Exam 5 Flashcards
(160 cards)
1
Q
of the anti-inflammatory meds, which should not be given w/ sulfa allergy?
A
celecoxib (COX 2)
2
Q
which non steroidal anti inflammatory drugs, whether administered orally or via injection, should be limited to a max duration of 72 hours due to potential risk of kidney damage?
A
ketorolac (toradol)
3
Q
which side effects / AE should nurses monitor for when administering COX 2 inhibitors
A
skin rxns such as Steven Johnson syndrome
platelet clumping which can lead to MI or stroke (CVAs)
4
Q
which side effects / AE should nurses monitor for when administering COX 1 inhibitors
A
sodium retention, edema, increased b/p
GI erosion, bleeding
these are NSAIDS , COX 1 is involved w/ clotting, protection of stomach lining, marinating water balance in kidneys
5
Q
what medical conditions are COX 2 inhibitors typically prescribed for, and what conditions serve as contraindications for their use
A
trauma / injury
contraindications - CV dysfunction, celecoxib is contraindicated in pts w/ sulfa allergy
6
Q
what medical conditions are NSAIDS typically prescribed for, and which conditions serve as contraindications for their use?
A
RA pain, decreases pain & inflammation, gout pain
contraindications - htn, HF, asthma, increased risk of bleeding, avoid in children
7
Q
what medical conditions are acetaminophen inhibitors typically prescribed for, and which conditions serve as contraindications for their use
A
used for fever and joint pain
*pts w/ hemophilia or peptic ulcers can not use other forms of meds that increase risk of bleeding
contraindications- alcohol hx, increased risk of bleeding w/ oral anticoagulant use
8
Q
which meds could be utilized to address pain in individuals with an autoimmune disease
A
aspirin, ibuprofen, acetaminophen, napoxen
9
Q
what diagnoses should be recognized as contraindications for NSAIDs
A
known allergy to NSAIDs or salicylates
preg/lac
bleeding disorders
known CVD or htn
GI bleeding
renal / hepatic dysfunction
peptic ulcer disease
10
Q
AE of NSAIDs
A
most common: nausea, dyspepsia (heartburn), GI pain, diarrhea, flatulence, GI bleeding, ulcer formation
can also cause renal impairment, acute kidney insufficient, h/a, dizzy, somnolence, fatigue, bleeding platelet inhabiting, htn, bone marrow suppression, rash, mouth sores, fatal anaphylactic shock
11
Q
max daily dosage of acetaminophen
A
4g/day
12
Q
what MOA is this- works by inhibiting the synthesis of prostaglandin, a key mediator of inflammation, thereby reducing inflammation & pain. Additionally, they affect platelet aggregation by inhibiting the synthesis of thromboxane A2 at low levels & prostacyclin at higher levels, which can make blood less likely to clot, potentially reducing the risk of clot-related issues
A
salicylates
13
Q
what do salicylates treat
A
mild to moderate pain, fever
various inflammatory conditions such as RA, OA, & inflammatory bowel disease
14
Q
what should pts be advised regarding the use of aspirin and other salicylates before surgery
A
avoid these meds the week prior to surgery to minimize risk of increased bleeding during and after procedure
15
Q
what do NSAIDs treat
A
Acute / chronic pain, inflammation
16
Q
what AE should nurses monitor for when administering acetaminophen
A
ha, hemolytic anemia, renal dysfunction, skin rash, fever, chest pain, liver toxicity/failure, bone marrow suppression
**chronic use or OD can lead to hepatotoxicity
**increased risk of bleeding w/ oral anticoagulants because of the effects on the liver
17
Q
antidote for acetaminophen
A
acetylcysteine
(Restores depleted liver glutathione levels and helps neutralize acetaminophen’s toxic byproducts, enabling safe elimination from the body)
18
Q
this can result in decreased production of RBCs, WBCs, platelets leading to conditions like hemolytic anemia, thrombocytopenia, bleeding and clotting issues
causes liver damage leading to bone marrow suppression
A
severe acetaminophen toxicity
19
Q
acetaminophen can have an increased risk of hepatotoxicity with which drugs
A
carbamazepine, hydantoins, rifampin
20
Q
what pt info would you provide about DMARDs and for what condition are they prescribed early in treatment
A
meds used to treat arthritis by controlling inflammation
often prescribed early in treatment to prevent joint damage & manage symptoms effectively
21
Q
how would you explain to pts the reasons behind their prescription of interferons (all have interferon in the name)
A
combat viral infections & inhibit tumor growth
-indirectly combat tumor cell growth by stimulating the immune system’s activity, which can lead to the destruction of cancer cells.
