Immunosuppression: Rheumatoid Arthritis and Transplants Flashcards
1
Q
BIOLOGICS
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
2
Q
TRADITIONAL
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
3
Q
Immunosuppressant’s
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
4
Q
MECHANISM OF ACTION: ◦Has two receptors which target and bind to TNF (Tumor Necrosis Factor) and neutralizes it a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
5
Q
ADVERSE EFFECTS: ◦Injection site reactions (37% of patients may experience) ◦ Itching, erythema, swelling, pain ◦ Subcutaneous (once weekly) a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
6
Q
NURSING CONSIDERATION: ◦ Monitor the site for redness, pain and swelling after administration ◦ Report if doesn’t improve after a few days a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
7
Q
ADVERSE EFFECTS: ◦ Serious Infections (this drug suppresses the immune system!) ◦ Higher risk for Fungal infections, Atypical bacteria (such as TB!) ◦ Legionella pneumophila, Mycobacterium tuberculosis a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
8
Q
◦ Don’t forget TNF is part of our defense system
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A
ok
9
Q
TNF ◦ Higher risk for Fungal infections, Atypical bacteria (such as ?)
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A
TB
b. Adalimumab
c. Infliximab
10
Q
◦ RISK FOR SERIOUS INFECTIONS- ◦ TB, HBV, bacterial, fungal, viral, you name it. ◦ ? + Steroids, or ? + Methotrexate a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
Etanercept
b. Adalimumab
c. Infliximab
11
Q
◦One of the requirements when using this medication is to check for latent TB and HBV. It is possible that use of this medication may REACTIVATE TB! a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
12
Q
◦ MALIGNANCIES ◦ We have seen lymphomas and other malignancies develop during use of this medication a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
13
Q
NURSING CONSIDERATIONS: ◦ Assess for s/s of malignancy (splenomegaly, hepatomegaly, night sweats, weight loss, persistent fever) a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
14
Q
ADVERSE EFFECTS: ◦ Heart Failure a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
15
Q
NURSING CONSIDERATIONS: ◦ Periodic monitoring ◦ Heart (Heart Failure) ◦ Liver (Hepatotoxicity) ◦ CBC (pancytopenia) a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
16
Q
Don’t forget the infection risk ◦ Watch out with additive effects of immunosuppressant's ◦ No LIVE vaccines with steroid ◦ Baseline screening for TB and HBV ◦ Do NOT give in malignancies! a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
17
Q
ADVERSE EFFECTS Injection Site reaction Immunosuppression Malignancy risk a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
18
Q
USED TO TREAT: ◦Rheumatoid Arthritis a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
19
Q
USED TO TREAT: ◦Rheumatoid Arthritis ◦Crohn’s ◦Ulcerative Colitis a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
b. Adalimumab
20
Q
MECHANISM OF ACTION: ◦Monoclonal Antibody that targets TNF of the immune system a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
c. Infliximab
b. Adalimumab
21
Q
BIOLOGICS: BICYCLE Blood Dyscrasias Infection Cardiac (heart failure) Yucky (injection site) Cancer Liver Educate about SJS/TEN a. Etanercept b. Adalimumab c. Infliximab d. Sulfasalazine e. Azathioprine/ Mercaptopurine f. Tacrolimus g. Cyclosporine h. Mycophenolate
A
a. Etanercept
b. Adalimumab
c. Infliximab
22
Q
BIOLOGICS: BICYCLE a. Etanercept b. Adalimumab c. Infliximab B? I? C? Y? C? L? E?
A
Blood Dyscrasias Infection Cardiac (heart failure) Yucky (injection site) Cancer Liver Educate about SJS/TEN
23
Q
? is given intravenously (IVPB), can see infusion reactions (flu-like, chills, headache, fever), rarely anaphylaxis a. Etanercept b. Adalimumab c. Infliximab
A
c. Infliximab
24
Q
? is also given subcutaneously (like Etanercept), so watch out for local reactions (20% of patients) a. Etanercept b. Adalimumab c. Infliximab
A
b. Adalimumab
25
TRADITIONAL DMARD Agents
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
i. Hydroxychloroquine
d. Sulfasalazine
| e. Azathioprine/ Mercaptopurine
26
```
USED TO TREAT
Malaria
Rheumatoid Arthritis
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
i. Hydroxychloroquine
```
i. Hydroxychloroquine
27
```
ADVERSE EFFECTS
Retinal damage
QT Prolongation
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
i. Hydroxychloroquine
```
i. Hydroxychloroquine
28
```
5- ASA
A Bowel (treats IBD)
Arthritis (Rheumatoid Arthritis)
Aplastic anemia
AST
ALT
Sulfa allergy, SUN sensitivity, SJS
Aspirin like- Reye Syndrome
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
i. Hydroxychloroquine
```
d. Sulfasalazine
29
```
d. Sulfasalazine
5- ASA
A ?
