Immunotherapy In Cancer Tx And Biological Factor Modifiers

Question 1

What are hematopoietic meds?
Include the two prototypes and what is does in general?

Answer 1

Used for immunotherapy for cancer treatment

Hematopoietic drugs are used to stimulate the body’s immune system, which detects and kills cancer cell and viral infections.

Two prototypes:
- Colony-stimulating factors:
Filgrastim (stimulates bone marrow and increases production of WBCs)
- erythropoetin drug: darbepoetin (produces RBC)

Question 2

What are the main AE associated with filgrastim and darbopoetin?

Answer 2

They both give flu like symptoms:
- fever
- muscle aches
- weakness
- chills
- rash
- cough
- dyspnea
- sore throat
- bone pain (mostly sternum, pelvis, shoulders) are to be expected

Occurs because meds stimulate the immune system causing the body to be tired and working hard

Question 3

What are the goal of hematopoietic drugs? (Filgrastim and darbopoetin)

Answer 3

Goal is to decrease the duration of chemotherapy-induced anemia, neutropenia and thrombocytopenia

Allows for higher doses of chemo to be given

Reduces the time and the lowest point of nadir (makes it drop a little less)

Reduces the myelosuppression

Question 4

When is filgrastim usually best to be given?

Hematopoietic colony stimulating factors med)

Answer 4

The best time to give this medication is usually a little after 24hrs post chemo tx (after myelosuppressive antineoplastics)

Not given within 24hrs to not counteract the therapeutic effect of the chemotherapy

Needs to be given before a pt develops an infection

Question 5

Is filgrastim given after every chemo treatment?

Answer 5

No, it will be given to pts experiencing myelosuppression as an AE of meds whose bone marrow are not producing enough.
Given to pts with severe myelosuppression to be able to keep giving chemo

Not given with all immunosuppressants therapy or chemo therapy either.

Question 6

Will filgrastim (colony stimulating factor hematopoietic drug) help treat an infection?

Answer 6

No, it will help prevent it by decreasing the myelosuppression and increasing the nadir but it will not help treat an infection.

If infection already present, filgrastim will do nothing so antibiotics will be given round the clock to always keep it at the same therapeutic level bc pt has no immune system

Question 7

What are interferons used for?

Answer 7

Used as part of immunotherapy.
Have antiviral, antitumor and immunomodulating properties.

Help tx certain viral infections and cancers by :
- protecting human cells from virus
- preventing cancer cell division and replication
- increasing activity of other immune cells (macrophages, neutrophils, NK cells)

Question 8

What are monoclonal antibodies used for in general?

Prototypes : adalimumab, and infliximab

All finish in mab

Answer 8

Used for tx of cancer, RA, organ transplant and some sclerosis

Have fewer AE than antineoplastic (chemo) drugs

Question 9

Do monoclonal antibodies make you immunosuppressed?

(Adalimumab and infliximab)

Answer 9

Yes because they block the cascade of your immune system to stop replication of cancer cells.

Question 10

What are some possible AE of adalimumab (Humira)?
And what is the route it administration?

Monoclonal antibody medication

Answer 10

Adalimumab is given SC

Possible AE:
- inflammation at injection site
- causes myelosuppression so risk of infection
- flu like symptoms
- neutropenia (due to abrupt stop in immune system response that would generate neutrophil production)

Question 11

What is an important contraindication of adalimumab (humira) ?

Monoclonal antibody

Answer 11

• pt with known active infection due to immunosuppressive effects
• pts with active TB (may reactivate it)
• pregnancy and up to 2yrs after
• no live vaccines

Question 12

What are some nursing implications to be done with the administration of adalimumab (humira)?

Used as antirheumatic drugs (for autoimmune diseases)

Answer 12

• tell pt to report any excessive fatigue, edema, loss of appetite,
• encourage pt to drink 2-3L per day
• instruct pt to avoid pregnancy during and up to 2 yrs post tx
• TB test before starting tx
• monitor VS closely, especially temperature
• monitor CBC and neutrophils count closely

Question 13

What are some interactions that can be dangerous for a pt taking adalimumab (humira)?

A monoclonal antibody for autoimmune diseases

Answer 13

Coadministration with other antirheumatic drug can cause increased risk of serious infections secondary to neutropenia

Question 14

What are some possible AE of infliximab (remicade)?

Monoclonal antibody for autoimmune diseases

Answer 14

• headache
• GI discomfort
• Upper and lower resp tract infections

May increase risk of neutropenia with other anti rheumatic drugs

Question 15

What are important assessments and monitoring to be done with administration of infliximab (Remicade)?

Answer 15

• test for latent TB before tx initiation
• monitor pt for HS (heart sounds), BP, PR, pulse oximetry reading, ECG reading
• monitor for signs of superinfections

Question 16

What is the purpose of tamoxifen?

Hormonal antineoplastic(selective estrogen receptor modulator)

Answer 16

Some cells are hormone driven, like cancer cells that are driven by estrogen in breast cancer and endometrial cancer

So tamoxifen works by blocking that hormone so it stops the divide and reproduce process stopping the cancer growing process

Question 17

What are some expected AE of tamoxifen?

Answer 17

Medication can provoke menopause so risk of:

• hot flashes
• fatigue
• weakness
• hypertension
• mood disorders
• depression
• nausea

Question 18

A pt diagnosed with rheumatoid arthritis (RA) will be starting tx using methotrexate PO

Identify another medication that this pt will receive to help manage the AE associated with methotrexate?

A. Folate
B. Darbopoetin
C. Leucovorin
D. Adalimumab

Answer 18

A

Question 19

What is an important assessment before starting methotrexate therapy?

Answer 19

Test for latent TB, because since the immune system will be compromised it can trigger that infection and reactivate it.

Always test before starting therapy.

Question 20

Several days later, the pt calls the clinic and explains that their “mouth is very sensitive” when on methotrexate tx. Select one statement that provides the best instruction to the pt.

A. The nurse should instruct the pt to use a mouth wash after every meal and at bedtime
B. The nurse should instruct the pt to continue with their regular oral cleaning habits.
C. The nurse should instruct the pt to eat meals that are high in carbs.
D. The nurse should instruct the pt to eat room temperature foods.

Answer 20

D.

• A is wrong bc it’s the magic mouthwash that needs to be used or else it may worsen symptoms, mouthwash is too general in this case
• ## B is wrong bc you do not know what their regular routine is and if it’s right (if mentioned swabs or soft toothbrush it could have been good)

Question 21

What are the four meds used in immunotherapy? And what are their two classes?

Answer 21

Hematopoietic meds:
- colony stimulating : filgrastim
- erythropoietic: darbopoetin

Monoclonal antibodies:
- adalimumab
- infliximab

Question 22

A pt is prescribed monoclonal antibody therapy for the tx of RA. What pt condition should alert the nurse to question the prescription for this class of drugs?

A) nephrotic syndrome
B) hypertensive emergency
C) COPD
D) AIDS

Answer 22

D