-Work by preventing virus replication, stimulating antiviral protein production, and enhancing the immune response
-Naturally occurring substances produced by human cells in response to viral invasion or other stimuli
22
Q
med prescribed for organ transplant prophylaxis against rejection and can cause gingival hyperplasia and hirsutism
A
cyclosporine (also prototype for T & B cell suppressors )
23
Q
med administered after antineoplastic therapy to manage severe neutropenia
A
tbo-filgrastim (colony stimulating factor)
24
Q
what is associated with high levels of aspirin intake
what are s/s
what doses does this occur at?
A
salicylism
s/s = dizzy, ringing in ears (tinnitus), difficulty hearing, n/v/d, mental confusion, fever, lethargy
20-25g in adults, 4g in children
25
how can hypersensitivity rxns be prevented when administering monoclonal antibodies, and why is caution advised with repeat doses
prevent rxns by treating fever prior to therapy, avoid in pts with known allergies
use caution w/ repeat doses due to the risk of severe rxns.
serious hypersensitivity reactions can occur with repeat administration
25
AE of monoclonal antibodies
- Can exacerbate fluid volume overload
- acute pulmonary edema aka PE!!!!! (manifested by dyspnea, chest pain, and wheezing) due to severe fluid retention / cytokine release around lungs
- fever, chills, malaise, myalgia, nausea, diarrhea, and vomiting
- heightened vulnerability to infection and cancer
- Avoid in pregnancy
26
treatment option considered for pts w/ rheumatic inflammatory conditions who don't respond to standard anti inflammatory therapy
Gold salts/chrysotherapy
- These substances inhibit phagocytosis by being taken up by macrophages.
- due to their high toxicity, they are reserved for patients who do not respond to conventional therapy.
27
which tumor necrosis factor blocker is contraindicated in pts allergic to Chinese hamster ovary products
etanercept
**must administer subcutaneously
28
what DMARD can act as an artificial meniscus for pts w/ severe rheumatoid arthritis of the knee
hyaluronidase derivatives such as hylan G-F 20 & sodium hyaluronate
injected directly into joints to cushion & lubricate them, providing relief from degenerative arthritis pain
29
what should be avoided if a pt is taking an agent that suppresses the immune response
(specifically cyclosporine, mycophenolate, corticosteroids)
avoid crowded places, ppl w/ infections, working w/ soil, invasive procedures, preg/breastfeeding
**use hand hygiene and monitor for s/s of cancer & infection
30
immune suppressants include
immune modulators
T & B cell suppressors
interleukin receptor antagonists
monoclonal antibodies
31
med administered to prevent or relieve coughing
antitussive drugs
Traditional:
Codeine (opioid)
Hydrocodone
Dextromethorphan (OTC) **Prototype
Locally acting:
Benzonate (Tessalon Perles)
32
Traditional:
Codeine (opioid)
Hydrocodone
Dextromethorphan (OTC) *** prototype
Locally acting:
Benzonate (Tessalon Perles)
these are what kinds of medications
antitussive meds
33
what OTC oral decongestant should pt w/ htn use cautiously
Pseudoephedrine (sympathomimetic agent)
**Causes vasoconstriction in mucus membranes of nasal passage resulting in their shrinkage, which promotes drainage & improvement of ventilation
34
these are what:
beclomethasone
budesonide *** P
ciclesonide
fluticasone
triamcinolone
inhaled steroids
35
how to use inhaler
- Shake inhaler
- Position the mouthpiece 2 to 4 cm (1 to 2 inches) in front of the mouth.
- After a complete exhalation, instruct the client to depress the inhaler once.
