Immune System Drugs
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What is Active Natural Immunity
- conferred by infection
- patients body produces antibodies against active infection
- confers limited and lifetime protection against re-infection
What is Active Artificial Immunity
- conferred by vaccine or toxoid
- stimulates an antibody-antigen response
- confers temp or lifelong immunity against certain communicable diseases
- hepatitis, chicken pox, tetanus, etc
What is passive natural immunity?
- directly transfers antibodies to fetus via placenta
- directly transfers antibodies via breastmilk
What is Passive Artificial Immunity?
- antitoxin or immunoglobulin
- directly injects antibodies or immunoglobulin
- occurs after exposure to communicable disease, confers temp defense against that disease until bodies defense mobilize
- confers temp defense against communicable disease in a immuno-compromised patient
What are the 9 categories of drugs that support treatment of cancer?
- alkylating agents
- platinum compounds
- anti-tumor antibiotics
- topoisomerase inhibitors
- hormonal agents
- biologic response agents
- targeted antineoplastic agents
What are the 3 types of antimetabolites?
- folic acid analog
- pyrimidine analog
- purine analog
What phase is antimetabolites able to kill cancer cells?
S phase of the cell cycle, where DNA is being synthesized
What is the result of killing cancer cells using antimetabolites during S phase of cell cycle?
results in a number of normal cells being killed along side cancer cells
normal cells grow back more quickly than cancer cells
must be available in the body for an extended period of time
What is the advantage of administering chemotherapy intermittently?
- more cancer cells are killed with each round of chemotherapy
- not able to grow back or repopulate as quickly as normal cells before the next treatment.
what is the advantage of combining folic acid analogs with other cancer treatments?
- To kill more cancer cells more effectively
- to prevent resistance to a single drug
What folic acid analog prototype drug treats rheumatoid arthritis and psoriasis?
used when disorders have not responded to other types of treatment
used in smaller doses
What types of cancer does folic acid analogs treat?
- acute lymphocytic leukemia in children
- lymphomas (non-hodgkins)
- choriocarcinoma (uterine associated with pregnancy)
- inoperable sarcomas of the head, neck and pelvis
what autoimmune disorders does folic acid analogs treat?
- rheumatoid arthritis
What is the prototype drug for folic acid analog (antimetabolite)
& other drugs used?
- methotrexate (Trexall)
- pemetrexed (Alimta)
What is the expected action of Folic Acid Analog (anti-metabolite) drug?
- blocks the folic acid synthesis by:
- -inhibiting the enzyme dihydrofolate reductase that is responsible for the activation of folic acid
disrupts the DNA synthesis that occurs in the S phase of cell formation
thus the Folic acid analog kills cancer cells during the S phase
What are the Adverse or Side effects of Folic Acid Analogs?
- 1. Severe bone marrow suppression:
- -decreased thrombocytes (Platelets),leukocytes (WBC), and erythrocytes (RBC)
- 2. Liver Damage
- 3. Oral + Gastrointestinal ulceration
- 4. Pulmonary Fibrosis (lung damage)
What are the Nursing Interventions for patients taking Folic Acid Analogs?
- 1. Monitor CBC before, during and after treatment
- 2. monitor for fever and infection
- 3. Monitor for bleeding, bruising and petichiae (thrombocytopenia)
- 4. Monitor Liver Function Test
- 5. Monitor for Respiratory Distress and decreased oxygenation
What is the rationale for monitoring CBC test for a patient taking a folic acid analog?
can cause a decrease in Thrombocytes (platelets), Leukocyte (WBC) and erythrocytes (RBC)
What is the rationale for monitoring a patient taking folic acid analog for fever and infection?
b/c patient is at risk for infection if leukocytes drop and neutropenia develops
filgrastim may be ordered to minimize the decrease of WBCs
What is the intervention used if the patient taking folic acid analogs experience a drop in thrombocytes (thrombocytopenia)?
- the patient is at risk for bleeding so
- --use measures to minimize bruising such as:
- apply prolong pressure to puncture sites
- use small gauge needles if necessary
What is the rationale for monitoring a patient taking folic acid analog for oral and GI ulcerations?
- patient is at risk for bleeding:
- -monitor common sites such as the gums, blood in vomit or in stool
it may cause bleeding + discomfort in patient
What is the intervention for monitoring a patient's Liver Function Test while taking folic acid analogs to treat cancer?
Monitor patients Liver Function Test for jaundice, yellowing of the skin.
What is the rationale for monitoring a patient taking folic acid analog for respiratory distress
Monitor patients breathing b/c folic acid analog drugs may cause pulmonary fibrosis which cause patient to experience respiratory distress and decrease in oxygenation
Why is bone marrow suppression a common side effect for chemotherapy using folic acid analog?
b/c the drugs that kill cancer cells also kill blood cell forming cells of the bone marrow (WBC, RBC, and Platelets)
decrease in neutrocytes is the most common form of leukocytes.
what is a patients who has a decreaed number of neutrophils at risk for?
- neutropenia, 2500 or less
- below 500 can make patient susceptible to infection
when would you stop chemotherapy treatment with a patient taking folic acid analog drugs (antimetabolite)?
