Immunomodulating Drugs

Question 1

Immunomodulating Drugs

Answer 1

Medications that therapeutically alter a patient’s immune response to malignant tumor cells

Question 2

Hematopoietic Drugs

Answer 2

Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia

Allows for higher doses of chemotherapy

Question 3

Filgrastim (Neupogen)

Answer 3

Hematopoietic drug

Granulocyte colony-stimulating factor

Stimulates precursor cells to turn into granulocytes such as basophils, eosinophils, and neutrophils

Question 4

Oprelvekin (Neumega)

Answer 4

Hematopoietic drug

Enhances synthesis of platelets

Indicated for the prevention of chemotherapy-induced thrombocytopenia and avoidance of the need for platelet transfusions

Question 5

Adverse Effects of Hematopoietic Drugs

Answer 5

Fever, muscle aches, bone pain, flushing

Question 6

Interferons

Answer 6

Restore the immune system’s function if it is impaired

Augment the immune system’s ability to function as the body’s defense

Inhibit the immune system from working

HELPFUL IN AUTOIMMUNE DISEASES

Question 7

Indications for Interferons

Answer 7

Genital warts, hepatitis

Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi’s sarcoma, malignant melanoma

Multiple sclerosis

Question 8

Adverse Effects of Interferons

Answer 8

Fever, chills, headache, myalgia, anorexia, dizziness, nausea, vomiting, diarrhea

Dose-limiting adverse effect is fatigue

Question 9

Monoclonal Antibodies

Answer 9

Treatment of cancer, rheumatoid arthritis, multiple sclerosis, and organ transplantation

Specifically target cancer cells and have minimal effect on healthy cells

Fewer adverse effects that traditional antineoplastic medications

Question 10

Rheumatoid Arthritis

Answer 10

Autoimmune disorder causing inflammation and tissue damage in joints

TREATMENT: RELIEVE SYMPTOMS, MAINTAIN JOINT FUNCTION, MIIMIZE SYSTEMIC INVOLVEMENT, DELAY PROGRESSION OF DISEASE, NONDRUG MEASURES

Treatment consists of NSAIDs and DMARDs

Question 11

Examples of Monoclonal Antibodies

Answer 11

ADALIMUMAB (HUMIRA) AND INFLIXIMAB (REMICADE)

Question 12

Disease-Modifying Antirheumatic Drugs

Answer 12

Modify the disease of rheumatoid arthritis

Exhibit antiinflammatory, antiarthritic, and immunomodulating effects

Inhibit the movement of various cells into an inflamed, damaged area

Slow onset of action of several weeks

Question 13

Nonbiologic Disease-Modifying Antirheumatic Drug

Answer 13

METHOTREXATE

Question 14

Biologic Disease-Modifying Antirheumatic Drugs

Answer 14

ETANERCEPT-ENBREL AND ABATACEPT-ORENCIA

Question 15

Eternercept (Enbrel)

Answer 15

Used to treat rheumatoid arthritis and psoriasis

Patients must be screened for latex allergy

1-2 weeks onset of action

Contraindicated in presence of active infections

Question 16

Abatacept (Orencia)

Answer 16

Used to treat rheumatoid arthritis

Caution if the patient has a history of recurrent infections or COPD

Patients must be up to date in immunizations

May increase risk of infections associated with live vaccines or decrease response to vaccines

Question 17

Nursing Implications of Immunomodulating Drugs

Answer 17

TEACH PATIENT TO IMMEDIATELY REPORT SIGNS OF INFECTION (SORE THROAT, DIARRHEA, VOMITING, FEVER OF 100.5 DEGREES FAHRENHEIT OR HIGHER)

Question 18

Immunosuppressants

Answer 18

Drugs that decrease or prevent an immune response

Used to prevent or treat rejection of transplanted organs

Used in rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, multiple sclerosis, myasthenia gravis, and psoriasis

Question 19

Transplants

Answer 19

IMMUNOSUPPRESSANTS ARE USED TO INHIBIT THE IMMUNE SYSTEM AND PREVENT ORGAN REJECTION

TRANSPLANT PATIENTS ARE ON IMMUNOSUPPRESSANT THERAPY FOR THE DURATION OF THEIR LIFETIME

Question 20

Major Classes of Immunosuppressants

Answer 20

Glucocorticoids (inhibit T-cell activation)

Calcineurin inhibitors (inhibit phosphate)

Antimetabolites (inhibit cell proliferation)

Biologics (inhibit cytotoxic T cell functions)

Question 21

Cyclosporine (Sandimmune)

Answer 21

Prevention of organ rejection

May be used for other autoimmune disorders

Black box warnings: renal impairment, increased risk of fatal infections, liver injury, seizures, encephalopathy, and skin cancer

Question 22

Azathiprine (Imuran)

Answer 22

Prophylaxis of organ rejection concurrently with other immunosuppressant drugs

Adverse effects include lymphoma and other malignancies as well as hepatosplenic T-cell lymphoma

Question 23

Tacrolimus (Prograf)

Answer 23

Used for the prevention of liver transplant rejection

Other uses are unlabeled uses

Question 24

Nursing Implications

Answer 24

Monitor WBC counts throughout therapy, and if WBC counts drop below normal range, contact prescriber

GRAPEFRUIT JUICE INTERACTS WITH THESE DRUGS

ASSESS THE ORAL CAVITY OFTEN FOR WHITE PATCHES ON THE TONGUE, MUCOUS MEMBRANES, AND ORAL PHARYNX

MIX ORAL CYCLOSPORINE IN A GLASS CONTAINER

INFORM PATIENTS THAT LIFELONG THERAPY WITH IMMUNOSUPPRESSANTS IS INDICATED WITH ORGAN TRANSPLANTATION