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Immune Modulators Flashcards

1
Q

What is the main purpose of immune modulators?

A

To modify the actions of the immune system.

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2
Q

What are immune stimulants?

A

Used to boost our natural immune system.

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3
Q

What are immune suppressants?

A

Used to stunt the immune system.

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4
Q

What are Monoclonal antibodies?

A

Monoclonal antibodies (mAbs) are laboratory-made proteins that can bind to specific targets in the body, such as cancer cells. Used to detect and treat.

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5
Q

What are Recombinant DNA technology?

A

Using bacteria to make chemicals that occur naturally in the body.

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6
Q

When are immune stimulants used?

A

When the body have been fighting an infection for a long time and need further help.

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7
Q

Where does Immune modulators work?

A

At different parts of the body to stimulate or suppress the immune system.

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8
Q

Immune modulators only suppress the immune system.

TRUE/FALSE

A

FALSE

They are stimulants AND suppressants.

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9
Q

What is the main action of Immune stimulants?

A

To energize the immune system when it needs help fighting a pathogen.

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10
Q

What is the main action of Immune suppressants?

A

To block the normal effects of the immune system in organ transplantation and autoimmune disorders.

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11
Q

Are Immune modulators tetarogenic?

A

They have found to be teratogenic in animal studies and are therefor not recommended in pregnancy or lactation.

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12
Q

What are some lifespan considerations that should be taken into account when giving immune modulators to a child?

A

Should be used with caution - monitor closely for infection, GI, renal, hematological or CNS effects.
Immune suppressants are needed in higher doses than adults.
Protect against infection and injury.

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13
Q

What are some lifespan considerations that should be taken into account when giving immune modulators to adults?

A

Teach proper injection technique.
Avoid infection and injury.
Contraindicated in pregnancy/lactation.
Some drug may impair fertility in both sexes such as decreasing sperm motility or the immune system may kill the sperm before fertilization may occur.

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14
Q

What are some lifespan considerations that should be taken into account when giving immune modulators to older adults?

A

Their immune system is less efficient and less responsive hence they are more susceptible to the drug effect.
Monitor renal and liver function to determine dosage.
More susceptible to infection - teach infection and injury prevention.

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15
Q

Why does children need higher doses of these drugs?

A

Due to the body surface to their body surface area to weight ratio and faster metabolism.

Older adults vice versa!

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16
Q

TRUE/FALSE

Immune modulators may be given as an injection

A

TRUE.
We should teach the patient how to properly inject the medication and have them demonstrate how to do it. We should also educate family members on how to inject the patient should they be unable to do this themselves as well as educate on any adverse reactions to the injection site.

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17
Q

What are the immune stimulants that we must know?

A

Interferons
Interleukins
Colony-stimulating factors

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18
Q

What are interferons?

A

Proteins that are naturally released from human cells in response to viral invasion.
They act in multiple ways to prevent the spreading of a virus within the body.
They are excreted by an infected cell and goes into a non infected cell and make antibody proteins so that those cells cannot become infected.
May also stimulate phagocytes and T-cells and can fight tumors.

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19
Q

Which immune stimulant increases the number of platelets?

A

Interleukins (think “leuk” for blood)

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20
Q

What does interferon alfa-2b do?

A

Interferon alfa-2b is a immune stimulator which prevents virus particles from replicating inside other cells.
Stimulates interferon receptors on noninvaded cells to produce antiviral proteins.
Inhibits tumor growth and replication.

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21
Q

Why would we give Interferon alfa-2b to a patient?

A

To help treat various cancers, hepatitis B&C and multiple sclerosis.

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22
Q

What is contraindicated to interferons?

A

Allergy and Pregnancy (teratogenic in animal studies)

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23
Q

What should we be cautious of when giving a patient interferons?

A
  • Lactation
  • Cardiac disease
  • Myelosuppression (A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelet)
  • CNS dysfunction
  • Alzheimer’s disease may be worsened.
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24
Q

What are some adverse reactions that may happen with interferons?

A

CNS effect such as Lethargy, Myalgia (muscle pain), arthralgia (joint paint), anorexia, nausea, headache, dizziness.
Bone marrow depression.
Worsening of Alzheimer’s disease.

