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Biological Response-Modifying and Antirheumatic Drugs Flashcards

1
Q

Biological Response–Modifying

Alter the body’s response to diseases such as (four)

A

Alter the body’s response to diseases such as cancer and autoimmune, inflammatory, and infectious diseases

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2
Q

Biological Response–Modifying Drugs 2 types of medications

A

Hematopoietic drugs

Immunomodulating drugs
-Interferons (IFNs)
-Monoclonal antibodies (MABs)
-Interleukin (IL) receptor agonists and antagonists
-Miscellaneous drugs

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3
Q

Immunomodulating Drugs action

A

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

Drugs that modify the body’s own immune response so that it can destroy various viruses and cancerous cells

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4
Q

Immunomodulating Drugs is also used for three other diseases

A

Fourth part of cancer therapy, in addition to:

-Surgery
-Chemotherapy
-Radiation

Also used for other diseases
-Autoimmune disease
-Inflammatory disease
-Infectious disease

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5
Q

Biological Response–Modifying Drugs: 6 Subclasses

A

Hematopoietic drugs
IFNs
MABs
IL receptor agonists and antagonists
Disease-modifying antirheumatic drugs
Miscellaneous drugs

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6
Q

Biological Response–Modifying Drugs:

Enhances two

Inhibits three

A

Enhancement of hematopoietic function

Enhancement or regulation of the host’s immune system defenses against the tumour

Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

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7
Q

Immune System

Two components of the immune system work together to recognize and destroy foreign particles and cells in the blood or other body tissues.

Types of cell in each

A

*Humoral immunity
–Mediated by B-cell functions (antibodies)

*Cell-mediated immunity
–Mediated by T-cell functions

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8
Q

Immune System

what attacks tumour antigens?

A

*Tumour antigens (chemical or tumour “markers”) label tumour cells as abnormal cells

*Antibodies attack tumour cells
–B lymphocytes (B cells) from the humoral immune system
–T lymphocytes (T cells) from the cell-mediated immune system

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9
Q

Humoral Immune System

Name of cell

Originates frrom?

When a foreign substance (antigen) is present, these turn into plasma cells, which in turn produce ______.

______ complex

_____ cells

A

B lymphocytes (B cells)
–Originate from bone marrow
–When a foreign substance (antigen) is present, these turn into plasma cells, which in turn produce antibodies.

Antibody–antigen complex

Memory cells

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10
Q

Antibodies are also known as

A

immunoglobulins

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11
Q

Monoclonal antibodies (MABs):

A

identical cells derived from a single cell

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12
Q

Five major types of naturally occurring immunoglobulins:

A

A, D, E, G, and M

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13
Q

T lymphocytes (T cells)

Originate from bone marrow but mature in the?

Three types, with different functions

A

Originate from bone marrow but mature in the thymus gland

Cytotoxic T cells
T-helper cells
T-suppressor cells

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14
Q

Cytotoxic T cells

A

directly kill their targets by causing cell lysis or rupture.

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15
Q

T-helper cells

A

direct the actions of many other components of the immune system.

control immune system
direct other immune cells

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16
Q

T-suppressor cells

A

limit or control the immune response.

opposite of T-helper cells
regulate immune response
allow tumours to grow

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17
Q

A healthy immune system has about

A

twice as many T-helper cells as T-suppressor cells at any one time.

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18
Q

Overactive T-suppressor cells may be responsible for clinically significant

A

cancer cases by permitting tumour growth beyond immune system control.

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19
Q

Other cells of the cell-mediated immune system help to destroy cancer cells.

A

Macrophages (derived from monocytes)

Natural killer (NK) cells (type of lymphocyte)

Polymorphonuclear leukocytes (neutrophils)

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20
Q

Therapeutic Effects of Biological Response–Modifying Drugs

A

Enhancement of hematopoietic function

Regulation or enhancement of the immune response, including cytotoxic or cytostatic activity against cancer cells

Inhibition of metastases, prevention of cell division, or inhibition of cell maturation

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21
Q

Hematopoietic Drugs

action

produced by

A

Promote the synthesis of various types of major blood components

by promoting the growth or differentiation and the function of their precursor cells in the bone marrow.

Produced by recombinant deoxyribonucleic acid (DNA) technology

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22
Q

Hematopoietic Drugs Uses

Decrease the duration of?

Enable?

A

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

Enable higher doses of chemotherapy to be given

Other uses

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23
Q

Hematopoietic Drugs Categories

A

Erythropoietic drugs

Colony-stimulating factors

Platelet-promoting drug oprelvekin not available in Canada.

