Topic 5: Drugs that affect the immune and hematological systems Flashcards
Antimetabolites
Antagonists analogue
- antineoplastic antimetabolites are cell-specific analgouges. Inhibit cellular growth by interfering w/synthesis/actions of the compounds critical to cellular reproduction: vitamin folic acid, purines, pyrimidines (DNA, RNA)
- Two mechanisms: falsely substituting for purines, pyrimidines, folic acid, or inhibit critical enzymes involved in synthesis/function of those compounds
- S phase of cell cycle
Folic acid antagonism
Methotraxate is an analogue of folic acid
- Inhibits action of dihydrofolate reductase (enzyme that converts folic acid to its active form folate needed for synthesis of DNA)
- DNA not produced and cell dies
Pyrimidine antagonism
Floxuridine and fluorouracil are synthetic analogues of uracil, and cytarabine is a synthetic analogue of cytosine
- Capecitabine is a prodrug of fluorouracil and is converted to that drug in the liver and other body tissues. Can be given orally
- Incorporating themselves into the metabolic pathway for synthesis of DNA & RNA and thereby interrupting synthesis of both of these nucleic acids
Antimetabolites Indicatons
Tx of variety of solid tumors and some hematologic cancers
- used in combination chemo regimens to enhance overall cytotoxic effect
- Methotrexate also for Tx of severe cases of psoriasis (skin) rheumatoid arthritis
- oral/topical can be used for low-dose maintenance/palliative (noncurative) cancer therapy
Antimetabolites adverse effects
- Hair loss
- N/V
- Diarrhea
- myelosuppression
- Major toxicity includes: neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, metabolic toxicity
- most common: fever, malaise
- metabolic toxicity: tumor lysis syndrome
- severe but reversible for of dermatologic toxicity (palmar-plantar dysesthesia or paresthesia)
Antimetabolites interactions
Administration of one antimetabolite drug with another that causes similar toxicities may result in additive toxicities
Methotrexate (Folate antagonist)
- Useful for Tx of solid tumors (breast cancer, head and neck, and lung cancers & for management of acute lymphocytic leukemia and non-Hodgkin’s lymphomas
- immunosuppressive activity, it inhibits lymphocyte multiplication, so it’s useful in Tx of rheumatoid arthritis
- its combined immunosuppressant and antiinflammatory properties make it useful for Tx of psoriasis
- high dose associated w/severe bone marrow suppression always given in conjunction w/the “rescue” drug leucovorin (antedote)
- injectable, oral (tablet) forms
- preservative free injectable required for intrathecal (into subarachoid space) administration, in Tx of cancers
Loucovorine
Rescue drug for methotrexate.
- Antidote for folic acid antagonists
- body produces active folic acid via metabolic steps utilizing enzyme dihydrofolate reductase. Because methotrexate inhibits this enzyme, healthy cells die due to lack of folic acid. By giving Loucovorine (which is rapidly converting to the active form of folic acid), it provides the body w/active folic acid, which prevents death of normal cells
Pyrimidine antagonists Fluorouracil (5-FU) (Efudex, Adrucil)
- parenteral formulations
- Variety Tx regimens, including palliative Tx of cancers of the colon, rectum, stomach, breasts, and pancreas
- also used in adjuvant setting in Tx of breast and colorectal cancer
Nursing process: Assessment for Antineoplastic drugs
- physical assessment
- bowel/bladder patterns
- neurologic status
- heart sounds
- heart rhythm
- breath sounds
- lung function
- exam skin/mucosa (turgor, hydration, color, temp.)
