Drugs for Immune System Modulation

immunostimulants

• Increase the immune system's ability to fight infection and disease

• Usually used to treat patients with cancer

• Categories: Interferon, interleukins

immunosuppressants

• Diminish the immune system's ability to fight infection and disease

• Usually used to prevent transplant rejection and dampen hyperactive immune responses (e.g., SLE or RA)

interferons

naturally occurring proteins (made by WBC’s)

• Interferon alfa – 2a (Roferon)

• Mechanism of action:

  • Bind to specific receptors on cancer cell

interleukins

• Aldesleukin (Proleukin)

• Mechanism of action:

  • activates T lymphocytes

interferons mechanism of action

• Increases the phagocytic activity of macrophages and monocytes

• Suppresses the growth of cancer cells

interferons therapeutic effects and uses

• Infections: Acute hepatitis C, Chronic hepatitis B

• Herpes simplex virus

• Cancers: (Multiple myeloma, renal)

• Human immunodeficiency virus (HIV)

• Varicella-zoster virus (VZV)

• West Nile virus

interferons side effects

(expected - do not stop medication)

• Flu-like syndrome of fever, chills, dizziness, weight loss, and fatigue

• Anemia

interferons adverse effects

(stop med and notify provider)

• Hepatotoxicity

• Shortness of breath, chest pain, rapid heart beat

• Neurotoxicity: somnolence, confusion

• Black box warning: depression/ suicide

interferons contraindications/precautions

• Autoimmune hepatitis or hepatic decompensation

• Cardiac disease

interferons nursing care

• Obtain baseline laboratory values; monitor monthly

• Teach techniques for self-administration of medication

interferons implementation

• Assess for flu-like syndrome

• Adverse effects:

  • Monitor for liver toxicity

  • Monitor for depression / suicidal thoughts throughout

interferons patient teaching

• Do not shake the medication container (vial or syringe)

• Check this product visually for particles or discoloration

• Side effects include flu-like symptoms (especially when medicine started); symptoms usually last about 1 day after injection and improve after a few weeks of continued use; may be administered with acetaminophen

• Best used in the evening before bedtime to reduce side effects.

• Drink plenty of fluids while using this medicine

• Notify your provider if your noticing irritability, depression

monoclonal antibodies

• Inflixamab (Remicade) – Crohns, UC, RA, Ankylosing spondylitis

• Rituximab (Rituxan) – Non hodgkins lymphoma, CLL, RA,

• Adalimumab (Humira) – Psoriatic arthritis. TNF blockade

• trastuzumab (Herceptin) – Cancer

• alemtuzumab (Campath) – Cancer

• Harvested from antibodies produced by a single B cell

• Very specific, targeting a single type of target cell or receptor

• Approaches for the development of therapeutic antibodies.

monoclonal antibodies adverse effects

• Serious infection: due to immune system aggression

• Malignancy: immune system suppression can allow for the growth of cancer cells

• Anaphylaxis: esp. when derived from murine sources

• Hypersensitivity: immune system activation due to presence of foreign body

monoclonal antibodies pre-administration assessment

Previous history or current case of cancer; fever or active infections (herpes, varicella, and cytomegalovirus); hepatic, renal, cardiovascular, neurologic, or autoimmune disease; dermatologic conditions; HIV infection

monoclonal antibodies implementation

• Infliximab infused over 2 hours (some meds will be given at an infusion center)

• Adalimumab administered subcutaneously (some meds can be administered at home)

• Continue to monitor CBC, platelets, electrolytes, glucose, liver and renal function studies, and lipid levels

monoclonal antibodies nursing care

• Instruct patient to avoid live vaccinations

• Instruct patient to report severe infections

• Instruct patient to report dizziness, chills, dyspnea, seizures or fatigue or rash immediately

cyclosporine

an immunosuppressant medication primarily used to prevent organ transplant rejection and to treat certain autoimmune diseases.

• 2 primary marketed formulations of ______

• ________ (Sandimmune); original formulation circa 1980’s

• ________ modified (Neoral)

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

cyclosporine therapeutic use

Solid organ transplant, RA, Severe plaque psoriasis

cyclosporine black box warning

serious infections and possible malignancies

cyclosporine adverse effects

• Hypertension - common

• Nephrotoxicity

• Infection

• Hepatotoxicity

• Rare anaphylaxis

• Hirsuitism (above right)

• leukopenia, gingival hyperplasia, gynecomastia, sinusitis and hyperkalemia

cyclosporine drug interactions

Nephrotoxic drugs

• Ciprofloxacin

• Gentamycin, tobramycin, vancomycin

• NSAIDS: Diclofenac, naproxen

• Grapefruit juice

• Methyprednisolone

• “Azoles” antifungals: fluconazole [not contraindicated but may increase cyclosporin levels]

cyclosporine implementation

• Oral solution: use provided measuring device

• Capsules should not be crushed or chewed

• Handled by caregivers with gloves

• Monitor serum creatinine, hyperkalemia, hyperuricemia

• Monitor LFT’s

• Monitor for symptoms of infection

• Antifungal drugs and steroids may be coadministered

cyclosporine patient teaching

• Stay well hydrated

• May increase the risk of some kinds of infections; notify your provider if you notice signs of an infection, such as fevers

• Importance of good, frequent handwashing.

• Avoid anyone who has infection.