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25
Are there any drug-drug interactions with interferons? If so, what are they?
No know drug-drug interactions.
26
How does interleukins work on the body?
They are chemicals produced by t-cells to communicate between leukocytes. They increase the number of NKC's and lymphocytes. Activates cellular immunity and inhibits tumor growth. Increases circulating platelets.
27
Why would we give Interleukins to a patient?
Aldesleukin : Specific renal carcinomas, possible treatment of AIDS and AIDS related disorders. Oprelvekin: Prevention of severe thrombocytopenia after myelosuppressive chemotherapy.
28
Which bacteria is used to make Aldesleukin, Filgrastim and Pegfilgrastim?
E-coli
29
In what patients are Interleukins contraidicated?
Patients that have an allergy to them, patients who are pregnant or breastfeeding.
30
In what patients should we exhibit caution when giving Interleukins?
Patients who suffer from renal, liver or cardiovascular impairment.
31
What are the most common adverse reactions to interleukins?
CNS effect: Lethargy. Myalgia, Arthralgia, Fever, Respiratory difficulties, Depression with suicidal ideation.
32
What are the Colony-Stimulating drug classes that we need to know?
Filgrastim Pegfilgrastim
33
What does colony-stimulating factors do?
Increase production of neutrophils in the bone marrow with little effect on other hematopoietic cells.
34
Why would we administer Filgrastim to a patient?
To reduce the incidence of infection in patients with bone marrow suppressions, to decrease neutropenia associated with bone marrow transplants and chemotherapy and to help in the treatment of various blood-related cancers. Colony stimulating factor
35
Why should we NOT give Colony-Stimulating Factors to patients with bone marrow cancer or sickle cell disease?
Because the drug will stimulate the production of the defected cell and make the conditions worse.
36
In what patients are Pegfilgrastim contraindicated?
* Patients with any sensitivity in products made with E-coli * patients undergoing radiations and chemotherapy - it should be given after chemotherapy is finished and not during. Colony stimulating factor
37
What patients should show caution when taking Colony stimulating factors?
Patients that are pregnant or breastfeeding.
38
What are the most common adverse effects to Filgrastim?
GI related side effects such as nausea, vomiting, diarrhea, constipation. This is due to bone marrow stimulation. CNS: headache, fatigue, generalized weakness. Derm- alopecia and dermatitis (due to overactive cytokines & other immune factors attacking the hair follicles) Enlarged Spleen Generalized pain & bone pain. Colony stimulating factor
39
What should we be assessing for prior to giving a patient Pegfilgrastim?
Assess for contraindications and cautions Physical : Skin lesions, weight, monitor temperature, check heart rate and rhythm and blood pressure, orientation and reflexes Baseline ECG Renal and liver function, CBC Colony stimulating factor
40
What nursing diagnosis should expected for colony stimulating agents?
Impaired comfort related to CNS, GI, and flulike effects Malnutrition risk related to flulike effects Acute or chronic fear or anxiety related to diagnosis and drug therapy Knowledge deficit
41
What nursing implementations should be made when giving a patient Filgrastim?
* Arrange for laboratory tests before and periodically during therapy * Administer drug as indicated; instruct the patient and a significant other if injections are required. * Monitor for severe reactions * Arrange for supportive care and comfort measures for flulike symptoms * Ensure patient is well hydrated. * Instruct female patients in the use of barrier contraceptives to avoid pregnancy patient teaching. Colony-stimulating agent
42
What drug categories are under immune suppressants?
Immune modulators T&B cell suppressors Interleukin receptor antagonists Monoclonal antibodies
43
What drug do we need to know for immune modulators?
Apremilast.
44
What does Apremilast do?
Inhibits the secretion of proinflammatory cytokines and increase the secretion of anti-inflammatory cytokines from monocytes and have varying effects on cell proliferation.
45
Why would you give a patient Apremilast?
For Psoriatic Arthritis - an inflammatory disease. We give this drug to stop the inflammatory response.
46
In which patients are apremilast contraindicated?
Pregnancy
47
what are the drug-drug interactions with Apremilast?
There are none that are known.
48
What are the most common adverse effects of Aprimelast?
There are no known adverse effects.
49
What are the drug classes we need to know for T&B cell suppressors?
Cyclosporine Mycophenolate Tacrolimus
50
Why would you give a patient Cyclosporine?
When other medications have not been effective. We would give it to transplant patients because it suppresses the rejection of the new organ. We would also give it for Rheumatoid arthritis and psoriasis. cyclosporine is a T and B cell supressor.
51
What is an adverse effect of Cyclosporine?
Hirsutism
52
Why would you give a patient Mycophenolate?
To prevent rejection after renal or heart transplant in adults. Mycophenolate is a T and B cell suppressor.
53
Why would you give a patient Tecrolimus?
To prevent rejection after heart or liver transplant. Tacrolimus is a T and B cell suppressor
54
Which patients should we not give T & B cell suppressors to?
Patients with a known drug allergy to the drugs, patients that are pregnant or breastfeeding. Patients with renal or hepatic problems.
55
Are there any drug-drug interactions with T and B cell suppressors? If so, what are they?
Hepatotoxic or Nephrotoxic drugs.
56
