Immune System and Corticosteroids

Question 1

what do NRTIs treat?

Answer 1

HIV

Question 2

what drugs are NRTIs?

Answer 2

zidovudine (AZT, Retrovir)

Question 3

what is the action of NRTIs?

Answer 3

• blocks viral replication (ability to substitute for DNA components, thymidine substitute)
• slows the progression of the infection

Question 4

what side effects are seen with NRTIs?

Answer 4

• headache
• malaise
• nausea and vomiting
• lactic acidosis (serious)
• hepatomegaly (serious)
• anemia/neutropenia (adjust dose, could lead to hospitalization)

Question 5

what nursing considerations should there be with NRTIs?

Answer 5

• infection prevention

- hazardous drug

Question 6

can NRTIs be used in pregnancy?

Answer 6

yes - it has been successful in stopping the transmission of HIV from mom to baby

Question 7

what is acyclovir used to treat?

Answer 7

herpes simplex virus (HSV) and varicella-zoster virus

Question 8

what is the action of acyclovir?

Answer 8

inhibits viral replication by suppressing the synthesis of viral DNA

Question 9

what are the side effects of acyclovir?

Answer 9

• nausea and vomiting
• headache
• neurologic toxicity when given IV
• drowsiness when combined with zidovudine

Question 10

can NRTIs be used alone?

Answer 10

no, must be used with another drug

Question 11

when could acyclovir cause neurotoxicity?

Answer 11

when given through an IV

Question 12

when could acyclovir cause drowsiness?

Answer 12

when used with zidovudine

Question 13

what routes can acyclovir be given?

Answer 13

topical - for something like a mouth sore

IV - for something more systemic

Question 14

acyclovir is only effective when …

Answer 14

when the virus is active (the virus could flare up when the immunosystem is suppressed or fighting something else)

Question 15

what is herpes zosters?

Answer 15

shingles - caused by dormant varicella-zoster

Question 16

At what age does herpes zosters typically happen?

Answer 16

after age 50 (vaccine is recommended around 50)

Question 17

is herpes zosters contagious?

Answer 17

yes - highly contagious

- spreads through open vesicles and pustules

Question 18

where does herpes zosters take place on the body?

Answer 18

sensory nerve cells

- very painful and can last for months

Question 19

is there treatment available for herpes zosters?

Answer 19

• antiviral can help in the first 48 hours

- supportive treatment

Question 20

what does interferon treat?

Answer 20

hepatitis B, C, and malignant melanoma

Question 21

what is the action of interferon?

Answer 21

blocks viral entry into cells and blocks synthesis of viral messenger RNA

Question 22

what route is interferon given?

Answer 22

subcutaneous

Question 23

what side effects are seen with interferon?

Answer 23

• flu-like symptoms (in 50% of pts, improves with time)
• depression (worsens with time)
• neutropenia and leukocytopenia (increased risk for infection)

Question 24

what is ribavirin used to treat?

Answer 24

hepatitis and RSV

Question 25

what is the action of ribavirin?

Answer 25

unknown

Question 26

what must ribavirin be taken with?

Answer 26

interferon

Question 27

can ribavirin be taken alone?

Answer 27

no - must be taken with interferon

Question 28

what side effects are seen with ribavirin?

Answer 28

- flu-like symptoms - depression - hemolytic anemia

Question 29

what route is ribavirin given?

Answer 29

oral

Question 30

can ribavirin be used in pregnancy?

Answer 30

no - can cause fetal injury | - if it is in an inhaler form, pregnant women can't even be in the room

Question 31

what kind of drug is mycophenolate mofetil (CellCept)?

Answer 31

cytotoxic immunosuppressive agent

Question 32

what is mycophenolate mofetil (CellCept) used for?

Answer 32

- chemotherapy | - organ transplant

Question 33

what is the action of mycophenolate mofetil (CellCept)?