- s/s fear/anxiety, insomina, irritability, shakiness, restlesness, palpitations
- past/present abilities for ADL
- pain assessment
- pattern of pain
- note oral, pharyngeal, esophageal, abdominal pain; painful swallowing; epigastric/gastric pain; achiness in joints or lower extremities; numbess, tingling, burning sensation, sharp pain in extremities
- lab tests (electrolytes, minerals, vitamins, uric acid, RBC, WBC, platelets/clotting & bleeding time, renal function (BUN, creatinine, serum uric acid, urine creatinine clearance) hepatic function (AST, ALT, LDH, bilirubin), cardiac enzymes
- assess for tumor markers
Nursing assessment for altered nutritional status and impaired oral mucosa
- s/s of altered nutrition w/focus on weight loss, abnormal serum protein-albumin and blood urea nitrogen (BUN) levels, weakness, fatigue, lethargy, poor skin turgor, pale conjunctiva
- oral mucosa for S/S stomatitis, difficulty swallowing, taste changes, viscous saliva, dryness, cracking, and/or fissures w/or w/out bleeding of the mucosa
Nursing assessment for effects on the GI mucosa
- bowel sounds
- presence of diarrhea, urgency, abdominal cramping
- presence of blood in stool/consistency, color, odor, amount
- N/V (acute, delayed, anticipatory; if V occurs, determine color, amount, consistency, frequency, odor, blood
Nursing assessment for alopecia
- pt’s views, concerns, emotions about hair loss
- need to prepare for hair loss
Nursing assessment for bone marrow suppression
- S/S of anemia or decrease in RBCs, hemoglobin level, & hematocrit (pallor, oral mucus membranes, conjunctiva; fatique, lethargy, loss of interest, SOB, inability to concentrate)
- S/S leukopenia (Decrease WBCs, and/or absolute neutorphil count) fever, chills; tachycardia, abnormal breath sounds; productive cough w/purulent, green/rust colored sputum; change in urine color; lethargy, fatigue, acute confusion
- S/S thrombocytopenia (decrease in thrombocytes <100,000) and platelet clotting factors; unusual bleeding (petechiae; purpura; ecchymosis; gingival (gum) bleeding, excessive bleeding from punture sites, joint pain, blood in stool, urine, V; loss of function of extremities; decrease in BP/elevated pulse
For possible sterility, teratogenesis, and damage to ovaries with amenorrhea: in adult male patients, asses?
Female?
Male: baseline reproductive history w/attention to sexual functioning, fathering of children, past/current reproductive or sexual problems
Female: in addition to those already mentioned, inquire about fertility, menstrual/childbearing history, age of onset of menses and menopause
(Antineoplastic) With cell cycle-specific drugs what should the nurse assess for?
Document allergies, cautions, contraindications, drug interactions
- most antimetabolite drugs do not produce severe emesis (vomiting)
- Pentostatin & some pyrimidine analogues have emetic potential, so perform baseline GI functioning
- folate antagonists not likely to cause emesis, but are associated w/GI abnormalities (ulcers, stomatitis). Since given parenterally (IV) assess peripheral access areas or central venous sites to prevent risk for damage to surrounding tissue, joints, and tendons. Assess every hour for redness, swelling, heat, or pain PRN
Antineoplastic drug: Topoisomerase I Inhibitor Mechanism of action
Semisynthetic analogues of the compound camptothecin (these drugs referred to as Camptothecins)
- Inhibit DNA function in S-Phase by binding to topoisomerase I complex (complex normally allows DNA strands to be temporaily cleaved and then reattached in a critical step called religation)
- binding retards the religation process and results in DNA strand break
Antineoplastic drug: Topoisomerase I Inhibitor Indications
- Tx of ovarian and colorectal cancer
- Irinotecan approved for Tx of metastatic colorectal cancer, small-cell lung cancer, and cervical cancer
Antineoplastic drug: Topoisomerase I Inhibitor Adverse effects (Irinotecan [Camptosar])
- Hematologic effects
- severe diarrhea (cholinergic diarrhea). Treated w/atropine
- delayed diarrhea may occur 2-10 days after infusion of irinotecan
- diarrhea can be severe & life-threatening must be treated aggressively with loperamide
- N/V (supportive care including IV rehydration and antimetic drug therapy)
Antineoplastic drug: Topoisomerase I Inhibitor Interactions with Irinotecan (Camptosar)
- Laxatives and diuretics NOT given due to risk of worsening dehydration
- severe cardiovascular toxicity, thrombosis, pulmonary embolism, stroke, acute fatal MI when Irinotecan is given w/fluorouracil and leucovorin
- only injectable form
Antineoplastic drug: Topoisomerase I Inhibitor nursing assessment
- hematologic adverse effects
- baseline WBC
- continual assessment of GI tract due to potential irinotecan-related cholinergic diarrhea
Before chemo assess patients for the presence of
1) genetic markers of oral cancer
2) genetic determinants of testosterone or estrogen metabolism
3) genetically linked enzyme system abnormalities
Premedication with antimetics give?
