Pharmacology of Immunosuppressants and Monoclonal Antibodies

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which interleukin receptor antagonist is used to treat Rheumatoid Arthritis (RA)?

Infliximab (Remicade)

Adalimumab (Humira)

Anakinra (Kineret) (correct)

Tocilizumab (Actemra) (correct)

What is the mechanism of action of interleukin receptor antagonists?

They directly kill the cells that produce interleukins.

They stimulate the production of antibodies against interleukins.

They block the binding of interleukins to their receptors. (correct)

They suppress the immune system by reducing the production of T cells.

Which of the following drugs are monoclonal antibodies?

Infliximab (Remicade) and Anakinra (Kineret)

Anakinra (Kineret) and Tocilizumab (Actemra)

Tocilizumab (Actemra) and Adalimumab (Humira)

Adalimumab (Humira) and Infliximab (Remicade) (correct)

What is a common adverse effect associated with both monoclonal antibodies and interleukin receptor antagonists?

Severe allergic reactions during infusion. (C) Signup and view all the answers

Tacrolimus is indicated for the prevention of organ rejection in which transplantation?

Liver, kidney, and heart transplantation, and other uses (D) Signup and view all the answers

Which immunosuppressant drug can cause nephrotoxicity and post-transplant diabetes mellitus?

Both B and C (D) Signup and view all the answers

Why might premedication with acetaminophen and/or diphenhydramine be required for patients receiving monoclonal antibody infusions?

To reduce the risk of severe allergic reactions. (A) Signup and view all the answers

Which drug is known to induce the metabolism of cyclosporine, sirolimus, and tacrolimus, thereby decreasing their effects?

Phenytoin (C) Signup and view all the answers

Which of these adverse events is NOT associated with Azathioprine sodium?

Nephrotoxicity (C) Signup and view all the answers

Which classification of medication is indicated for both rheumatoid arthritis and systemic lupus erythematosus?

Corticosteroids (B) Signup and view all the answers

What is the mechanism of action of cyclosporine?

Inhibits T cell synthesis by blocking the production and release of interleukin-2. (B) Signup and view all the answers

Which of the following is a contraindication to the use of anti-rejection medications?

Uncontrolled infection (B) Signup and view all the answers

Which of these immunosuppressant drugs inhibits the synthesis of T cells by blocking the production and release of IL-2?

Cyclosporine (A) Signup and view all the answers

Which of these is NOT a potential adverse effect of cyclosporine?

Thrombocytopenia (A) Signup and view all the answers

Which of these drugs is used for the treatment of rheumatoid arthritis?

Azathioprine sodium (A), Cyclosporine (B) Signup and view all the answers

What is the mechanism of action of corticosteroids?

They inhibit the inflammatory response by stabilizing cell membranes. (C) Signup and view all the answers

Which of the following is NOT a characteristic of Cushing Syndrome, a systemic effect of corticosteroid use?

Increased bone density (A) Signup and view all the answers

What is the purpose of Biological Response-Modifying Drugs?

To alter the body's response to diseases like autoimmune, inflammatory, and infectious diseases. (C) Signup and view all the answers

Which of the following is NOT a class of Biological Response-Modifying drugs?

Antibiotics (C) Signup and view all the answers

Which of the following drugs is known to interact with grapefruit juice, potentially affecting its absorption?

Cyclosporin (B) Signup and view all the answers

What is the mechanism of action of protease inhibitors used in treating HIV/Hepatitis C?

They block the enzyme that helps the virus replicate. (D) Signup and view all the answers

What is the main characteristic of 'Immunomodulating Drugs' within the class of Biological Response-Modifying Drugs?

They alter the immune system's response to disease. (C) Signup and view all the answers

Which of these drugs is NOT a type of Immunomodulating Drug?

Prednisone (B) Signup and view all the answers

What is one mechanism of action of immunomodulating drugs?

Restore impaired immune system function (D) Signup and view all the answers

Which condition is NOT a contraindication for the use of immunomodulating drugs?