Answer 33

blocks cell replication and growth

Question 34

what are the side effects seen with mycophenolate mofetil (CellCept)?

Answer 34

- nausea and vomiting - infection (increased risk) - activation of latent infection (herpes zoster or tuberculosis)

Question 35

what group is the use of mycophenolate mofetil (CellCept) contradicted in?

Answer 35

women of child-bearing age

Question 36

what is cyclosporine and tacrolimus (Prograf) used for?

Answer 36

- transplant - rheumatoid arthritis - psoriasis

Question 37

what kind of drug is cyclosporine and tacrolimus (Prograf)?

Answer 37

cytotoxic immunosuppressant agent

Question 38

what is the action of cyclosporine and tacrolimus (Prograf)?

Answer 38

suppress lymphocyte cell lines

Question 39

what are the side effects of cyclosporine and tacrolimus (Prograf)?

Answer 39

- nephrotoxicity - increased risk of infection (monitor WBC) - hypertension - tremor - hirsutism (excessive hair growth)

Question 40

what drugs are used to treat the flu?

Answer 40

- oseltamivir (Tamiflu) - zanamivir (Relenza) - peramivir (Rapivab)

Question 41

when are flu drugs effective?

Answer 41

they are only effective if taken within the first 48 hours of symptoms

Question 42

who is at risk for the flu?

Answer 42

- elderly - babies - HIV - pregnancy - immunocompromised - retirement homes - healthcare workers

Question 43

when should flu drugs be held?

Answer 43

when the pt. had a previous bad reaction

Question 44

what kind of drugs are glucocorticoids?

Answer 44

- beclomethasone dipropionate (Beclovent, Vanceril) - dexamethasone (Decadron) - prednisone (Deltasone) - methylprednisolone (Solu-Medrol)

Question 45

what kind of glucocorticoid is used to treat back pain and brain swelling?

Answer 45

dexamethasone (Decadron)

Question 46

what kind of glucocorticoid is kind of a catch-all?

Answer 46

prednisone (Deltasone)

Question 47

what routes are glucocorticoids given?

Answer 47

- IV - IM - PO - topically

Question 48

what different things are glucocorticoids used for?

Answer 48

- asthma - arthritis - COPD - IBS - poison ivy, allergic reaction, eczema, and other skin conditions - organ and tissue transplants

Question 49

what is the action of glucocorticoids?

Answer 49

- reduces the concentration of thymus-dependent leukocytes, monocytes, and eosinophils, but increases red blood cells - suppresses immune response - systemic distribution, non-selective

Question 50

are glucocorticoid selective?

Answer 50

no - nonselective

Question 51

what teaching is needed with glucocorticoids?

Answer 51

it must be tapered off to avoid an adrenal crisis - when on a glucocorticoid the body stops producing on its own and needs to be reminded to do so with tapering - z-pack

Question 52

what adverse effects are seen with glucocorticoids?

Answer 52

- adrenal insufficiency - osteoporosis - infection - myopathy - glucose intolerance - growth retardation in children - mood and sleep cycle changes - cataracts and glaucoma - fluid and electrolyte imbalance - weight gain

Question 53

glucocorticoid and adrenal insufficiency ...

Answer 53

- our bodies get used to the drug and stop producing | - in times of stress our bodies need more

Question 54

glucocorticoid and osteoporosis ...

Answer 54

- glucocorticoid increases osteoclast activity | - glucocorticoid decreases osteoblasts and calcium absorption

Question 55

glucocorticoid and infection ...

Answer 55

- suppressed immune response and neutrophils | - teach good hand hygiene and avoid crowded areas

Question 56

glucocorticoid and cataracts/glaucoma ...

Answer 56

eye exams are needed if on glucocorticoids long term

Question 57

glucocorticoid and fluid/electrolyte imbalance

Answer 57

- Na+ and water loss | - potassium retention

Question 58

glucocorticoid and weight gain

Answer 58

- cushingoid features - moon face - buffalo hump