24
Q

Erythropoietic drug name

A

darbepoetin alfa

25
Colony-stimulating factors 1 drug Action when to administer?
filgrastim Granulocyte colony-stimulating factor Stimulates precursor cells for the type of white blood cells known as granulocytes (including basophils, eosinophils, and neutrophils) Administered before patient develops infection
26
Filgrastim Typically given as _____ 7-14 days Do not start until ____ after chemo is completed Sites Discontinue after the ANC has reached? Could start ____ days post chemo and last as long as ____ days
-Do not start until 24hrs after chemo is completed -Keep refrigerated, take out minimum 30 minutes to warm up before use -Use abdomen or back of arms for SC location -Discontinue after the ANC has reached 1 x 10(9) / L Note: Nadir is when the blood counts (mainly ANC and platelet counts) are at their lowest. Nadir could start 7-10 days post chemo and last as long as 28 days
27
Hematopoietic Drugs: Decrease the duration of chemotherapy-induced ______, ________, and _________. Allow for ______ dosages of chemotherapy Decrease bone marrow _____ _____ after bone marrow transplantation or irradiation Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells, as well as ______ or _______infected cells
Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia Allow for higher dosages of chemotherapy Decrease bone marrow recovery time after bone marrow transplantation or irradiation Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells, as well as virus- or fungus-infected cells
28
Hematopoietic Drugs: Indications
Used for patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemotherapy Decrease the duration of low neutrophil counts, thus reducing the incidence and duration of infections Enhance the functioning of mature cells of the immune system, resulting in greater ability to kill cancer cells as well as virus- and fungus-infected cells Enhance red blood cell and platelet counts in patients with bone marrow suppression resulting from chemotherapy Allow higher doses of chemotherapy, resulting in the destruction of a greater number of cancer cells
29
Hematopoietic Drugs: Adverse Effects
Usually mild Most common include: Fever Muscle aches Bone pain Flushing
30
Interferons three basic properties Are used to treat _____ and _____
Proteins with three basic properties -Antiviral -Antitumour -Immunomodulating Used to treat certain viral infections and cancer Interferon (IFN)-α, -ß, and -γ
31
Interferons action
Recombinantly manufactured substances that are identical to the IFN cytokines that are naturally present in the human body -Protect human cells from virus attack -Prevent cancer cells from dividing and replicating -Increase the activity of other immune system cells, such as macrophages, neutrophils, and NK cells
32
Interferons: Effects on the Immune System Restores? Can be helpful in which disorder? because?
Antiviral/Antitumor/Immune Modulator/Suppress 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 disorders
33
Interferons: Indications (three)
Viral infections ---Genital warts, hepatitis – alfa interferons (anti-viral action) Cancer ---Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi’s sarcoma, malignant melanoma – alfa interferons (anti-tumor action) Autoimmune disorders ---Multiple sclerosis – beta interferons (immune modulating/immune-suppressive)
34
Interferons: Adverse Effects
Flulike effects ---Fever, chills, headache, myalgia Dose-limiting adverse effect is fatigue. Other adverse effects -Anorexia -Dizziness -Nausea -Vomiting -Diarrhea
35
Interferons: Products
IFN-α products: “leukocyte IFNs”—produced from human leukocytes IFN alfa-2b (Intron-A®) – wider uses listed peginterferon alfa-2a (Pegasys®) – chronic Help C IFN-ß products - – RRMS *allergy to human albumin -IFN β-1a (Avonex®, Rebif®) -IFN β-1b (Betaseron®, Extavia®) IFN-γ (Gamma) products are not available in Canada.
36
Monoclonal Antibodies Treats (four) Contraindicated for (2)
For treatment of cancer, rheumatoid arthritis (RA), multiple sclerosis, and organ transplantation Specifically target cancer cells and have minimal effect on healthy cells Fewer adverse effects than traditional antineoplastic medications Contraindicated for active TB and other infections
37
Monoclonals: Anti TNF Property Tumor necrosis factor (TNF)
is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. It is produced chiefly by activated macrophages, although it CAN be produced by other cell types as well.
38
Monoclonals: Anti TNF Property TNF inhibitors
are drugs that help stop inflammation. They're used to treat diseases like rheumatoid arthritis (RA), juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, ulcerative colitis (UC), and Crohn's disease. They're also called TNF blockers, biologic therapies, or anti-TNF drugs.
39
Monoclonal Antibodies four drug names
Adalimumab (RA) infliximab (RA, Crohn’s) Rituximab (NHL) Natiluzumab (MS)
