Immunostimulants and Immunomodulators (Chap 48)

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Epoetin alfa

-Epogen, Procrit, Retacrit -anemias associated w CKD -ads rxn: HTN, headache, n/v, fatigue Titrated to Hb level (should be no higher than 12 g/dL) -contraindicated in patients w HTN, hypersensitivty to human albumin

Filgrastim

-Neupogen -colony stimulating factor -treat/prevent severe neutropenia (caution with hypothyroid) -start 24 hours after chemo -ads rxns: bone pain, n/v, diarrhea, alopecia 5-10 mcg/kg subQ or IV daily

Vitamin B12

-cyancobalamin -ads rxn: mild diarrhea, itching, edema -need intrinsic factor to absorb -B12 deficiency causes macrocytic anemia -Alchol, neomycin, colchicize, decrease absorption of oral B12

Folic Acid

-megaloblastic anemia from deficiency of folic acid -ads rxn: allergic sensitzation 1 mg/day, PO, IM, IV, sub Q -in leafy greens, meat, poultry, whole grains -take w pregnancy to decrease neural tube defects (0.8 mg/day) -if taken w hyantoins can cause seizure

Ferrous

-prevent/treat iron anemia ads rxn: GI irritation, n/v, constipation, diarrhea

What is the recommended daily amount of folic acid during pregnancy and lactation?

0.8 mg/day

What lab value is important with CSFs?

Absolute neutrophil count (ANC)

What are treatment guidelines for filgrastim?

Absolute neutrophil count (ANC) is monitored and therapy is continued until an ANC of at least 10,000 mm3 is achieved

What should clients avoid while taking interferons and why?

Alcohol because it causes an asymptomatic elevation in liver enzyme

When is CSF filgrastim (Neuopgen) started?

CSF filgrastim is started at least 24 hours after the completion of a cycle of chemotherapy

How are CSFs used in hematopoiesis?

CSF used to signal undifferentiated stem cells in bone marrow to multiple and differentiate into erythrocytes, leukocytes, or megakaryocytes

How do CSFs affect thrombopoiesis?

CSFs increase/stimulates thrombopoiesis

Promacta

Eltrombopag

Epogen, Procrit, Retacrit

Epoetin alfa

What causes fatigue associated with CSF use?

Fluid retention

What are common GI reactions to iron?

GI irritation, n/v, constipation, diarrhea, darker stools

What two patient conditions are contraindications of iron use?

Hemochromatosis or hemolytic anemia

Which administration route can cause a brownish discoloration of the skin?

IM route

What lab value is important for CSFs?

ITP and platelet count

What can thrombocytopenia cause

Idiopathic thrombocytopenic purpura (ITP)

Does adequate folic acid decrease the risk for embryonic neural tube defects?

If taken before conception and during early pregnancy

What can chemo drugs cause from impact on neutrophils?

Infection can result if client develops neutropenia

What are two classifications of cytokines?

Interferons and Colony-Stimulating Factors (CSFs)

Is there an increase or decrease in absorption of iron when taken with vitamin C?

Iron absorption is increased when taken with vitamin C

Should iron be taken with food or other medications?

Iron should be taken on an empty stomach

If anemia is associated with diet, what strategies can the nurse use to encourage adequate dietary intake?

Lean red meats, cereals, dried beans, and leafy green vegetables, liver, yeast, beef, pork, eggs, milk, and milk products

What happens to the levels of antibiotics or levothyroxine when taken with iron?

Levels of antibiotics and levothyroxine are decreased in absorption when taken with iron

What is one of the major conditions that interferons treat?

Multiple Sclerosis (MS)

In clients on ESAs such as epoetin alfa, what should their hemoglobin level be no higher than?

No highter than 12 g/dL, if higher?

What medication is used to treat iron deficiency anemia?

Oral iron supplements are used to treat iron deficiency anemia

Eltrombopag

Promacta -severe chronic thrombocytopenia (ITP) -ads rxn: excessive menstural bleeding, nausea -max dose 75 mg/day -can be toxic to liver, discontinuation can lower platelet counts

What are the 3 distinct cells that circulate in the blood?

RBC (erythrocytes) WBC (leukocytes) Platelets (megakaryocytes)

What is a patient is hypersensitive to aspirin- should the nurse take special precautions?

Take precaution because of hypersensitivity to tartrazine or sulfite

Why are neutrophils a prime target for destruction by chemotherapy drugs and cancer cells?

They have a rapid growth cycle

What do ESAs treat?

