pharm module 8: immune system modulation

what are immunostimulants?

• they increase immune systems ability to fight infection and disease

• usually used to treat pts with cancer 

• enhance body’s immune system, ideal for pts w/ cancer

what categories are interferons and interleukins in? sitmulant or suppresants?

• immunostimulants

what are immunosuppressants?

• diminish the immune systems ability to fight infection and disease 

• usually used to prevent transplant rejection and dampen hyperactive immune responses (ex: SLE or RA)

what are interferons? 

naturally occuring proteins made by WBCs

interferon trade name 

interferon alfa - 2a is tade named Roferon 

MOA of interferons

• bind to specific receptors on cancer cell

  • only works on certain cancer cells 

interleukin trade name

aldesleukins trade name is proleukin

MOA of interleukins 

• activates T lymphocytes 

  • protects body from infections and can help fight cancer 

what are some side effects of interferons?

• flu like syndrome of fever, chills, dizziness, weight loss, fatigue

• anemia

adverse effects of interferons

• hepatotoxicity 

• SOB, chest pain, rapid heart beat

• neurotoxicity: somnolence, confusion

what is the black box warning of interferons

• depression/suicide

containdications/precautions of interferons

• autoimmune hepatitis or hepatic decompensation 

• cardiac disease

what should you monitor and why when taking interferons

• obtain baseline labs because med can cause hemolytic anemia and neutropenia

  • monitor monthly 

what should you assess while taking interferons?

• assess for flu-like syndrome

  • can take NSAIDs or acetaminophen

• assess for liver toxicity

  • AST, ALT, can cause jaundice, LOC changes

• monitor for depression/suicidal thoughts throughout

pt teaching of interferons

• teach tecniques for SQ admin

• do not shake med container 

• check product for discoloration or particles 

• side effects last about a day after injection and then approve within a few weeks, may take acetaminophen 

• best used in evening before bedtime to reduce side effects 

• drink plenty of fluids while using this medicine 

• notify your provider if noticing irritability, depression

what is murine made from?

• mouse/rat

what is chimeric made from?

DNA from 2 different sources

what is humanized made from?

• vaccinated human

what is human made from?

• antibodies from human cells

what are monoclonal antibodies?

• drugs are named by the way antibody was created in lab

• approaches for the development of therapeutic antibodies 

what are adverse effects of monoclonal antibodies?

• serious infection

  • due to immune system suppression

• malignancy

  • immune system suppression can allow for growth of cancer cells 

• anaphylaxis 

  • esp. when derived from murine sources

• hypersensitivity 

  • immune system activation due to rpesence of foreign body 

what shouldl you assess before administering monoclonal antibodies?

• history or current case of cnacer 

• fever or active infections (herpes, varicella, cytomegalovirus)

• hepatic, renal, cardiovascular, neurologic, or autoimmune disease

• dermatologic conditions

• HIV infection

how should monoclonal antibodies be given?

• infliximab infused over 2 hours (some meds fiven at infusion center)

• adalimumab administered subcutaneously (some meds administered at home)

• monitor CBC, platelets, electrolytes, flucose, liver and renal function studies, lipid levels 

pt instruction for monoclonal antibodies

• avoid live vaccinations like MMR

• report severe infections (fever, UTI, skin infections)

• report dizziness, chills, dyspnea, seizures, fatigue, or rash immediately (hypersensitivity rxn)

what are the 2 different cyclosporins?

• cyclosporine (sandimmune)

  • fromulaltion from 1980s

• cyclosporine modified (neonoral)

froms are not bioequivalent and have serious implications for drug levels (possibly organ loss)

what are cyclosporins used for?

• solid organ transplant 

• RA, secere plaque psoriasis 

can you give pt 2 different cyclosporins?

no, they must e the one provider prescribes, they cannot switch

what is the black box warning for cyclosporins?

• serious infections and possible malignancies

adverse effects of cyclosporins

• HTN - common 

• nephrotoxicity 

• infection 

• hepatotoxicity 

• rare anaphylaxis 

• hirsuitism 

• leukopenia, gingival hyperplasia, gynecomastia, sinusitic, and hypeerkalemia 

how often will pt be taking cyclopsorins until?

• most likely the rest of their lives

how may nephrotoxicity present to a pt taking cyclosporins?

• hyperkalemia - resistance aldosterone creates tubular malfunction

• sodium potassium - altered and changes LOH processes and secretes urine 

• hyperuricemia - caused by decrease in kidney tubules 

drug interactions of cyclosporins

• nephrotoxic drugs

• cyprofloxacin 

• gentamycin, tobramycin, vancomycin 

• NSAIDs: diclofenac, naproxen, ibuprofen

drug/food interactions that increase cyclosporin level

• grapefruit juice 

• methylprednisolone

• Azoles antifungals: fluconazole (not contraindicated but mat increase cyclosporin levels)

what should you monitor before giving cyclosporins?

• vital signs 

• especially temp and BP

what should you monitor WHILE giving cyclosporins?

• monitor serum creatinine, hyperkalemia, hyperuricemia (due to potential for nephrotoxicity)

• monitor LFTs (AST, ALT)

• monitor for symptoms of infection (UTI, skin, systemic)

• antifnugal drugs and steroids may be coadministered (due to oral/fungal infections)

how are cyclosporins given?

• oral solution - used measuring device 

• capsules shouldnt be crushed or chewed 

• handled with gloves

pt teaching of cyclosporins

• stay hydrated 

• may increase some risk of infections, notify provider if you notice signs of infection like fevers 

• importance of good, frequent handwashing 

• avoid anyone who has infection