- Inhale deeply & slowly through the mouth.
- Hold their breath for 5 to 10 seconds (hold in chest as long as they can)
- Remove the metered-dose inhaler (MDI).
- Exhale slowly.
36
which med is contraindicated in narrow angle glaucoma and why
Ipratropium
bc it can dilate pupils & increase intraocular pressure, potentially worsening the condition or triggering an acute glaucoma attack
37
what are tumor necrosis factor blockers used for
RA, polyarticular juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis
end in "-mab"
38
what med was previously favored for treating asthma and bronchospasm but is no longer first choice due to its relatively narrow safety margin
theophylline aka Xanthine class aka bronchodilator
39
pt education for topical nasal steroid
med depresses immune response so it's contraindicated in pts w/ acute infections
avoid in active infections such as TB
avoid exposure to any airborne infection such as chickenpox or measles
caution in preg/lac
causes mucosal drying (leads to nose bleeds)
40
this is a sympathomimetic agent commonly used for nasal congestion that causes an increased blood pressure
pseudoephedrine
41
what is montelukast
also known as Singulair, antiinflammatory
not for acute asthma attacks... used as a daily med
take med daily to maintain therapeutic level
best taken in evening
long acting
42
examples of mucolytics
acetylcysteine, dornase alfa
43
what are monoclonal antibodies used for
Treatment to prevent rejection in renal transplant patients
steroid-resistant acute allograph rejection in cardiac and hepatic transplant patients
- MAB
44
pts who need to drive or be alert should use these antitussives w/ extreme caution due to the sedation & drowsiness effect
codeine, hydrocodone, dextromethorphan
avoid alcohol & driving heavy machinery
45
what is gold compound used for
RA/juvenile RA
46
s/s of caffeine overdose
Tachycardia, nervousness, restlessness, insomnia, nausea, vomiting, agitation, headache, dizziness, tremors, sweating, flushed face
47
these meds are what
zafirlukast
montelukast
zileuton
what is prototype
leukotriene receptor antagonists
for prophylaxis & treatment of asthma, not for acute asthma attacks
***prototype = zafirlukast
48
which generation of antihistamines has anticholinergic effects
first
49
therapeutic level of theophylline (oral) aka Xanthine class aka bronchodilator
what would severe toxicity do
10-20 mcg/mL
severe toxicity may cause life threatening arrhythmias, hypotension, coma
50
emergency use for anaphylaxis
epinephrine
-induces bronchial smooth muscle relaxation, which alleviates bronchospasm
51
these are used for asthma & COPD
**rescue and long acting
bronchodilator
52
what are interleukins used for
what is common AE
communicate between lymphocytes which stimulates cellular immunity & inhibit tumor growth
Aldesleukin: Treatment of metastatic renal carcinomas, metastatic melanoma in adults. (produced by DNA for E. coli)
Oprelvekin: Prevention and treatment of severe thrombocytopenia in adult patients being treated with myelosuppressive chemotherapy. (stimulates stem cell to mature into platelets)
**sympathetic compounds
AE - flu like symptoms
53
this MOA belongs to what - Breaks down respiratory tract mucus by separating extracellular DNA from proteins.. metabolized by proteases
-also treatment of atelectasis from thick mucus secretions in CF
-Used for cystic fibrosis
mucolytics specifically dornase alfa
**Acetylcysteine MOA : splits disulfide bonds responsible for holding together mucous material... metabolized by liver
54
what are interleukin receptor antagonist (anakinra) used for
used to reduce s/s of moderately to severely active RA in adult pts
developed off of E. coli so watch out for allergy
causes upper resp s/s
can't use w/ other meds... does not play nicely.... life threatening if taken w/ etanercept
55
azelastine
cetirizine
desloratadine
these meds are what
second generation antihistamines
**cause least amt of drowsy
56
what are colony stimulating factors used for
Reduce incidence of infection in patients with bone marrow suppression, decrease neutropenia associated with bone marrow transplant and chemo, treat blood related cancers
57
what are anti gout and hyperuricemia agents
allopurinol (prevents gout)
colchicine (for acute gout attacks).. but can cause OD, so make adjustments for renal disease
58
salmeterol is what
long acting inhaler
59
topical decongestant caution
- Should not be used for more than 3-5 days due to the risk of rebound congestion.
