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Pharmacology Exam #2 > Immune Modulators > Flashcards

Immune Modulators Flashcards

1
Q

What are Immune Modulators?

A

Agents that either stimulate OR suppress the immune system

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2
Q

What are Immune Stimulants?

A

Agents that help ENERGIZE the immune system when it needs help fighting a specific pathogen

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3
Q

What are Immune Suppressants?

A

Agents that BLOCK the normal effects of the immune system for things like organ transplantation and autoimmune disorders

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4
Q

Lifespan considerations of Immune Modulators
In Children

A
  • Use with CAUTION
  • Monitor closely for infection, GI, renal, hematological or CNS effects
  • Immune suppressants are needed in HIGHER doses than in adults
  • Protect against infection and injury
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5
Q

Lifespan considerations of Immune Modulators
In Adults

A
  • Teach proper injection technique
  • Avoid infection and injury
  • Contraindicated in pregnancy and lactation
  • Some drugs may impair fertility in both men and women
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6
Q

Lifespan considerations of Immune Modulators
In Older Adults

A
  • Aging immune system is less efficient and less responsive - more susceptible to drug effects
  • Monitor renal and liver function to determine dosage
  • More susceptible to infection - teach to avoid infection and injury
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7
Q

What are the different classes of Immune Stimulants?

A
  • Interferons (naturally released from human cells in response to viral invasion, stimulate T Cells and phagocytes, fight tumors)
  • Interleukins (communicate between lymphocytes, stimulate cellular immunity via NK cells, inhibit tumor growth, increase # of platelets)
  • Colony-Stimulating Factors (stimulate bone marrow to produce more WBCs, reduces neutropenia, fights some blood cancers)
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8
Q

Interferons
Drug Name

A

Interferon alfa-2b

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9
Q

Interferons
Mechanism of Action

A
  • Prevents virus particles from replicating inside other cells
  • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
  • Inhibits tumor growth and replication
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10
Q

Interferons
Indications

A
  • Various cancers (leukemias, sarcoma, melanoma, follicular lymphoma)
  • Hepatitis B & C
  • Multiple Sclerosis
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11
Q

Interferons
Contraindications

A

Absolute:
* Allergy
* Pregnancy

Caution:
* Lactation
* Cardiac disease
* Myelosuppression
* Central Nervous System dysfunction (Alzheimer’s Disease, ALS, etc.)

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12
Q

Interferons
Adverse Effects

A
  • Flu-like symptoms due to the inflammatory response
  • Lethargy
  • Myalgia (muscle pain)
  • Arthralgia (joint pain/stiffness)
  • Anorexia (loss of appetite)
  • Nausea
  • Headache
  • Dizziness
  • Bone Marrow Depression
  • Suicide Ideation
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13
Q

Interferons
Drug Interactions

A

NONE known

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14
Q

Interleukins
Mechanism of Action

A
  • Increase the number of Natural Killer (NK) cells and lymphocytes
  • Activate cellular immunity
  • Inhibit tumor growth
  • Increase circulating platelets
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15
Q

Interleukins
Indications

A
  • Aldesleukin: specific renal carcinomas; possible treatment of AIDS and AIDS related disorders
  • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy (platelets)
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16
Q

Interleukins
Drug Names

A

Aldesleukin

Oprelvekin

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17
Q

Interleukins
Contraindications

A

Absolute:
* Allergy
* Pregnancy

Cautions:
* Renal impairment
* Liver Impairment
* Cardiovascular impairment

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18
Q

Interleukins
Adverse Effects

A
  • Lethargy
  • Myalgia (muscle pain)
  • Arthralgia (joint pain/stiffness)
  • Fatigue
  • Fever
  • Respiratory difficulties
  • Depression with SI

(Flu-like symptoms)

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19
Q

Colony-Stimulating Factors
Drug Names

A

Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)

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20
Q

Colony-Stimulating Factors
Mechanism of Action

A

Increases the production of neutrophils in the bone marrow with little effect on other hematopoietic cells

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21
Q

Colony-Stimulating Factors
Indications

A
  • Reduce the incidence of infection in pts with bone marrow suppression
  • Decrease neutropenia associated with chemotherapy and bone marrow transplants
  • Treat some blood-related cancers

(NOT for bone marrow cancers or Sickle-Cell Anemia as it would multiply the damaged/diseased cells)

22
Q

Colony-Stimulating Factors
Contraindications

A

Absolute:
* Allergy to any products made with E. coli
* Ongoing chemo or radiation (for use POST-treatment)

Cautions:
* Pregnancy
* Lactation

23
Q

Colony-Stimulating Factors
Adverse Effects

A
  • 🤢 GI effects: Nausea & diarrhea
  • 🧠 CNS effects: headache, fatigue, generalized weakness
  • Dermatologic: alopecia, dermatitis
  • Generalized pain
  • Bone Pain
  • Splenomegaly (enlarged spleen)
  • Leukocytosis
24
Q

Immune Stimulants
Assessment

A

History:
* Assess for contraindications and cautions

Physical:
* Skin - lesions
* Weight
* Temperature
* Heart rate and rhythm
* Blood pressure
* Orientation and reflexes