30-60 minutes BEFORE administration of the antineoplastic to help reduce N/V, prevent dehydration& malnutrition, and promote comfort
Antineoplastic patient teaching
- OTC medications to avoid: aspirin, ibuprophen, combination of these)
- measures to prevent infection
- frequent skin care
- measures to minimize oral mucosal breakdown
- daily regiment to increase urinary health (cranberry)
- discuss options for alopecia (hair loss)
- methotrexate: report N/V, fever, sore throat, muscle aches, and pains, unusual bleeding. Avoid alcohol, salicylates, NSAIDs, exposure to sunlight or ultraviolet light. Alternative contraceptive measures for 3 months or longer
Nadir refers to the?
average number of days it takes for a chemotherapeutic drug to have its peak effect on the bone marrow, which would coincide with the client’s lowest white blood count and highest risk for infection or bleeding.
The nurse would anticipate administering which medication to clients receiving high-dose methotrexate (Trexall)?
Leucovorin (Wellcovorin)
Leucovorin is given to block the systemic toxic effect of high-dose methotrexate. It is a form of folic acid that does not require dihydrofolate reductase to produce folic acid. Therefore, it is used to prevent or treat toxicity induced by methotrexate, a folic acid antagonist.
Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. What should the nurse advise clients experiencing these unpleasant adverse effects?
Try to maintain hydration and nutrition, which are very important during treatment.
It is very important for clients undergoing chemotherapy to maintain adequate nutrition and hydration. Several antiemetic drugs are used to prevent these adverse effects.
Combinations of antineoplastic drugs are frequently used for which purpose? (Select all that apply.)
Prevent drug resistance
Provide a synergistic action
Decrease the severity of adverse effects
Administering a combination of antineoplastic drugs allows for smaller doses of each, which can minimize the severity of adverse effects and help prevent drug resistance. Additionally, there is a synergistic action between some of the medications.
The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection?
Fever, sore throat, chills
The nurse is assessing a patient who had developed anemia after two rounds of chemotherapy. What are indications of anemia?
Hypoxia, fatigue
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics
Natural substances produced by the mold Streptomyces as well as semisynthetic substances
-Bone marrow suppression common toxicity, also heart failure, acute left ventricular failure (doxorubicin)
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics mechanism of action
Interact w/DNA through intercalation (drug molecule inserted between the two strands of a DNA molecule, blocks DNA synthesis)
- inhibit enzyme topoisomerase II, leads to DNA strand breaks
- many generate free radicals which leads to DNA strand breaks and programmed cell death
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics Indications
Tx solid tumors & some hematologic malignancies
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics Adverse effects
- Hair loss
- N/V
- Myelosuppression
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics Toxicity/management
- Severe cases of cardiomyopathy are associated w/doxorubicin
- routine monitoring of cardiac ejection fraction, cumulative dose limitations, use of cytoprotective drugs can decrease the incidence of toxicity
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics Interactions
- Increased toxicity when in combination w/other chemo drugs/radiation therapy
- bleomycin & doxorubicin cause serum digoxin levels to increase. Observe for signs of digoxin toxicity
Antineoplastic Cell cycle non-specific (CCNS) Cytotoxic antibiotics Doxorubicin (Adriamycin)
- used in combinations
- contraindicated in those with hypersensitivity, severe myelosuppression, those @risk for severe cardiotoxicity
- ONLY injectable form
- liposomal drug delivery system (Doxil). Drug encapsulated in a lipid bilayer called a liposome. Caused reduced systemic toxicity and increased duration of action
Miscellaneous antineoplastics: Hydroxyurea (Hydrea)
- Antimetabolite interferes w/synthesis of DNA by inhibiting incorporation of thymidine into DNA
- Works mainly in S and G1 phase of cell cycle
- Tx of squamous cell carcinoma in concert w/radiation to take advantage of its radiosensitizing activity. Also leukemia
- Oral form only
- Adverse effects: edema, drowsiness, headache, rash, hyperuricemia, N/V, dysuria, myelosuppression, elevated liver enzyme levels, muscular weakness, peripheral neuropathy, nephrotoxicity, dyspnea, pulmonary fibrosis
- Interacts with anti-HIV drugs
- concurrent use w/fluorouracil increases risk for neurotoxic symptoms
- can reduce clearance of cytarabine, so dosage reduction of cytarabine is recommended when in combination
Miscellaneous antineoplastics: Octreotide (Sandostatin)
Management of a cancer-related conditon called carcinoid crisis and Tx of the diarrhea caused by vasoactive intestinal peptide-secreting tumors (VIPomas)
One of major adverse effects of cytotoxic antibiotics is
Pulmonary fibrosis
In patients with documented cardiac disease or a history of thoracic irradiation, administer dactinomycin, daunorubicin, and doxorubicin with?