Chronic fatigue syndrome (C) Signup and view all the answers

Which of the following is a common adverse effect of immunomodulating drugs?

Flu-like symptoms (D) Signup and view all the answers

Immunomodulating drugs are indicated for treatment of all the following EXCEPT:

Severe depression (C) Signup and view all the answers

How do anti-TNF-alpha drugs function in the treatment of rheumatoid arthritis?

Prevent TNF-alpha from binding to its receptors (B) Signup and view all the answers

What is the primary purpose of Disease-Modifying Anti-Rheumatic Drugs (DMARDs)?

To alter the underlying disease process (C) Signup and view all the answers

Which of the following is NOT a category of Disease-Modifying Anti-Rheumatic Drugs?

Synthetic (C) Signup and view all the answers

What is a common adverse event associated with the use of DMARDs?

Bone marrow suppression (B) Signup and view all the answers

Which of the following conditions is a contraindication for the use of DMARDs?

Active bacterial infections (C) Signup and view all the answers

Which of the following DMARDs is classified under Biologic agents?

Abatacept (A) Signup and view all the answers

Which of the following is a recommended strategy for managing fatigue in patients with Systemic Lupus Erythematosus (SLE)?

Energy conservation and pacing techniques (A) Signup and view all the answers

What is the primary purpose of using NSAIDs in patients with Rheumatoid Arthritis (RA)?

To promote physical comfort (D) Signup and view all the answers

What should be avoided to minimize the risk of infection in patients with SLE?

Exposure to individuals with infections (B) Signup and view all the answers

Which drug is commonly used as an immunomodulator in the treatment of Rheumatoid Arthritis?

Methotrexate (A) Signup and view all the answers

What is an important consideration for managing pain in rheumatoid arthritis patients?

Combining pharmacological and non-pharmacological methods (A) Signup and view all the answers

Which of the following lifestyle modifications is suggested for individuals with SLE?

Encouraging physical activity and healthy eating (D) Signup and view all the answers

What is a side effect that needs to be monitored in patients taking DMARDs for rheumatoid arthritis?

GI and renal effects (B) Signup and view all the answers

Which complementary therapy may be suggested for rheumatoid arthritis patients to help manage their condition?

Massage therapy and acupuncture (B) Signup and view all the answers

What factor is essential to consider regarding diet in patients receiving corticosteroid therapy for rheumatoid arthritis?

Maintaining a well-balanced diet (C) Signup and view all the answers

What is a key benefit of physiotherapy for children with rheumatoid arthritis?

It helps develop upper extremity function (D) Signup and view all the answers

Which aspect of patient teaching is important for individuals with rheumatoid arthritis in relation to activity?

Pacing activities to manage fatigue (C) Signup and view all the answers

In managing the emotional aspects of rheumatoid arthritis, which approach is advisable?

Fostering long-term relationships with a healthcare team (A) Signup and view all the answers

Which drug therapy is known to inhibit janus kinase, helping to alleviate inflammation in moderate to severe RA?

Tofacitinib (C) Signup and view all the answers

What is a crucial consideration when providing psychiatric support for rheumatoid arthritis patients?

Addressing weight management related to medication side effects (A) Signup and view all the answers

Study Notes

Pharmacology and Nursing Interventions for Patients with Chronic Alterations in Immunity

The presentation covers various chronic immune disorders, their pharmacological interventions, nursing considerations, and treatment.
Topics include immunosuppressant medications, biological response-modifying drugs and antirheumatic medications, cannabis and HIV, Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Juvenile Idiopathic Arthritis, and Severe Combined Immunodeficiency (SCID)

Immunosuppressant Therapy

Mechanism of Action: Drugs decrease or prevent immune responses.
Classes: Azathioprine, cyclosporin, sirolimus, tacrolimus, and corticosteroids.
Corticosteroids (Glucocorticoids) used for SLE and RA.
Contraindications: Known drug allergy, kidney/liver failure, uncontrolled infection, concurrent radiation therapy.
Important Note: Not contraindicated during pregnancy, but use cautiously.