What are the drugs that we need to know for Interleukin receptor Antagonists?
Anakinra
57
How does Anakinra work?
They block the activity or the interleukins that are released in an inflammatory or immune response. Interleukin-1 thought to be responsible for degradation of cartilage.
58
Why would you give Interleukins Receptor Antagonist to a patient?
To treat Rheumatoid Arthritis.
59
Which patients would be not give Anakinra to?
Patients with a known allergy to Escherichia coli-produced products or allergy to Anakinra.
60
Which patients would we be cautious of giving Anakinra to?
Patients that are pregnant or breastfeeding. Patients with renal impairment and immunosuppression or any active infection. There may also be some injection site pain associated with administration.
61
What are the adverse effects of Anakinra?
Headache, sinusitis, neausea and diarrhea.
62
Are there any drug-drug interactions to Anakinra and if so what are they?
Yes, Etanercepts may cause severe and possibly life-threatening infections because this combination increases the risk of sepsis.
63
What are the drugs/suffixes we need to know for Monoclonal Antibodies?
(-mab) Adalimumab, Certolizumab, Golimumab, infliximab.
64
How does Monoclonal Antibodies work?
They are antibodies that attaches to specific receptors and are developed to respond to specific situations.
65
What would we give Infliximab for?
We would give Monoclonal antibodies such as Infliximab for a variety of diagnosis such as cancers, arthritis, Crohn's disease, ulcerative colitis and MS.
66
Which patients should we not give Monoclonal Antibodies to?
Patients with a know allergy to the drug. Patients who are experiencing fluid overload (may be exacerbated) Patients who are pregnant or breastfeeding.
67
Which patients should we be cautious with giving Monoclonal antibodies to?
Patients with a fever. The fever should eb treated prior to Mab administration due to fever already being a side effect of Mabs. If the fever is caused by an infection the drugs should be held.
68
What are some adverse reactions to monoclonal antibodies?
Acute Pulmonary edema (cytokine release syndrome - may cause shock) Fluid retention Flu like symptoms (fever)
69
Are there any drug-drug interactions to monoclonal antibodies and if so what are they?
Yes, severe immune suppression may occur with the use of other suppressants and may lead to sepsis.
70
When administering Immune suppressants to a patients, what assessments should we do prior to this?
Assess for contraindications and cautions Physical: Obtain weight, monitor for fluid retention, temperature, pulse and blood pressure, orientation and reflexes. Obtain baseline ECG Labs: Monitor renal and liver functions and CBC
71
What nursing diagnosis could be made prior to administering Immune Suppressants?
Impaired comfort related to CNS, GI, and flulike effects Infection risk related to immune suppression Malnutrition risk related to nausea and vomiting Knowledge deficit risk regarding drug therapy
72
What implementations should we expect to possibly make when giving patients immune suppressants?
Arrange for laboratory tests before and periodically during therapy. Administer the drug as indicated; instruct the patient and a significant other if injections are required. Protect the patient from exposure to infections and maintain a strict aseptic technique for any invasive procedures. Arrange for supportive care and comfort measures for flulike symptoms. Monitor nutritional status during therapy; provide small, frequent meals, mouth care, and nutritional consultation. Instruct females in use of barrier contraceptives. Suggest another method of feeding the baby. Provide thorough patient teachings.
73
When are immune suppressants given?
Used mainly for organ transplants and autoimmune disorders.
74
What are the 3 Categories of Immune Stimulants?
Interferons. Interleukins. Colony Stimulating Factors.
75
With which immune modulator is there a risk of suicidal ideation?
Aldesleukin and Oprelvekin which are Interleukins.
76
What labs are important to check for patients taking immune stimulants?
BUN, CBC, ALT, AST
77
What overgrowth may cyclosporine cause?
Overgrowth of the gums.
78
Which drug category is hepatoxic and nephrotoxic and should therefore not be mixed with any other drugs that affect the kidneys or liver?
B and T cell suppressors such as cyclosporine.
79
Which immune suppressant may exacerbate fluid overload?
Monoclonal Antibodies such as Adalimumab.
80
Why is coughing sometimes a reaction that we see after administering immune suppressants and how dangerous is this adverse reaction?
Its caused by edema in the throat and requires quick intervention to prevent it from escalating.
81
Which drug may worsen myelosuppression?
Interferons
82
Which drug is given for treatment of AIDS and AIDS related disorders?
Aldesleukin (Interleukin)
83
Which drug is given for prevention of severe Thrombocytopenia after myelosuppressive chemo?
Oprelvekin (Interleukin)
84
Which drug name have "stim" in the name and are the drugs for Colony - STIMulating Factors?
FilgraSTIM and PegfilgraSTIM
85
Which drug inhibits secretion of pro-inflammatory cytokines and increase secretion of ant-inflammatory cytokines?
Apremilast
86
Which drug is used to treat psoriatic arthritis?
Apremilast
87
Which drug is used to treat suppression of rejection in a variety of transplants, rheumatoid arthritis and psoriasis?
Cyclosporine
88
Which drug to prevent rejection of renal & heart transplant?
Mycophenolate
89
Which drug to prevent rejection of liver & heart transplant?
Tacrolimus
90
Which drug may cause hirsutism?
cyclosporine

Pharmacology Exam 2 (20 decks)

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