- Should be avoided if experiencing nosebleeds as this can lead to systemic absorption
60
what are immune modulators used for
benralizumab (Fasenra)
dupilumab (Dupixent)
mepolizumab (Nucala)
omalizumab (Xolair)***P!!
reslizumab (Cinqair)
**END IN MAB
BLOCK RELEASE OF CYTOKINES
used for: cancer. autoimmune disorders, organ transplant
***these are add on meds for maintenance therapy for moderate to severe asthma
60
brompheniramine
clemastine
cyproheptadine
these are what
first generation antihistamines
can cause drowsiness/CNS depression & fatal cardiac arrhythmia due to QT prolongation
61
which generation of antihistamines can cause drowsiness/CNS depression & fatal cardiac arrhythmia due to QT prolongation
first generation of antihistamines
62
prophylaxis of children getting DPT (Diphtheria pertussis tetanus)
acetaminophen (only this med!!)
63
oral decongestants/sympathomimetics such as pseudoephedrine should be avoided in what pts
glaucoma, htn, DM, thyroid disorders, coronary artery disease, BPH
64
topical decongestants are used for what
common cold, sinusitis, allergic rhinitis
64
what antitussives should be used with caution in pts w/ hx of narcotic addiction
codeine, hydrocodone
65
what are T & B cell suppressors used for
prevention & treatment of specific transplant rejections as well as treating some types of arthritis
66
this MOA belongs to what
Cause vasoconstriction, leading to decreased edema and inflammation of the nasal membranes
- decreases inflammation and helps open the airway
topical decongestants
67
What is the specific topical surfactant intended exclusively for neonates and pediatric populations?
Beractant is used for pts with immature lungs & insufficient surfactant levels.
- It is administered topically through an endotracheal tube as an intratracheal agent.
67
this MOA belongs to what
splits disulfide bonds responsible for holding together mucous material
- Liquification and clearing of secretions
- Helps with productive cough
acetylcysteine
**also antidote for acetaminophen
68
Which generation of antihistamines can help with pruritus?
First
69
Which nasal steroid is suitable for chronic allergies?
Fluticasone
- May require 2-3 weeks to cause any changes so use daily
- Concurrent use may lead to reduced effectiveness and absorption of secondary agents, so it's essential to space out medication use
70
theophylline & caffeine are examples of what class
XANTHINES (prototype = theophylline) .. bronchodilator
71
this is a rescue inhaler
albuterol
72
what are interferons used for
Inhibit tumor growth and replication
Viral infections
**teratogenic so use barrier contraceptive
73
pt education for inhaled corticosteroids
- Rinse your mouth with water after each use to prevent oral thrush.
-May take 2-3 weeks before the medication reaches its full therapeutic effect.
74
What can repeated use of bronchodilators (sympathomimetics) lead to?