Extreme caution due to cardiovascular toxicity. CT scans and ultrasound studies may be needed before and during Tx to assess cardiac ejection fraction because of risk for cardiotoxicity, which is often associated with cumulative doses
With the use of miscellaneous drug hydroxyurea (misc. antineoplastic) the nurse will assess
-Liver, renal, neurologic, pulmonary function, baseline blood cell counts
Patients receiving cytotoxic antibiotics require more?
Frequent monitoring of pulmonary function
- baseline chest x-rays obtained for comparison w/subsequent x-rays if pneumonitis occurs
- monitor results of liver, renal function tests throughout therapy w/doxorubicin
- heart sounds, daily weights, BP, pulse rate, monitoring for s/s of cardiovascular toxicities important w/doxorubicin
- an increase in 2 lbs or more in 24 hrs or 5lbs in a week notify prescriber could indicate fluid retention or heart failure.
Misc. antineoplastic: Hydroxyurea used sparingly. Given orally. Monitor for?
- Platelet/leukocyte counts before, during, after Tx due to bone marrow suppression
- platelet counts below 100,000 platelet/mm or leukocyte count falls below 2000 cells/mm, temporarily halt therapy until counts rise to normal
- hyperuricemia may precipitate gout-related symptoms
- allopurinol prescribed to control levels of uric acid
- sipuleucel-T associated with infusion-related reactions
In case of allergic reaction with antineoplastic drugs what can you give them?
Epinephrine, antihistamines, antiinflammatory
Patient centered care for antineoplastic drugs
- Avoid aspirin, ibuprofen, products containing them to prevent excessive bleeding
- be open about alopecia risk
- encourage fluid increase (3000mL/day)
- if constipation occurs tell them ways to manage: increasing fluids, balanced diet,
- diarrhea: avoid spicy foods, gas-producing foods, caffeine; high-fiber foods; alcohol; very hot/cold foods, & beverages. Preventive medication (synthetic opioids) or absorbents-protectants
- importance of daily weights
- proper technique for monitoring BP/PR. Use journal
- cytotoxic importance of adhering to daily heart healthy regimen of conserving energy, planned activities, seeking/asking for assistance w/care PRN
- importance of reporting hypotension, bradycardia, chest pain dyspnea
Clients receiving doxorubicin need to be monitored for?
cardiac toxicity. There is a lifetime limited dose that clients are allowed to receive to minimize the occurrence of cardiomyopathy.
The nurse should question a prescription of hydroxyurea (Hydrea) for a client with which laboratory test result?
Platelet count of 8000/mm3
Hydroxyurea causes bone marrow suppression, which is evidenced by a decrease in red blood cells, WBCs, and platelets. A platelet count of 8000/mm3 compared with a normal platelet count range of 150,000 to 400,000/mm3 is significantly lower than normal.
What are the possible severe adverse effects specific to the cytotoxic antibiotics?
Pneumonitis Liver toxicity Nephrotoxicity Cardiovascular toxicity As with all of the antineoplastic drugs, cytotoxic antibiotics have the undesirable effects of hair loss, nausea and vomiting, and myelosuppression. Severe adverse effects specific to the cytotoxic antibiotics include pulmonary fibrosis, pneumonitis, liver toxicity, heart failure, cardiovascular toxicity, tissue damage in the event of extravasation, kidney toxicity, and lung toxicity. This class of drugs is not known for neurotoxicity.
When providing education to a client undergoing antineoplastic drug therapy, the nurse instructs the client to immediately notify the health care provider for which signs and symptoms?