- When the patients neutrophil count is 500 or less. This lets the nurse know that the patient is at extreme risk for getting an infection or disease.
- The nurse would take neutropenia percautions
what precautions would the nurse take when treating a patient that is hospitalized with extreme risk of infection, with a neutrophil count of 500 or less?
- 1. place patient in private room
- 2. limit the # of HCP who enter the room
- 3. restrict those who are sick from providing care
- 4. limit the # of invasive procedures such as Blood draws
- 5. using aseptic techniques when necessary
what intervention should the nurse do first when caring for a patient whose neutrophil count is below 500?
- notify HCP immediately when patient shows signs of fever
- assess patient for source of infection
How is Folic Acid Analog administered?
Orally, IM, IV, and preservative free intrathecal form.
What would you administer to a patient who is receiving a high dose cancer therapy with a Folic Acid Analog?
Leukovorin, a reduced form of folic acid
also given as a anecdote for severe bone marrow depression associated with folic acid analogs.
Should the nurse give methotrexate oral dose with or without food?
both, it may be given to a patient with food or without.
Why would you administer an IV dose of methotrexate using a dedicated IV Line?
b/c methotrexate is incompatible with other drug solutions
Why would a nurse take special precautions such as the use of special equipment when reconstituting or mixing methotrexate, a folic acid analog chemotherapy drug?
To protect the Health Care Personel
What must a nurse who administers anticancer drug therapies do?
Get special training and certification in order to admin IV anticancer drugs
What patient instruction should be included in a patient who is at risk for bone marrow depression? (folic acid analog -->methotrexate)
- report fever, sorethroat, bruising, and unusual fatigue
- wash fresh fruits, vegetables, and cook food well done
what would good oral care prevent in a patient who is at risk for bone marrow depression?
Stomatitis, yeast supra infection in the mouth
Washing hands frequently, fruits and vegetables, and limiting visitors who are sick would prevent or lower risk of what?
what patient teaching should be included in caring for a patient who is taking methotrexate, anticancer medication?
- use soft bristle tooth brush to prevent bleeding of the gums
- use electric razor to prevent bruising
patient is at risk for bleeding caused by bone marrow supression a common side effect of anti cancer drug administration
What special instructions should the HCP include with a patient taking methotrexate, and is at risk for liver failure?
- to avoid drinking any alcoholic beverages
- report jaundice of the skin or eyes immediately
Risk of oral and GI bleeding, what special instructions should HCP give a patient taking methotrexate, a folic acid analog?
report any ulceration in the mouth (stomatitis), blood in the vomit or in their stool
Why should the HCP provide special instructions for the patient taking methotrexate who experiences respiratory distress or decreased oxygenation?
They may be having pulmonary fibrosis or damage which respiratory distress and decreased oxygenation are s/s
What are the contraindications for mexthotrexate?
its considered to be a pregnancy category X drug
What contraindications must a nurse assess before administering to the patient?
if the patient has any history of liver disease or hepatitis, or renal insufficiency: the drug should not be given
What precautions should the nurse take before administering methotrexate to the patient?
- ask the patient if had any history of oral or GI ulcerations
- ask patient if has any active bacterial or viral infections
what are the drug interactions with methotrexate?
concurrent use of methotrexate and digoxin can lower the digoxin levels
use with NSAIDS, salicylates and sulfonamides may cause toxic levels when taking concurrently with methotrexate.
what can alcohol use cause a patient taking methotrexate?
it may increase the risk of hepatitis toxicity
what would taking folic acid supplements do to a patient who is taking methotrexate, a folic acid analog?
It may change the patients response in taking methotrexate
what does pyridmidine analogs treat?
- acute myeloctyic and acute lymphocytic leukemia
- non-hodgkins lymphoma
- prevents and treats meningitis caused by leukemia
- maintains the remission of all of the above
What is the prototype drug for pyrimidine analog?
- cytarabine (Cytosar-U via subQ, IV)
- cytarabine (DepoCyt via intrathecal)
- other drugs:
- flourouracil (Adrucil)
- floxuridine (FUDR)
- gemcitibine (Gemzar)
What is the action for pyrimidine analogs?
- after pyrimidine analog, cytarabine in the body changes into its active form:araCTP.the drug becomes incorporated into the DNA of the cells during the S phase:
- when the cells are changing rapidly
- supresses both RNA and DNA synthesis by destroying both cancer and normal cells
What does Purine Analogs treat?
- lymphocytic and acute myelogenous leukemia in both adults and children
- may cause temporary remission in chronic granulocytic leukemia
what is the prototype drug of purine analogs?
- other drugs:
- thioguanine (Tabloid)
- fludarabine (Fludara)
- cladribine (Leustatin)
what are the drug actions of purine analogs?
Blocks the purine creation during the S-phase of cell life cycle
DNA can't form due to it s inability of the cell to synthesize the necessary nucleic acids
necessary to produce nucleic acids, which purine analogs convert to its active form after administration
what does the Nitrogen Mustard drugs treat?
- broad spectrum chemotherapy agent that may be used alone or with other agents to treat:
- multiple myeloma
- solid tumors (adenocarcinomas) of head, ovary or breast
- lung cancer
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