Immunostimulants & Immunosuppressants

Question 1

Immunomodulators

Answer 1

substances that either enhance or suppress the body’s immune system

Question 2

Immunostimulants

Answer 2

BOOST immune system; usually used to treat pt’s w/cancer

Question 3

Immunosuppressants

Answer 3

DEPLETE immune system; usually used to treat transplant rejection and hyperactive immune responses

Question 4

Cytokines

Answer 4

substances that help the body mediate and intensify an immune response

Question 5

Biologic response modifiers

Answer 5

natural cytokines made in enough quantity to treat certain disorders; boost specific functions of immune system

Question 6

Interferons

Answer 6

cytokines that:
have antiviral and antineoplastic activity; promote protection of uninfected cells, inactivate pathogens, and promote apoptosis of infected cells

Question 7

interferon alpha 2b (Intron A)

Answer 7

immunostimulant; interferon, biologic response modifier
USE: certain cancers or viral infections
MOA: increase phagocytic activity of macrophages and monocytes; suppress growth of cancer cells
AE: flu-like syndrome, hepatotoxicity, & neurotoxicity
NC: monitor labs, I/O, weights, assess for flu-like syndrome, use high-calorie/high-protein meals; monitor for unexplained bleeds

Question 8

interleukins

Answer 8

stimulate cytotoxic T cell activity, activate increased production of NK cells, promote inflammation, and stimulate other immune cells

Question 9

Vaccines

Answer 9

mobilize body against specific antigens

Question 10

Colony-stimulating factors

Answer 10

promote production of WBCs

Question 11

aldesleukin (Proleukin)

Answer 11

immunostimulant; biologic response modifier
USE: select cancers
MOA: activates interferons and other interleukins; promotes proliferation of B cells and T cells, macrophages, and NK cells
BLACK BOX WARNING: capillary leak syndrome
AE: systemic infection (if severe fatigue develops, hold med)
NC: use w/extreme caution in pt’s w/hx of cardiac or pulmonary disease

Question 12

Calcineurin inhibitors

Answer 12

drugs of choice when preventing transplant rejection; blocks IL2 and suppresses immune response

Question 13

Cytotoxic agents & Antimetabolites

Answer 13

used to suppress proliferating B cells and T cells

Question 14

Antibodies

Answer 14

used to prevent acute transplant rejection, autoimmune disorders, and malignancies

Question 15

Corticosteroids

Answer 15

widely used as immunosuppressants but have significant long-term effects

Question 16

cyclosporine (Gengraf)

Answer 16

immunosuppressant; calcineurin inhibitor
USE: prophylaxis of heart, liver, and kidney transplant rejection, psoriasis, severe RA, and xerthalmia
MOA: inhibits function of calcineurin = decreased activity of B cells and T cells
AE: nephrotoxicity (up to 75% experience decreased urine flow), HTN, tremor, infections, and decreased leukocytes
BLACK BOX WARNING: only administered by experienced HCPs

Question 17

azathioprine (Imuran)

Answer 17

immunosuppressant; cytotoxic drug
USE: prophylaxis of kidney transplant rejection & severe RA
MOA: inhibits DNA synthesis = DNA damage & chromosome breakage
AE: myelosuppression, serious infections/reactivated HSV or VZV, n/v
BLACK BOX WARNING: may result in serious/fatal infections & possible malignancies
NC: monitor CBC & hepatic functioning
Pregnancy: contraindicated unless benefits to mother outweigh risks to baby

Question 18

antibodies

Answer 18

proteins produced following antigen challenge to help the body get rid of an antigen

Question 19

monoclonal antibodies

Answer 19

names end in -mab; harvested from antibodies produced by single B cell; target only single type of target cell/receptor

Question 20

basiliximab (Simulect)

Answer 20

immunosuppressant; monoclonal antibody
USE: prophylaxis against acute kidney transplant rejection
MOA: inhibits binding of IL2 to CD25 on surface of activated T cells = inhibit cytokine release that would attack transplanted tissue
AE: n/v, diarrhea, abd pain
BLACK BOX WARNING: only administered by qualified HCP
Pregnancy: effects unknown; use contraception during & 4 months post treatment

Question 21

corticosteroids/glucocorticoids

Answer 21

names end with -sone; used as immunosuppressants but have significant long-term adverse effects; drugs of choice for short-term therapy for severe inflammation

Question 22

long term effects of corticosteroids

Answer 22

osteoporosis
cataracts
mental status changes
fluid and salt retention
HTN
hyperglycemia
obesity
adrenal atrophy