tremors
74
these belong to what
naphazoline
oxymetazoline
phenylephrine
tetrahydrozoline **prototype
xylometazoline
Topical decongestants
75
lower vs upper respiratory tract
low - trachea, bronchi, bronchioles, alveoli (conditions = atelectasis, PNA, bronchitis)
upper - nasal cavity, larynx, pharynx (conditions = common cold, seasonal rhinitis, sinusitis, pharyngitis & laryngitis)
76
collapse of once expanded lung tissue
atelectasis
(results of outside pressure against the alveoli) ..usually due to blockage of airway
77
inflammation of the lungs
caused by bacterial or viral invasion of tissue
PNA
(localized swelling, engorgement, exudation of protective sera)
78
narrowed airway from inflammation
bronchitis
caused by bacteria, virus, or foreign material infects inner lining of bronchi
79
these block the cough reflex
antitussives
(traditional - codeine, hydrocodone, deyextromethorphan
(long acting - benzonatate)
80
these decrease the blood flow to the upper respiratory tract & decrease the production of secretions
decongestants
naphazoline (Privine)
oxymetazoline (Afrin and others)
phenylephrine (Coricidin, many others)
tetrahydrozoline (Tyzine) *** prototype
xylometazoline (Otrivin)
81
these block the release or action of histamine, a chemical that increases secretions & narrows airways
antihistamines
First generation
brompheniramine (J-Tan and others)
clemastine (Dayhist Allergy)
cyproheptadine (generic)
Second generation
azelastine (Astelin, Astepro)
cetirizine (Zyrtec)
desloratadine (Clarinex)
82
these increase productive cough to clear airways
expectorants
guaifenesin (Mucinex)
83
these increase or liquefy respiratory secretions to aid clearing of airways
mucolytics
acetylcysteine
dornase alfa (Pulmozyme)
84
prototype for antitussives
dextromethorphan
85
when do pts take antitussives
& what's important to know about them
to treat / relieve UNPRODUCTIVE cough
rapidly absorbed, crosses placenta, enters human milk
can produce drying effect and CNS AE
85
what are traditional anti tussives
codeine, hydrocodone, dextromethorphan (prototype)
86
tetrahydrozoline is prototype for what
topical nasal decongestants
87
pseudo-ephedrine (P**) and phenylephrine
also known as sudafed which is an oral decongestant
88
what MOA is this
shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptor TO decrease size of membrane size to promote drainage in the sinuses and improve airflow
oral decongestant (pseudo-ephedrine**P and phenylephrine)
89
a pt with what should take caution w/ psudoephedrine (Sudafed) aka oral decongestant
htn
90
how to steroid nasal decongestants work
have an anti inflammatory effect - exact action unknown
91
prototype for steroid nasal decongestants
flunisolide - END IN "ONE" or or "IDE"
92
beclomethasone (Beconase AQ and others)
budesonide (Rhinocort)
flunisolide **P
fluticasone (Flonase Allergy Relief)
triamcinolone (Nasacort Allergy 24 Hour)
these belong to what class
steroid nasal decongestant
93
what are the indications for steroid decongestants like flunisolide
how long do they take to work
allergic rhinitis
-relieve inflammation after nasal polyps
-nasal congestion
**can take up to 1 week to see change
93
these decrease ability to fight off infection bc this is a steroid... it suppresses healing
steroid nasal decongestant
94
94
prototype for antihistamines
diphenhydramine (Benadryl!)
95
what do first gen antihistamines do
what to assess
cause changes in body to make them sleepy
assess Neuro!
these are :
brompheniramine
clementine
cryptoheptadine
96
what second gen anti histamine is OK to take while driving
loratadine
97
CI for expectorants
persistent cough (will make cough more)
98
what meds fall under bronchodilators
xanthines
sympathomimetics
anticholinergics
99
what do xanthines do
MOA unknown but effects smooth muscle of resp tract in bronchi & blood vessels to bronchodilator them
bronchodilator !!
100
these are contraindicated in asthma due to bronchospasm being a SE... common SE is upset stomach / stomatitis
mucolytic (prototype = acetylcysteine)
101
what are indications for xanthines
COPD
asthma & bronchospasm
102
AE of theophylline / xanthine class
restless, arrhythmia, palpitations, anorexia, flushing, proteinuria, resp arrest
103
what level of theophylline increases risks for toxicity
what are s/s of toxicity
over 20 mcg in serum levels
think caffeine OD like tremors, h/a, htn, seizures, extreme tachycardia, even coma or death
104
what do sympathomimetics do for the lower resp tract
beta 2 selective adrenergic agonist to CAUSE / INDUCE bronchodilation
105
albuterol (Proventil HFA and others)
arformoterol (Brovana)
ephedrine (generic)
epinephrine (EpiPen and others)
formoterol (Foradil and others)
isoproterenol (Isuprel and others)
levalbuterol (Xopenex HFA)
metaproterenol (generic)
olodaterol (Striverdi)
salmeterol (Serevent)
terbutaline (generic)
