Immunosuppressants Alternative and Complementary Therapies and Vaccines Flashcards
Immunosuppressants
These medicines are given to suppress the immune system
Why do want to suppress our immune system?
Don’t want system to close up
Autoimmune Diseases
Celiac disease Chron’s disease Grave’s disease Gullian Barre Syndrome Myasthnis Gravis Lupus
Others are for patients with autoimmune disease.
Where the body’s own immune system is attacking normal organs.
Celiac disease – triggered by gluten ingestion
chron’s – gi inflammation
Graves diease – too much thyroid
GB MG– neuromuscular disorder that attacks the nerves
lupus - skin, joints, kidneys
Donor Network
It is also given to transplant patients, so the body does not reject the new organ.
This is a patient who received lung transplant due to covid
Immunosuppressants
With this med, we are telling the WBCs to simmer down from attacking our own organs
It does work and the body stops attacking itself
BUT»»
Effects of bone marrow suppression
Low RBC Low CBC Low platelets <100,000 is thrombocytopenia Low WBC <4,000 is leukopenia
Hydroxychloroquine
Malaria Lupus Helps decrease inflammation Helps decrease fatigue It takes several months to reach therapeutic levels
Lupus – where the body attacks its own skin and joints
We we’ll see increased energy with this drug.
Results are not overnight
Adverse Effect
Retinal damage
Vision problems
Must have eye exam
(every 6-12 months)
Must have eye exam every 6-12 months
I need to see my optometrist at least once a year
No need for medical alert bracelet or Vit-D
Methotrexate
Indications
RA – body is attacking its own joints
Psoriasis – body is attacking its own skin
To slow certain types of cancer
A nurse at Valley is on this
Method of action
It stops folic acid metabolism which stops cellular reproduction in the fastest replicating cells.
It suppresses B and T lympcytes, which basically means it suppresses WBC
Where are fastest replicating cells in the body?
Blood and immune system.
Also pregnant ladies with a weak fetus.
On that note, the major side effect of methotrexate is R/T to these.
Adverse effects
Adverse Effects
Leading to weak immune system
Bleeding
Fetal death
Contraindications
Pregnant women
No live vaccines
No razors
No hard brushing of teeth
No BABY!! The baby is not safe, MUST use birth control.
No baby until after the treatment or months after the treatment
No need for eye exam, this one is not eye toxic
Remember the difference between hydroxychloroquine and methotrexate
Nursing considerations
Watch for infection Report fever > 100.3 F or 38 C Avoid crowds Avoid sick people No fresh fruits or flowers
Watch for bleeding Under 50 plt – very risky Report bleeding Petchiae Melano Hemoptysis
Monitor for plt 150
Petachiae – bleeding under the skin
Melano – black tarry stool
, gi bleed
Gum bleeding?
NO live Vaccines
Inactivated vaccines
Flu
Pneumonia
Live vaccines MMR Smallpox Chickenpox yellow fever
One thing to consider with immunosuppressive drugs is they cannot have live vaccines.
Inactivated vaccines – used the dead version of the germ
Live vaccines – weakened version of the germ
Tumor Necrosis Factor inhibitors
Etanercept
Infliximab
Adalimunab
The third type of immunosuppressant is the TNF
Here’s three samples
What do you need to know about TNFs?
TNF Nursing consideration
Fever is a priority Bleeding Infections Take it same time Qday Low grade fever 100.3 or 38 Infection Infection infection
TNF Nursing consideration
Tuberculosis can be reactivated
Need a negative TB test before starting
They need Tx if positive
Follow up TB testings
One thing about TNF is it can reactivate TB
Most Asians from asia – have positive TB test
Because we reeived BCG vaccine when we were kids. We may or may not have latent TB
Latent TB - patient has mycobacterium tuberculosis
But the patient does not have active TB
This can wake them up
Trerat with TB before treatment since it can make it worst
Labs
Elevated WBC
Elevated CRP
Remember, these patients are immunosuppressed
C-reactive protein – normal to have elevated CRP with inflammation
Whats a priority when I see labs?
Elevated WBC is priority
Elevated iCRP s NOT a priority
Cardiac enzymes, renal panel, liver enzymes are NOT a priority
Cyclosporine/azathioprine
Prevent transplant rejection
Lifelong
Another immunosuppressive drug is the cyclosporine
It can be given for RA and inflammatory bowel disease, but mainly for transplant.
Remember my post lung transplant ptient from covid. He is going to be on it for the rest of his life
Contraindications
Pregnant women No live vaccines No razors No hard brushing of teeth Same contraindications as the other immunisuppresive drugs. Same priority Risk for bleeding and infection
Side effect
Gingival hyperplasia
One SE of cyclosporine is gingival hyperplasia.
It is a chronic SE, so it is not emergent when discovered
They need to see their dentist Q 6-12 mos
