30 Questions
What is the goal of treatment at all phases of the RA disease process?
To decrease joint pain and swelling, achieve clinical remission, decrease the likelihood of joint deformity, and minimize disability
What is the recommended initial treatment approach once the diagnosis of RA is made?
Begin with either a nonbiologic or biologic DMARD
Which medication is the preferred nonbiologic DMARD for the treatment of RA?
Methotrexate
What should be monitored when using DMARD therapy for RA?
Liver and kidney function, along with monitoring the CBC for anemia
What have biologic DMARDs been specifically engineered to target in RA?
TNF-α, B cells, T cells, IL-1, and IL-6
When is it recommended to begin biologic or tofacitinib therapy for RA?
Within 3 months of disease onset
Which type of therapy for RA shows quicker results and greater delay in disease progression compared to nonbiologic DMARDs?
Biologic DMARDs
What is the recommended use of corticosteroids in RA treatment?
As a 'bridge' in early treatment
What is the main excretion route of methotrexate, and why is monitoring renal function essential?
Mainly in the urine, monitoring for renal function
What is the mode of action of JAK inhibitors in RA treatment?
Inhibiting cytokine production and decreasing the immune response
Why are NSAIDs used with caution in RA treatment?
Due to the possibility of gastric ulcers and increased risk of cardiovascular disease
Why are opioid analgesic agents avoided in RA treatment?
Due to the potential for continuing need for pain relief
Which immunosuppressant has a BLACK BOX WARNING for fetal loss and malformations?
Leflunomide
Which immunosuppressant is indicated for refractory Crohn’s disease and carries risks of infection and allergic reactions, especially in patients with heart failure?
Certolizumab
Which immunosuppressant is approved for use in children 4 to 17 years with severe juvenile rheumatoid arthritis?
Etanercept
Which immunosuppressant is a recombinant IL-receptor antagonist used for moderate to severe rheumatoid arthritis in adults?
Anakinra
Which immunosuppressant is a monoclonal antibody used to treat moderate to severe psoriasis and causes adverse effects such as lymphopenia and injection site reactions?
Alefacept
Which immunosuppressant inhibits TNF activity in inflammatory and immune responses and is indicated for moderate to severe rheumatoid arthritis in adults and children?
Etanercept
Which medication is a humanized monoclonal antibody that blocks IL-6 receptors for severe rheumatoid arthritis?
Tocilizumab (Actemra)
Which cytokine is found in higher concentrations in joints of rheumatoid arthritis patients, contributing to chronic inflammation and joint destruction?
IL-6
What is the common adverse effect of Tocilizumab (Actemra)?
Upper respiratory infection
Which medication is a fusion protein inhibitor used to inhibit activation of T lymphocytes in rheumatoid arthritis?
Abatacept (Orencia)
Which medication is a fusion protein inhibitor approved for the prevention of acute organ rejection after kidney transplantation?
Belatacept (Nulojix)
Which drug is used to prevent or reduce the graft rejection response in transplant therapy, affecting T lymphocytes significantly more than B lymphocytes?
Cyclosporine
What is the main reason for careful monitoring of older adults during antirejection drug therapy?
Increased risk of infection and greater risk of malignancy
Why is it essential to monitor serum blood levels for patients with renal impairment using cyclosporine?
To reduce the risk of nephrotoxicity
What is a significant adverse effect of cyclosporine according to the FDA?
Nephrotoxicity
What is the main reason for consistent daily intake of cyclosporine at the same time?
Variable bioavailability when taken orally
What is the main reason for avoiding combined use of antirejection drugs with the same mechanism of action and toxicities?
Increased risk of adverse effects
How is cyclosporine mainly metabolized in the body, leading to the need for caution with drug interactions?
Mainly by CYP3A4 enzymes
Study Notes
Cyclosporine Use and Nursing Implications
- Cyclosporine dosing is weight-based in both adults and children, with higher doses given immediately before and after the transplant and then tapered over several months to minimize adverse effects and avoid excessive immunosuppression.
- Older adults require careful monitoring during antirejection drug therapy due to an increased incidence of infection and a greater risk of malignancy. Doses are individualized based on age, function, and concurrent conditions.
- Patients with renal impairment using cyclosporine are at an increased risk of nephrotoxicity, which is dose-related, and monitoring serum blood levels is essential to reduce this risk.
- Patients with hepatic impairment using cyclosporine need to have their serum bilirubin and liver enzymes checked prior to and during treatment.
- The use of immunosuppressants during critical illness requires individualized risk versus benefit decision making to balance the need to prevent transplant organ rejection against the risk of infection and associated drug toxicities.
- In home care, promoting correct medication use and maintaining therapeutic blood levels after transplantation is critical, and patients should consistently take the drug at the same time each day due to its variable bioavailability when taken orally.
- Significant adverse effects of cyclosporine include nephrotoxicity, hirsutism, gingival hypertrophy, hypertension, and hyperlipidemia, with a BLACK BOX WARNING from the FDA regarding risks of hypertension and nephrotoxicity.
- Long-term use of antirejection drugs is associated with an increased risk of infections and certain malignancies, with regular screening tests recommended for transplant recipients.
- Contraindications to cyclosporine include the combined use of antirejection drugs with the same mechanism of action and toxicities, such as tacrolimus and cyclosporine, which prescribers usually avoid after organ transplant.
- Numerous potential drug interactions affect the blood levels of cyclosporine, and it is metabolized mainly by CYP3A4 enzymes, making it important to prevent interactions and be cautious of drugs that alter its blood levels.
- Antirejection drugs need to be initiated several hours prior to the transplant procedure, and administration is by IV infusion until the patient can take the drug orally, with the risk of a severe allergic reaction significantly higher following IV administration.
- To improve bioavailability, cyclosporine preparations were once prepared in alcohol and olive oil for oral administration and in alcohol and castor oil for IV administration.
Test your knowledge of nursing implications for the use of cyclosporine in transplant patients with this quiz. Explore dosing considerations, monitoring requirements, adverse effects, contraindications, and drug interactions specific to cyclosporine therapy.
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