Anti-Rejection Medications

Azathioprine: Blocks purine metabolism, inhibiting T-cell responses.
Cyclosporin: Inhibits T-cell synthesis, blocking cytokine production.
Tacrolimus: Inhibits T-cell synthesis.

Adverse Events of Immunosuppressant Anti-rejection Medications

Azathioprine (Imuran): Leukopenia, thrombocytopenia, hepatotoxicity.
Cyclosporine (Ciclosporin): Moderate HTN, neurotoxicity, hepatotoxicity, nephrotoxicity, post-transplant diabetes mellitus.
Tacrolimus: Agitation, anxiety, confusion, hallucinations, neuropathy, albuminuria and other renal issues.

Immunosuppressant Therapy: Drug Interactions

Inhibits metabolism: Fluconazole, ketoconazole, clarithromycin, protease inhibitors, grapefruit juice (with cyclosporin).
Induces metabolism: Phenytoin, carbamazepine, St. John's Wort, rifampin.

Corticosteroids

Mechanism of Action: Inhibit inflammation by stabilizing cell membranes.
Drug Names: Prednisone, methylprednisolone sodium succinate, prednisolone sodium phosphate, triamcinolone acetonide.
Indications: Allergies, autoimmune diseases, organ transplantations.
Adverse Effect: Cushing syndrome.

Cushing Syndrome

Systemic effect of corticosteroid use.
Symptoms: Moon face, truncal obesity, "buffalo hump," wasting of muscle mass, increased blood glucose, increased sodium levels, and loss of potassium.

Biological Response-Modifying Drugs and Antirheumatic Medications

Purpose: To alter the body's response to autoimmune, inflammatory, and infectious diseases.
Types: Immunomodulating drugs - interferons, monoclonal antibodies— and Disease-modifying antirheumatic drugs (DMARDs).

Immunomodulating Drugs: Interferons

Mechanism of Action: Restore immune system function if impaired, augment its ability to function as the body's defense, and inhibit it from working as in autoimmune dysfunction
Contraindications: Known drug allergy, hepatitis, or liver failure, concurrent use of immunosuppressants, AIDS-related Karposi sarcoma, severe depression, and severe liver disease.
Adverse Effects: Flu-like symptoms (fever, chills), cardiovascular effects (tachycardia, cyanosis, ECG changes, orthostatic hypotension), central nervous system effects (confusion, somnolence, irritability, seizures, hallucinations), gastrointestinal effects (nausea, diarrhea, vomiting, anorexia), hematological effects (neutropenia, thrombocytopenia), and renal/hepatic effects (increased BUN/creatinine levels, proteinuria, abnormal liver function tests).

Immunomodulating Drugs: Monoclonal Antibodies

Mechanism of Action: Prevents TNF-alpha from binding to TNF cell surface receptors; modulates inflammatory responses.
Specific Drugs and Indications: Adalimumab for RA, Psoriatic arthritis, AS, Crohn's disease, psoriasis; Infliximab for AS, Crohn's disease, RA, and ulcerative colitis—psoriatic arthritis.
Adverse Effects: Severe allergic inflammatory-type infusion reactions.

Immunomodulating Drugs: Interleukins

Mechanism of action: Inhibits the binding of IL-1 or IL-6 to its corresponding receptor. Specifically mentioned Anakinra (IL-1 receptor antagonist), and tocilizumab(IL-6 antagonist).
Adverse Effects: Infection, injection site reaction, headache.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Purpose: Alter underlying disease rather than treating symptoms.
Action: Exhibit anti-inflammatory, antiarthritic, and immunomodulating effects; inhibit cell movement into inflamed areas.
Non-Biologic DMARDs: Methotrexate, Leflunomide, Hydroxychloroquine sulphate, Sodium aurothiomalate, Cyclosporine, Azathioprine, Sulfasalazine.
Biologic DMARDs: Adalimumab, Certolizumab, Abatacept, Golimumab, Rituximab, Infliximab, Tocilizumab, Adalimumab, Tofacitinib, Anakinra, Etanercept.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Mechanism of Action, Contraindications, and Nursing Considerations

Mechanism of Action: Varies with each medication.
Contraindications: Active bacterial infections, active herpes, active or latent TB, and acute or chronic hepatitis B or C.
Nursing Considerations: Main adverse event is bone marrow suppression; monitor RBC, WBC, platelets, and LFTs.

