fever
Hematopoietic factors for infection ex
Filgrastim, pegfilgrastim, sargramostin,
Hematopoietic factors for bleeding ex
Eltrombopag, oprelvekin, romiplostim
Adjuvant immunostimulant agents
Plerixafor
Hematopoietic factors for anemia ex
Darbepoetin Alfa, epoetin Alfa, methoxy polyethylene, peginesatide, ferrous, folic acid, iron dextran, iron sucrose, leucovorin, sodium ferric gluconate complex, vitamin B12,