these belong to what
sympathomimetics
**albuterol is prototype!
AE = increased HR
106
what are the indications for using sympathomimetics w/ respect to breathing
short term emergency use to reverse bronchospasm or asthma attack
long term scheduled use for COPD and asthma
AE = increased HR
107
what do anticholinergics do for breathing and what are they used for
block acetylcholine at vagal mediated receptor site & relax smooth muscle in the bronchi
used for COPD & bronchospasm
***INHALERS!!!!!
108
arformoterol (Brovana)
formoterol (Foradil)
olodaterol (Striverdi)
salmeterol (Serevent)
terbutaline (generic)
what class do these belong to & what are they for
long acting bronchodilators
long term scheduled use for COPD and asthma
109
albuterol (Proventil HFA)
ephedrine (generic)
epinephrine (EpiPen)
ephedrine (generic)
epinephrine (EpiPen)
short acting bronchodilators
for short term emergency use to reverse bronchospasm or asthma attack
110
ipratropium (Atrovent) **P!
tiotropium (Spiriva)
aclidinium (Tudorza Pressair)
glycopyrrolate (Lonhala Magnair)
revefenacin (Yupelri)
umeclidinium (Incruse Ellipta)
these belong to what class
anticholinergics
these are inhalers
111
contraindications for anticholinergics
anything that would be aggravated by anticholinergic (drying) or atropine like effects
gluacoma, BPH, dementia, hyperthyroidism
112
pt w/ what disease should not be given ipratropium
glaucoma bc this is an anticholinergic
113
how is ipratropium given
what are AE
only one route --> inhaled!
AE = dry mouth, blurry vision, urinary ret, drying effects
114
what do inhaled steroids do (MOA) and what do they treat
& what is the prototype
decrease swelling & beta adrenergic receptor activity
treat / prevent asthma
prototype - budesonide
115
what is the main med that falls under leukotriene receptor agonists
& what are the CI
montelukast for daily asthma, not used in exacerbations (not the prototype, the prototype is zafirlukast)
CI = acute asthma attacks, renal / hepatic for zileuton & zafirlukast
116
benralizumab (Fasenra)
dupilumab (Dupixent)
mepolizumab (Nucala)
omalizumab (Xolair)*** P!!
reslizumab (Cinqair)
what class do these belong to (END IN MAB)
Immune Modulators
add on meds for maintenance therapy, for pts w/ moderate to severe asthma
they decrease inflammation
117
prototype for leukotriene receptor antagonist
zafirlukast
118
prototype for immune modulator
omalizumab
(decreases inflammation , add on med for asthma)
119
beractant (Survanta)***P!!
calfactant (Infasurf)
poractant (Curosurf)
these belong to what class
& what do they do
lung surfactants
replace surfactant missing in lungs of neonates w/ RDS (rescue treatment!)
this is an emergency drug
120
prototype for lung surfactant
& how to administer
any CI?
beractant
**for respiratory distress syndrome in infants
**administered intratracheal
no CI bc it's an emergency med
121
what is first line of treatment for acute asthma attacks
bronchodilators
- xanthines: theophylline
- sympathomimetics: albuterol
- anticholinergics: ipratropium
122
what does the inflammatory response do
protect the body from injury and pathogens
123
CI for salicylates / aspirin
ppl under 18
bleeding abnormalities
renal / hepatic
surgery within 1 week
124
prototype for NSAIDs
ibuprofen (Motrin)
125
indications for NSAIDs
pain
inflammation
primary dysmenorrhea (pain due to menstruation)
126
daily safe dose of ibuprofen
toxic dose is 4g
2,400 mg safe daily dose
toxic dose is 4g
127
what MOA is this :
acts on thermoregulatory cells in hypothalamus to decrease fever (acts as antipyretic)
what is it used for
what are CI
acetaminophen
for pain/fever, and prophylaxis for kids receiving DPT therapy
CI = hepatic disorder, alcohol abuse disorder
128
what MOA is this
stops phagocytosis and release lysosomal agents to decrease tissue destruction caused by arthritis
what is prototype
what is it for
Gold Compound (prototype = auranofin)
for RA and juvenile arthritis
causes dermatitis, stomatitis (sores lips to anus) , gingivitis, bone marrow suppression but does NOT cause dyspnea
**can cause renal toxicity
129
adalimumab (Humira)
certolizumab (Cimzia)
etanercept (Enbrel)
golimumab (Simponi)
infliximab (Remicade)
these belong to what class
tumor necrosis factor blockers