Cannabis

Mechanism of Action: Affects the endocannabinoid system, influencing homeostasis and physiological processes.
Short-Term Studies: Support use for HIV/AIDS weight loss, MS pain, and chronic pain including rheumatologic conditions.
How it Works: The ECS is composed of CB1 and CB2 receptors, plus endogenous cannabinoids (like anandamide). Cannabinoids modulate various bodily functions, like appetite, digestion, and, pain.
Risks: Mental health conditions; impaired driving; respiratory issues; addiction, and dependence, psychological issues. Various side Effects such as psychological symptoms, nausea, weight loss can also appear.
Contraindications: Patients under 25 years with rheumatic conditions; patients with allergic reactions to cannabinoids; pregnant and breastfeeding women. patients with psychosis; or substance abuse disorder.

Nursing Management for Patients Living with Systemic Lupus Erythematosus (SLE)

Drug Therapy: NSAIDs (mild polyarthritis), DMARDs (hydroxychloroquine), Corticosteroids (Methylprednisolone)
Monitor for: GI and renal effects, specific ophthalmologic exams with hydroxychloroquine (retinopathy), and long term use of corticosteroids.
Nursing Diagnoses: Fatigue (chronic inflammation and immune changes), and impaired comfort (variable and unpredictable disease progression)
Patient Teaching: Avoid harsh chemicals and soaps; limit environmental triggers for infections; emotional and physical stress management, maintain balance of lifestyle. Monitor skin for rashes, joint pain; and other conditions. Manage pain, fatigue, lupus fog, and other issues.

Nursing Management for Patients Living with Rheumatoid Arthritis (RA)

Drug Therapy: NSAIDs (GI and renal monitoring), DMARDs (methotrexate, sulfasalazine, hydroxychloroquine, leflunomide), immunosuppressants (tofacitinib), biologics (etanercept, infliximab, adalimumab), corticosteroids (prednisone); monitor effectiveness and side effects.
Nursing Diagnoses: Impaired physical mobility because of joint damage, pain, stiffness, and chronic pain.
Patient Teaching: Activity pacing, joint protection, complementary therapies(massage, herbs, supplements, acupuncture, and meditation). Importance of diet, managing fatigue, and emotional health. Discuss pain management and disease process. Understand age related considerations from the patient perspective.

Helping Children Live Well with Rheumatoid Arthritis

Drug Therapy for Juvenile Idiopathic Arthritis (JIA): NSAIDs (first-line), DMARDs (methotrexate), and corticosteroids, biologics.
Therapies: Physiotherapy and occupational therapy to maximize mobility, joint protection, and activities of daily living (ADL).

Nursing Considerations for Children with Rheumatoid Arthritis

Importance of promoting: General health through well-balanced diet, sleep and rest, and caloric intake; physical and emotional support for the child and family.
Other Considerations: School attendance, family support, summer camps.

Severe Combined Immunodeficiency (SCID)

Therapeutic Management: Hematopoietic stem cell transplant (HSCT) from a histocompatible donor; and augment humoral immunity with IVIg and prophylaxis prior.
Nursing Considerations: Prevent infections; support family and child (life-threatening disease); genetic counseling.

Healthcare Professional Resources

Various websites are provided as resources for SLE, Lupus, Arthritis, etc..

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers key concepts related to immunosuppressive drugs, including interleukin receptor antagonists, monoclonal antibodies, and their mechanisms of action. It also addresses common adverse effects and specific drug indications in transplantation and autoimmune diseases. Test your knowledge on important pharmacological treatments and their implications in clinical practice.