A?
A?
A?
A?
S?
A?
```
```
5- ASA
A Bowel (treats IBD)
Arthritis (Rheumatoid Arthritis)
Aplastic anemia
AST
ALT
Sulfa allergy, SUN sensitivity, SJS
Aspirin like- Reye Syndrome
```
30
```
NURSING CONSIDERATIONS
Should not use in Sulfa allergy or Aspirin/Salicylate allergy
Similar to Sulfamethaxozole (monitor CBC)
a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
d. Sulfasalazine
31
ADVERSE EFFECTS
Bone marrow Suppression
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
e. Azathioprine/ Mercaptopurine
32
```
USED TO TREAT
Irritable Bowel Disease/ Ulcerative
Colitis/Crohn’s Disease
Rheumatoid Arthritis
TRANSPLANTS
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
```
e. Azathioprine/ Mercaptopurine
33
Transplant Medications
LIFE
Lifelong therapy
Immunosuppressed (infection and malignancy risk)
Frequent monitoring of liver, kidneys , blood pressure and drug levels
Electrolyte abnormalities
ok
34
```
USED TO TREAT:
◦Rheumatoid Arthritis
◦Transplants
◦Ulcerative Colitis
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
g. Cyclosporine
35
MECHANISM:
◦Inhibition of production and release of interleukin II and
inhibits interleukin II-induced activation of resting Tlymphocytes.
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
36
```
PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND
TRANSPLANTS
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
g. Cyclosporine
37
◦ IMMUNOSUPPRESSION/ MALIGNANCY RISK
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
38
◦ BIOAVAILABILITY (DO NOT SWITCH BRANDS/MANUFACTURERS)
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
39
◦ HYPERTENSION/ NEPHROTOXICITY
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
40
```
ADVERSE EFFECTS:
◦ Hirsutism
◦ Gingival Hyperplasia
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
g. Cyclosporine
41
◦Just like with phenytoin, good oral hygiene
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
42
```
◦ We check trough levels
◦ Lots of drug interactions (Like NO GRAPEFRUIT JUICE!)
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
g. Cyclosporine
43
No LIVE vaccines, do not use in active/recent Herpes/Chickenpox infection
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
g. Cyclosporine
44
```
USED TO TREAT:
◦Transplants
◦ Lots of off label auto-immune uses
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
f. Tacrolimus
| h. Mycophenolate
45
```
MECHANISM
(inhibits T-lymphocyte activation)
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
f. Tacrolimus
46
```
◦ 2 BOXED WARNINGS FROM THE FDA
◦ IMMUNOSUPPRESSION- INFECTION RISK
◦ MALIGNANCY RISK
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
f. Tacrolimus
47
DO NOT USE STYROFOAM OR PAPER CUPS. USE GLASS OR PLASTIC
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
f. Tacrolimus
48
◦ FETAL TOXICITY
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
h. Mycophenolate
49
```
◦ 4 BOXED WARNINGS FROM THE FDA
◦ PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND
TRANSPLANTS
◦ SERIOUS INFECTIONS/IMMUNOSUPPRESSION
◦ MALIGNANCY RISK
◦ FETAL TOXICITY
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
h. Mycophenolate
50
CONSISTENCY- SAME TIME DAILY- CHECK TROUGH LEVELS! ( DON’T CHANGE BETWEEN MANUFACTURERS!)- NO GRAPEFRUIT JUICE
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
51
```
ADVERSE EFFECTS:
◦Hepatotoxicity
◦Nephrotoxicity
◦Electrolyte Abnormalities
◦Hypertension
◦Infections
◦Malignancies
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
```
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
52
•LIFE
- Lifelong therapy
- Immunosuppressed (infection and malignancy risk)
- Frequent monitoring of liver, kidneys , blood pressure and drug levels
- Electrolyte abnormalities
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