Blood in urine
Bleeding gums
Swollen tongue
New and persistent cough
The client must contact the health care provider immediately if any of the listed signs or symptoms occur:
· Fever or chills with a temperature higher than 100.5° F (38.1° C)
· New sores or white patches in the mouth or throat
· Swollen tongue with or without cracks and bleeding
· Bleeding gums
· Dry, burning, “scratchy,” or “swollen” throat
· A cough that is new and persistent
· Changes in bladder function or patterns
· Blood in the urine
· Changes in gastrointestinal or bowel patterns, including “heartburn” or nausea, vomiting, constipation, or diarrhea lasting longer than 2 or 3 days
· Blood in the stools
Hematopoietic drugs
Promote synthesis of various types of major blood components by promoting the growth, differentiation, & function of their corresponding precursor cells in the bone marrow
Hematopoietic drugs Mechanism of action
- Not toxic to cancer cells, they have beneficial effects in Tx of cancer
- They decrease duration of chemo-induced anemia, neutropenia, & thrombocytopenia and enable higher doses of chemo to be given ; decrease bone marrow recovery time after bone marrow transplant or irradication; & stimulate other cells in immune system to destroy/inhibit growth of cancer cells as well as virus-fungus-infected cells
- produced by recombinant DNA technology
- they bind to receptors on surfaces of specialized progenitor cells in bone marrow
Hematopoietic drugs Indication
Colony stimulating factors stimulate neutrophils to grow and mature and directly oppose the detrimental bone marrow actions of chemo.
Hematopoietic drugs Contraindications
- drug allergy
- use of filgrastim, sargramostim, and pegfilgrastim contraindicating in presence of more than 10% myeloid blasts (immature tumor cells in bone marrow) because they colony-stimulating factors may stimulate malignant growth of these myeloid tumor cells
Hematopoietic drugs adverse efffects
Mild
-common are fever, muscle aches, bone pain, flushing
Hematopoietic drugs interactions
- Filgrastima nd sargramostim significant drug interactions when given with myelosuppressive (bone marrow suppressant) antineoplastic drugs. They are administered to enhance production of bone marrow cells, so if myelosuppressive antineoplastics are given the drugs antagonize each other
- they are not given w/in 24 hrs of administration of myelosuppressive
- they are given soon after this time to help prevent the WBC nadir from dropping
- use with caution; don’t give with other meds that potentiate their myeloproliferative (bone marrow stimulating) effects (lithium, corticosteroids)
Hematopoietic drugs: Filgrastim (Neupogen)
- synthetic analogue of humane granulocyte colony-stimulating factor (also called G-CSF)
- Promotes proliferation, differentiation, activation of cells that make granulocytes
- prevents/treats febril neutropenia in pt’s receiving myelosuppressive for nonmyeloid (non bone marrow)
- given BEFORE infection, NOT w/in 24 hrs AFTER myelosuppressive chemo
- pegfilgrastim (Neulasta)=long acting, reduces # of injections required
Nursing assessment for hematopoetic drugs
- Assess medication order/indications
- lab values (WBC w/sargramostin & filgrastim)
- monitor baseline blood counts
- measure drug response
- prior to administration assess: vital signs, skin turgor/intactness, bowel sounds/patterns, breath sounds
- assess IV/subcutaneous sites PRN
- from lab values assess chemo-induced absolute neutrophil nadir (low point). Important because dose timing is critical in helping to boost blood cell counts
- with filgrastim assess for existing joint/bone pain for possible adverse effect of mild-severe bone pain
Implementation for hematopoietic drugs
- administer as ordered
- rotate subcutaneous/IV sites
- administer Filgrastim BEFORE pt receives myelosuppressive chemo develops infection, NOT w/in 24 hrs before/after myelosuppressive chemo. Once their absolute neutrophil count (ANC) reaches 10,000 cells/mm discontinue
- give Filgrastim and use D5W to dilute
Patient teaching for hematopoietic drugs
- avoid hazardous tasks, fatigue common
- report signs of infection: sore throat, diarrhea, vomiting, and/or fever of 100.5F (38.1 C) or higher. Report excessive fatigue, loss of appetite, edema, bleeding
- pregnancy discouraged
- bone pain and flulike symptoms can occur, use of non-opioids or opioid analgesics, some relief w/ acetaminophen and ibuprofen
- FDA black box warning
- adverse effects usually disappear w/in 72 to 96 hrs after therapy
Nursing management associated with administration of biologic response-modifying drugs (hematopoietic)
Focuses on use of careful aseptic technique and other measures to prevent infections: proper nutrition, oral hygiene, monitoring of blood counts; management of adverse effects including joint/bone pain and flu-like symptoms
-do NOT administer filgrastim and sargramostim w/in 24 hrs of a myelosuppressive antineoplastic and follow timeframe
Hematopoietic factors: Erythropoietin (Epogen)
Epoetin alfa (Epogen, Procrit) Biosynthetic form of the natural hormone erythropoietin, which normally secreted by kidneys in response to a decrease in RBCs. Promotes the synthesis of erythrocytes (RBCs) by stimulating RBC progenitor cells in bone marrow
-Tx of anemia associated w/end-stage renal disease, chemo-induced anemia, anemia associated w/zidovudine
-causes progenitor cells in bone marrow to manufacture large # of immature RBCs to speed up maturation
-ineffective w/out adequate iron stores/bone marrow function
-those receiving also need oral/IV iron
-Injection (IV or subcutaneously)
-sub route=slower
CONTRAINDICATIONS
-Drug allergy
-uncontrolled HPT
-hemoglobin levels above 10g/dL for cancer pt’s & 11g/dL renal pt’s
-head/neck cancers, those @risk for thrombosis
ADVERSE EFFECTS
-HPT
-fever, headache, pruritus, rash, N/V, arthralgia, injection site reactions
FDA REQUIRES
-those receiving for chemo-induced anemia must be registered in a risk mitigation program called ESA Apprise Oncology
Biological Response-Modifying and Antirheumatic Drugs: Interferons
Proteins that have 3 basic properties: antiviral, antitumor, immunomodulating
- 3 groups of drugs: alfa, beta, gamma interferons; each with own antigenic and biologic activity. Most used in Tx of certain viral infections and certain types of cancer
- in body they are activated by T cells & other cells in response to viral infection.
