RH

Adams Chap 34 partial Immunosuppressants

Drugs to Know

Methotrexate (MTX)

  • Classification: Folic acid antagonist.

  • Therapeutic Uses: Rheumatoid arthritis (RA), Crohn’s disease, ectopic (tubal) pregnancy.

  • Mechanism of Action: Blocks cancer cells’ utilization of folic acid, exhibiting multiple anti-inflammatory effects; cytotoxic to rapidly reproducing cells.

  • Nursing Considerations: Monitor for bone marrow suppression, assess liver and renal function; ensure patient takes folic acid supplements.

  • Side Effects: Bone marrow suppression, nausea/vomiting (N/V), mucositis, alopecia (hair loss), hepatic/renal dysfunction.

  • Adverse Effects: Risk of severe infection due to immunosuppression.

  • Contraindications: Pregnancy, liver disease, active infections.

Adalimumab (Humira)

  • Classification: TNF blocker.

  • Therapeutic Uses: Moderate to severe rheumatoid arthritis, inflammatory bowel disease, psoriasis.

  • Mechanism of Action: Inhibits TNF-alpha, a cytokine involved in systemic inflammation.

  • Nursing Considerations: Mandatory TB screening before starting therapy; monitor for signs of infection or malignancy.

  • Side Effects: Site reactions, headache, rash; risk of infections.

  • Adverse Effects: Potential for serious infections, malignancy.

  • Contraindications: Active infections, tuberculosis, hypersensitivity to components.

Infliximab (Remicade)

  • Classification: TNF blocker.

  • Therapeutic Uses: Crohn's disease, rheumatoid arthritis, ulcerative colitis.

  • Mechanism of Action: Chimeric monoclonal antibody that neutralizes TNF-alpha.

  • Nursing Considerations: Monitor infusion reactions; premedication with antihistamines or corticosteroids may be needed.

  • Side Effects: Infusion reactions, headache, abdominal pain; upper respiratory infections.

  • Adverse Effects: Increased risk of opportunistic infections; malignancies.

  • Contraindications: Active infections, tuberculosis, hypersensitivity to infliximab.

Cyclosporine

  • Classification: Calcineurin inhibitor.

  • Therapeutic Uses: Used in organ transplantation to prevent rejection; also in treatment for autoimmune diseases such as psoriasis, ulcerative colitis, Crohn's disease.

  • Mechanism of Action: Inhibits interleukin production, stopping helper T cell activity.

  • Nursing Considerations: Monitor for kidney toxicity, hypertension (HTN), and tremors; give on an empty stomach for enhanced absorption; avoid grapefruit juice.

  • Side Effects: Nephrotoxicity, hypertension, tremors, infections.

  • Adverse Effects: Risk of malignancies (Boxed Warning).

  • Contraindications: Hypersensitivity to cyclosporine; concurrent therapy with other nephrotoxic drugs.

Tacrolimus

  • Classification: Calcineurin inhibitor.

  • Therapeutic Uses: Organ transplantation, many autoimmune conditions.

  • Mechanism of Action: Similar to cyclosporine, inhibits T cell activation and proliferation.

  • Nursing Considerations: Monitor renal function and blood levels due to narrow therapeutic index; assess for signs of infection.

  • Side Effects: Nephrotoxicity, neurotoxicity, hypertension.

  • Adverse Effects: Risk of developing infections and malignancies.

  • Contraindications: Hypersensitivity to tacrolimus; concurrent use with certain nephrotoxic agents.

Conclusion

Review and understand the therapeutic uses, mechanisms of action, nursing considerations, side effects, adverse effects, and contraindications of these immunosuppressive and immunomodulatory drugs to ensure safe administration and effective patient care.