Labs:
* ECG
* Renal & liver function tests
* CBC

25
**Immune Stimulants** Nursing Diagnoses
* Impaired comfort *r/t CNS, GI, and flu-like effects* * Risk of Malnutrition *(r/t flu-like effects)* * Acute or chronic fear or anxiety *(r/t diagnosis and drug therapy)* * Knowledge deficit
26
**Immune Stimulants** Implementation/Patient Teaching
* Monitor baseline labs and periodically during therapy * Proper administration if injections are required * Monitor for severe reactions * Comfort measures for flu-like symptoms * Ensure pt is well hydrated * Barrier contraception to prevent pregnancy *(from personal experience - administer antihistamine such as claritin BEFORE colony stimulating factors to prevent/decrease bone pain)*
27
What are the different classes of **Immune Suppressants**?
* **Immune modulators** *(Apremilast)* * **T and B cell suppressors** * **Interleukin Receptor Antagonists** *(Anakinra)* * **Monoclonal Antibodies**
28
**Immune Modulator: Apremilast** Mechanism of Action
* **Blocks** the release of *proinflammatory* cytokines and **increases** the secretion of *ANTI-inflammatory* cytokines from monocytes --> **DECREASING** overall immune activity * Has varying effects on cell proliferation
29
**Immune Modulator: Apremilast** Indication
**Psoriatic Arthritis**
30
**Immune Modulator: Apremilast** Contraindications
**Pregnancy**
31
**Immune Modulator: Apremilast** Adverse Effects AND Drug Interactions
**UNKNOWN** *Relatively new drug class*
32
**T- and B-Cell Suppressors** Mechanism of Action
* Block antibody production by B cells * Inhibit suppressor and helper T cells * Modify the release of interleukins and T cell growth factor
33
**T- and B-Cell Suppressors** Indications
* **Cyclosporine:** Suppression of rejection in variety of transplants; rheumatoid arthritis; psoriasis * **Mycophenolate:** Prevention of rejection after ***renal*** or ***heart*** transplants in adults * **Tacrolimus:** Prevention of rejection after ***heart*** or ***liver*** transplant
34
**T- and B-Cell Suppressors** Contraindications
**Absolute:** * Allergy * Pregnancy * Lactation **Cautions:** * Renal or hepatic impairment
35
**T- and B-Cell Suppressors** Adverse Effects
* Increased risk of infection * Increased risk of development of neoplasms *(tumors)* * Hepatotoxicity * Renal dysfunction or toxicity * 🫁 Pulmonary edema * 🤢 GI upset * 🧠 Headache * 💓 Hypertension * **Cyclosporine**: Hirsutism and gum overgrowth
36
**T- and B-Cell Suppressors** Drug Interactions
Drugs that are hepatotoxic or nephrotoxic
37
**Interleukin Receptor Antagonists** Drug Name
**Anakinra**
38
**Interleukin Receptor Antagonists: Anakinra** Mechanism of Action
* **Blocks** the activity of interleukins that are released in an inflammatory or immune response *(Interleukin-1 are thought to be responsible for the degradation of cartilage)*
39
**Interleukin Receptor Antagonists: Anakinra** Indication
**Rheumatoid arthritis** *(when other traditional treatments haven't worked)*
40
**Interleukin Receptor Antagonists: Anakinra** Contraindications
**Absolute:** * Allergy to products made with E. *coli.* * Allergy to Anakinra **Caution:** * Pregnancy & lactation * Renal impairment * Immunosuppression * Any active infection
41
**Interleukin Receptor Antagonists: Anakinra** Adverse Effects
🧠 Headache 👃 Sinusitis 🤢 Nausea 💩 Diarrhea
42
**Interleukin Receptor Antagonists: Anakinra** Drug Interactions
* Etanercept *(TNF blocker)* may cause severe and even life-threatening infections.
43
**Monoclonal Antibodies** Mechanism of Action
* Antibodies that attach to SPECIFIC antigen receptors *(designed to respond to very specific situations)* * Binds to T cells, disabling them, and acting as an immune suppressor * Decrease inflammatory response
44
**Monoclonal antibodies** Indications
* Cancers * Arthritis * Crohn's Disease * Ulcerative colitis * Multiple Sclerosis (MS)
45
**Monoclonal Antibodies** Drug Names
Adalimu**mab** Certolizu**mab** Golimu**mab** Inflixi**mab**
46
**Monoclonal Antibodies** Contraindications
**Absolute:** * Allergy * Fluid Overload *(exacerbated)* * Pregnancy & Lactation **Cautions:** * Fever (r/t infection) *(okay to give if fever is related to disease process)*
47
**Monoclonal Antibodies** Adverse Effects
* Acute pulmonary edema *(caused by Cytokine Release Syndrome CRS = leads to shock)* * Fluid retention * Flu-like symptoms
48
**Monoclonal Antibodies** Drug Interactions
**Other immune suppressants** => severe suppression can lead to sepsis
49
**Immune Suppressants** Nursing Diagnoses
* Impaired Comfort *(r/t CNS, GI, and flu-like effects)* * Risk of infection *(r/t immune suppression)* * Risk of malnutrition *(r/t nausea & vomiting)* * Knowledge deficit
50
**Immune Suppressants** Assessment
**History:** * Assess for contraindications & cautions **Physical:** * Weight * Monitor for fluid retention * Temperature * Pulse and BP * Orientation & reflexes * Check for coughing ➡️ sign of pulmonary edema - quick intervention needed **Labs:** * Baseline ECG * Renal & Liver Function Tests * CBC
51
**Immune Suppressants** Implementation/Patient Teaching
* Monitor baseline and then periodic labs during treatment * Administer drug as indicated; teach proper administration * Protect pt from infection * Strict aseptic technique * Comfort measures for flu-like symptoms * Monitor nutritional status * Small frequent meals for GI upset * Barrier contraception to prevent pregnancy * Alternative to breastmilk

Pharmacology Exam #2 (14 decks)

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