40
Rituximab (Rituxan)
*Associated with allergic response; premedicate with diphenhydramine and acetaminophen
41
Interleukins action classified as? drug classification and name
Natural part of the immune system: classified as lymphokines Beneficial antitumour action Interleukin (IL) receptor agonists --aldesleukin
42
Interleukins Antitumour action: IL-2 derivative aldesleukin: Aldesleukin: Lymphokine-activated killer cells:
Antitumour action: IL-2 is produced by activated T cells in response to macrophage- “processed” antigens and secreted IL-1. IL-2 derivative aldesleukin: stimulates or restores immune response Aldesleukin: binds to receptor sites on T cells, which stimulates the T cells to multiply Lymphokine-activated killer cells: recognize and destroy only cancer cells and ignore normal cells
43
Capillary Leak Syndrome
Severe toxicity of aldesleukin therapy Capillaries lose ability to retain vital colloids in the blood; these substances are “leaked” into the surrounding tissues. Result: massive fluid retention -Respiratory distress -Heart failure -Myocardial infarction -Dysrhythmias Reversible after IL therapy is discontinued
44
aldesleukin (Proleukin) Treatment of? Contraindicated in? ROUTE
Treatment of metastatic renal cell carcinoma and metastatic melanoma Contraindicated in those with organ transplants Available only for injection
45
Rheumatoid Arthritis Describe: Diagnosis: Treatment: TWO
Autoimmune disorder causing inflammation and tissue damage in joints Diagnosis primarily symptomatic Treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs)
46
Osteoarthritis Caused? Symptoms? TWO
Age-related degeneration of joint tissues Pain and reduced function Not an auto-immune related condition
47
Disease-Modifying Antirheumatic Drugs Modify the disease of ______ Three effects? Inhibit the movement of various cells into an inflamed, damaged area, such as a _____ ________ onset of action of several weeks versus _____ to ______ for NSAIDs Also referred to as __________ antirheumatic drugs
Modify the disease of RA Exhibit anti-inflammatory, antiarthritic, and immunomodulating effects Inhibit the movement of various cells into an inflamed, damaged area, such as a joint Slow onset of action of several weeks versus minutes to hours for NSAIDs Also referred to as slow-acting antirheumatic drugs
48
Nonbiological Disease-Modifying Antirheumatic Drug names (two)
methotrexate leflunomide
49
Methotrexate Frequency AEs How to lessen AEs
First line therapy recommended by Canadian Rheumatology Association usually in a combo of two Given PER WEEKLY not daily basis (oral most common) Lower doses than for cancer (7.5mg – 20 mg/wk) Bone marrow suppression is most common adverse effect; stomatitis may also occur fairly commonly Folic acid supplement taken concurrently to lessen adverse effects Onset of action 3-6weeks, half-life 3-10 hours
50
Biological Disease-Modifying Antirheumatic Drug names
adalimumab etanercept infliximab abatacept
51
etanercept (Enbrel®) Treats? Important consideration contraindication? because?
Used to treat rheumatoid arthritis (including juvenile rheumatoid arthritis) and moderate to severe chronic plaque psoriasis Patients must be screened for latex allergy (some dosage forms may contain latex). Onset of action: 1 to 2 weeks Contraindicated in presence of active infections --Reactivation of hepatitis and tuberculosis has been reported
52
abatacept (Orencia®) Treats? Caution? Important consideration? may increase may decrease
Used to treat RA Caution if the patient has a history of recurrent infections or chronic obstructive pulmonary disease Patients must be up to date on immunizations before starting therapy. May increase risk of infections associated with live vaccines May decrease response to dead or live vaccines
53
Nursing Implications
Assess for allergies, specifically allergies to egg proteins and IgG. Assess for conditions that may be contraindications. Assess baseline blood counts; perform cardiac, kidney, and liver studies. Assess for presence of infection. Follow specific guidelines for preparation and administration of drugs. Monitor the patient’s response during therapy. With some BRMs, treatment with opioids, antihistamines or anti-inflammatory drugs may be required for management of bone pain and chills. Aniemetics used for nausea and vomiting
54
Teach patients to report signs of infection immediately.
Sore throat Diarrhea Vomiting Fever of 38.1°C or higher Watching for febrile neutropenia; needs urgent treatment and monitoring
55
Monitor therapeutic responses.
Decrease in growth of lesion or mass Improved blood counts Absence of infection, anemia, and hemorrhage Observe for and monitor adverse effects. Remember we are looking for signs of immune system triggered or immune system suppressed

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