**for RA, juvenile arthritis, polyarticular juvenile arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis
130
important to know if a pt is taking DMARDs
they're high risk for infection
131
what do anti gout / hyperuricemia agents do
decrease inflammation or lower uric acid levels
132
prototype for anti gout meds
colchicine
other meds = allopurinol, sodium hyaluronate
133
what to know about administering sodium hyaluronate
inject directly into joint !! ( for gout )
134
immune suppressants vs immune stimulants
immune suppressants - Block normal effects of the immune system (ie: organ transplantation, autoimmune disorders, some cancers)
***Immune modulators
T and B cell suppressors
Interleukin receptor antagonist
Mono-clonal antibodies
immune stimulants - energize the immune system when its exhausted from fighting a prolonged invasion or needs help fighting a specific pathogen
*** Interferons , Interleukins, Colony -stimulating factors
135
what's the intended effect of interferon alpha 2b
enhance the immune system
136
AE of interferons
related to immune/inflammatory reaction that is being stimulated
- Heme: bone marrow suppression
- Derm: photosensitivity
- GI: liver impairment
- Psych: depression, suicidal ideation
137
AE of interleukins
attributed to the effect not he body during inflammation
- Resp: difficulty
- CNS: changes that progress to coma
- Cardiac: arrhythmia
138
AE and CI for colony stimulating factors
CI = sickle cell disease or bone marrow cancer
AE = bone pain / skeletal pain
***colony stimulating factors increase production of neutrophils in the bone marrow / WBC
139
what's important to know about immune modulators
decrease immune activities
140
What do T and B cell suppressors do?
specific to each agent but in general blocks antibody production by B cells and inhibits suppressor and helper T cells
141
What is the prototype for T and B cell suppressors?
what is it for
AE?
cyclosporine
used to prevent & treat specific transplant rejections
AE = irreversible gingival hyperplasia, irreversible hirsutism
142
What does interleukin receptor antagonist do?
what is the prototype
what is it used for
AE?
block the acidity of interleukin - 1
prototype = anakinra (Kineret)
used for severely active RA in adults
AE = URT infections, sinusitis & other URT infections
143
what do monoclonal antibodies do
AE?
designed to attach to a specific target
-mab
adalimumab, infliximab
AE = dyspnea, chest pain, wheezing
144
if pt has a known allergy to E.coli products, these should be avoided due to contraindication
interleukin receptor antagonist
145
before giving this, patients must be screened for infection, specifically TB
what is black box warning for these
tumor necrosis factor blockers
black box wanting - serious fatal infections / other lymphomas to other cancers due to blockage of body to immune / inflammatory response
adalimumab (Humira)
certolizumab (Cimzia)
etanercept (Enbrel)
golimumab (Simponi)
infliximab (Remicade)
146
these are very dangerous drugs, first dose is given in office due to high risk for anaphylactic rxn.
AE = infection
used for RA.. reduces progression, does not undo it
DMARDs
disease modifying anti rheumatic drugs
147
this is antigout med that is also the prototype. it can cause fatal OD, so adjust dosage in pts w/ severe renal disease ... used for ACUTE gout compared to prevention like allopurinol
colchicine
148
these work by blocking xanthine (enzyme involved in uric acid production)
antigout, hyper uricemia agents
149
aldesleukin (Proleukin)
oprelvekin (Neumega)
these belong to what class & what is common AE
interleukins
AE - flu like symptoms
150
filgrastim (Neupogen)
pegfilgrastim (Neulasta)
sargramostim (Leukine)
tbo-filgrastim (Granix)
**end in stim
these belong to what class
what do they do
colony stimulating factors
**increase production of WBC aka neutrophils
Reduce the incidence of infection in patients with bone marrow suppression
Decrease the neutropenia associated with bone marrow transplants and chemotherapy
Help in the treatment of various blood-related cancers
***causes BONE PAIN
151
what does interferon alfa - n3 treat
warts
152
pt education for receiving an interferon would include
proper methods injecting the drug