Biological Response-Modifying and Antirheumatic Drugs: Interferons Mechanism of action
- protect human cells from virus attack by enabling human cells to produce enzymes that stop viral replication & prevent viruses from penetration of healthy cells
- prevent cancer from dividing/replicating & increase activity of other cells in immune system (macrophages, neutrophils, NK cells)
- effect on cancer cells caused by combination of direct inhibition of DNA and protein synthesis w/in cancer cells (antitumor effects) & mult. immunomodulatory effects on host’s immune system
- increase cytotoxic activity of NK/phagocytic ability of macrophages
- increase expression of cancer cell antigens on cell surface, enabling immune system to recognize cancer cells easily (destruction)
Interferons have three different effects on the immune system
1) Restore function, if impaired
2) augment (amplify) immune’s ability to function as body’s defense
3) inhibit immune system from working. May be useful when immune system dysfunctional (autoimmune disease) case in MS
- Interferon beta 1a and 1b indicated for Tx of MS; inhibiting dysfunctional immune system prevents further damage
Biological Response-Modifying and Antirheumatic Drugs: Interferons indications
(Antiviral, antineoplastic, immunomodulatory)
Tx of viral infections, various cancers, some autoimmune disorders
Biological Response-Modifying and Antirheumatic Drugs: Interferons Contraindications
- known drug allergy
- may include autoimmune disorders, hepatitis or liver failure, concurrent use of immunosuppressant drugs, severe liver disease
Biological Response-Modifying and Antirheumatic Drugs: Interferons adverse effects
-AE=Adverse effect
Flu-like symptoms: fever, chills, headache, malaise, myalgia, and fatigue
- dose-limiting AE=fatigue
- high dose=exhausted, confined to bed
- alfa-2b black box warning related to potential to cause or aggravate autoimmune disorders and neuropsychiatric symptoms
Biological Response-Modifying and Antirheumatic Drugs: Interferons Interactions
- seen w/both interferon alfa-2a and 2b when used w/drugs metabolized in liver via cytochrome P-450 enzyme. Combination results in decreased metabolism and increased accumulation of these drugs, leads to drug toxicity
- interferon w/antiviral enhances activity of both, lead to toxicity
- additive toxic effects to bone marrow from interferon gamma w/myelosuppression
Before administering interferons assess the patient for?
History of drug allergies as well as autoimmune disorders, hepatitis, liver failure, or AIDS
Contraindications for interferons include
Concurrent use of immunosuppressant drugs, liver dysfunction, severe liver disease, & AIDS-related Kaposi’s sarcoma
It is important to note that interferon alfa-2b has a black box warning associated with possible?
Aggravation and/or precipitation of autoimmune disorders and neuropsychiatric symptoms
- determine baseline WBC & platelet couts PRIOR to initiation of therapy
- monitor serum lab values (blood urea nitrogen, creatinine levels, ALP, AST levels) BEFORE & DURING Tx
- document baseline neurologic functioning, bowel status, heart sounds, PR, BP
Administer interferons parenterally by either subcutaneous, IV, or IM route, be sure to?
Rotate sites/use accurate technique
