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Phamacology Summer > Immunosuppression: Rheumatoid Arthritis and Transplants > Flashcards

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

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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

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3
Q

Immunosuppressant’s

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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
Q

TRADITIONAL DMARD Agents

a. Etanercept
b. Adalimumab
c. Infliximab
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
i. Hydroxychloroquine

A

d. Sulfasalazine

e. Azathioprine/ Mercaptopurine

26
Q 
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
A

i. Hydroxychloroquine

27
Q 
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
A

i. Hydroxychloroquine

28
Q 
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
A

d. Sulfasalazine

29
Q 
d. Sulfasalazine
5- ASA
A ?
A?
A?
A?
A?
S?
A?
A 
5- ASA
A Bowel (treats IBD)
Arthritis (Rheumatoid Arthritis)
Aplastic anemia
AST
ALT
Sulfa allergy, SUN sensitivity, SJS
Aspirin like- Reye Syndrome
30
Q 
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
A

d. Sulfasalazine

31
Q

ADVERSE EFFECTS
Bone marrow Suppression
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine

A

e. Azathioprine/ Mercaptopurine

32
Q 
USED TO TREAT
Irritable Bowel Disease/ Ulcerative
Colitis/Crohn’s Disease
Rheumatoid Arthritis
TRANSPLANTS
d. Sulfasalazine
e. Azathioprine/ Mercaptopurine
A

e. Azathioprine/ Mercaptopurine

33
Q

Transplant Medications
LIFE
Lifelong therapy
Immunosuppressed (infection and malignancy risk)
Frequent monitoring of liver, kidneys , blood pressure and drug levels
Electrolyte abnormalities

A

ok

34
Q 
USED TO TREAT:
◦Rheumatoid Arthritis
◦Transplants
◦Ulcerative Colitis
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

g. Cyclosporine

35
Q

MECHANISM:
◦Inhibition of production and release of interleukin II and
inhibits interleukin II-induced activation of resting Tlymphocytes.
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

36
Q 
PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND
TRANSPLANTS
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

g. Cyclosporine

37
Q

◦ IMMUNOSUPPRESSION/ MALIGNANCY RISK

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

38
Q

◦ BIOAVAILABILITY (DO NOT SWITCH BRANDS/MANUFACTURERS)

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

39
Q

◦ HYPERTENSION/ NEPHROTOXICITY

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

40
Q 
ADVERSE EFFECTS:
◦ Hirsutism
◦ Gingival Hyperplasia
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

g. Cyclosporine

41
Q

◦Just like with phenytoin, good oral hygiene

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

42
Q 
◦ We check trough levels
◦ Lots of drug interactions (Like NO GRAPEFRUIT JUICE!)
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

g. Cyclosporine

43
Q

No LIVE vaccines, do not use in active/recent Herpes/Chickenpox infection

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

g. Cyclosporine

44
Q 
USED TO TREAT:
◦Transplants
◦ Lots of off label auto-immune uses
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

f. Tacrolimus

h. Mycophenolate

45
Q 
MECHANISM
(inhibits T-lymphocyte activation)
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

f. Tacrolimus

46
Q 
◦ 2 BOXED WARNINGS FROM THE FDA
◦ IMMUNOSUPPRESSION- INFECTION RISK
◦ MALIGNANCY RISK
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

f. Tacrolimus

47
Q

DO NOT USE STYROFOAM OR PAPER CUPS. USE GLASS OR PLASTIC

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

f. Tacrolimus

48
Q

◦ FETAL TOXICITY

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

h. Mycophenolate

49
Q 
◦ 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
A

h. Mycophenolate

50
Q

CONSISTENCY- SAME TIME DAILY- CHECK TROUGH LEVELS! ( DON’T CHANGE BETWEEN MANUFACTURERS!)- NO GRAPEFRUIT JUICE

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

A

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

51
Q 
ADVERSE EFFECTS:
◦Hepatotoxicity
◦Nephrotoxicity
◦Electrolyte Abnormalities
◦Hypertension
◦Infections
◦Malignancies
f. Tacrolimus
g. Cyclosporine
h. Mycophenolate
A

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

52
Q

•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
A

f. Tacrolimus
g. Cyclosporine
h. Mycophenolate

Phamacology Summer (48 decks)

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