Used to treat anemia in CKD, chemotherapy for cancer treatment, AZT therapy for HIV, and postsurgical blood replacement in place of allogenic transfusions

What are cytokines?

a broad group of proteins involved in cell-to-cell communication

What can cause a B12 deficiency?

a deficiency of intrinsic factor results in abnormal formation of erythryoctyes becasue of body failure to absorb vitamin B12

What are colony-stimulating factors (CSF)?

a group of immunostimulants used in cancer treatment and chronic renal failure to support hemopoietic system

How should adverse reactions of interferons be treated?

acetaminophen and antihistamines

What substances may decrease the absorption of oral vitamin B12?

alcohol, neomycin, and colchicine

What are the categories of interferons?

alfa, beta, gamma

A patient with interferons is more likely to have?

an infection (reduction in WBC)

What should never be given concurrently with iron?

antacids or milk

What is iron deficiency anemia?

body doesn't have enough iron, iron is in hemoglobin and picks up oxygen from lungs and carries it to the body tissues

What are the general system reactions of CSFs?

bone pain, HTN, n/v, alopecia, hypersensitivity or allergic reactions

How do interferons treat Multiple Sclerosis (MS)?

by interferon beta-1b to enhance T cell activity and reduce inflammation in CNS

When taking oral iron, how can a patient prevent teeth staining?

by mixing liquid iron preparation with water or juice and drink through a straw

What are uses for CSFs?

cancer, kill off fast growing cells of hematopoietic system

What medication is used to treat a vitamin B12 deficiency?

cyanocobalamin

How do interferons work?

cytokine antiviral agents that get their name from ability to interefere with viral replication inside the cell -stimulate phagocytoes to be more aggressive, stimulate receptors on other healthy cells to prevent viral invasion, prevent viruses from replicating inside of host cells, inhibit tumors/stimulate T cells, act as anti-viral to some bacterial infections

What are immunomodulators

drugs that modify the actions of the immune system

What are erythropoiesis-stimulating agents (ESAs)?

drugs that stimulate erythropoiesis, making RBCs.

When would supplemental iron be needed?

during pregnancy and lactation

What signs should the nurse look for for parenternal administration of iron dextran (fatal anaphylactic-type reactions)?

dyspnea, urticaria, rashes, itching, and fever

In anemia caused by chronic kidney disease, what substance in the body is reduced, resulting in decreased RBC production?

erythropoietin?

Neupogen

filgrastim (CSF)

What are common adverse reactions of interferons?

flu-like symptoms: chills, cough, fever, headache, malaise

When should you give interferons to help avoid adverse reactions?

give in evening

Filgrastim should be used with caution in clients with what condition?

hypothyroid disease

What can happen if a client develops neutropenia?

infection

What is anemia?

insufficient amount of hemoglobin delivering oxygen to tissues

what are man made cytokines?

interferons and interleukins

What substane is required to absorb B12?

intrinsic factor (made by cells in stomach)

In patients being treated for HTN, what is vitally important if they are taking epoetin alfa?

it is important if they are taking epoetin alfa because it can result in increased mortality, or serious cardio/thromboembolic events

What foods contain folic acid?

leafy greens, fish, meat, poultry, whole grains

What organ is susceptible to damage from Eltrombopag?

liver, should do liver studies

What can happen if Eltrombopag is discontinued?

lower platelet counts

What anemia does B12 cause?

macrocytic anemia

What type of anemia does folic acid deficiency cause?

megaloblastic anemia

Should interferons be taken during pregnancy?

no, unless the woman is at high risk of MS activity

What are the different preparations of iron?

parenteral, oral iron preparations

What are the cardiovascular system reactions that can occur with CSFs?

peripheral edema, palpitations, atrial fib, emboli resulting in stroke and pulmonary edema, capillary leak syndrome

What is megaloblastic anemia?

presence of large, abnormal, immature erythrocytes circulating in the blood

What is thrombopoiesis?

production of platelets

Cytokines

proteins that are messengers to communicate between cells

How does Interferon B (REBIF) work?

reduces ability to APC to activate T cells (prevents cascade)

What can happen if folic acid is administered with hydantoins?

seizure activity

Because CSFs can cause hypersensitivity reactions, what can you expect to be ordered to maintain their use?

should be ordered with antihistamines, steroids, and bronchodilators

What are interleukins?

specific cytokines made by WBC and boost immune system during cancer therapy

What is a thrombopoietin receptor agonist?

stimulate megakaryocytic production

What is hematopoiesis?

stimulate the body to make more of the specific blood cells

Aldesleukin/Proleukin

synthetic form of interleukin-2, activates cancer attacking cells, causing them to reproduce so they can target cancer cells *always given in hospital setting, risk of severe hypotension

How can a nurse encourage the patient to continue taking CSF?

teach energy saving skills

What strategies can the nurse use to help prevent or treat constipation in a patient taking iron?

to prevent constipation= increase fluid intakes, eat diet high in fiber, active lifestyle

Epoetin alfa contraindicated in patients with what conditions?

uncontrolled HTN, in need of emergency transfusion, and hypersensitvity to human albumin


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