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Transcript
Drugs for Modifying Biologic Response Lana Chase RN,MN,CS. Biologic Modifiers Medications that are naturally occuring proteins used to alter the body’s: Hemotologic and immunologic responses 4 Types of Drugs 4 Classifications of Agents 1. Hematopoietic Growth Factors – epotin alpha (Epogen) 2. Cytokines – 3. Poly / Mono Clonal Antibodies – interferon Alpha 2a (Roferon-A) rutiximab (Rituxan) 4. Immune Modulators – cylclsporine (Sandimmune) Hematopoietic Cells Located in the bone marrow and produce: RBC’s- carry oxygen to cells (Hg) WBC’s-protect against infection granulocytes , monocytes, lymphocytes Platelets - assist in blood clotting Erythropoietin is produced in kidneys secondary to hypoxia and acts in bone marrow on stem cells. . Epogen has identical action Barrier Defenses Skin – 1st line of defense Mucus membranes GI Tract –acid protector If a pathogen gets past one of these, and injures a cell, the body initiates a non specific inflam. reaction. Specific Immune Response Invader gets past barrier and non-specific response WBC’s- digest foreign mat.,release chemicals in inflam resp, active in allergies T Cells –modify the immune response & protect body from non-self cells B Cells- produce antibodies to specific antigens Immunity Body forms specific antibodies to a pathogen. – Vaccines stimulate active immunity to prevent serious illnesses – Sera are preformed antibodies or passive immunity. (give the antibody instead of the antigen.) Hemotologic Failure Anemia – inadequet RBC’s – Folic acid defiency – Kidney failure Thrombocytopenia- low platelets vit B12 def , folic acid def., aplastic anemia, systemic lupus, Neutropenia- low wbc cancer, radiation, some drugs Immune Dysfunction Weaken immune system: 1. Neoplasms- mutant cell growth 2. Viral invasion HIV-changes cell membrane 3. Autoimmune Disease- making antibodies against self cells 4. Organ Transplantation- reaction to foreign cells Hematopoietic Growth Factors epoetin alfa (Epogen / Procrit) – Works same as endogenous – Stimulates RBC production – Takes 2-6 wks. for inc. in HCT or Hg – Decreases need for transfusion – Less effective if malignancy in bone marrow – Risks: CVA, MI,TIA’s, hypertension – Teach: self adm. – Can be given to Jehovah’s Witness Other Hematopoietic Agents filgrastin (Neupogen) neutropenia due to bone marrow transplant Given S.C. injection 3 x/wk. decrease risk of infections-never reenter used vial, wash hands, avoid crowds & sick people. s.e.- bone pain Chemical Mediators Cytokines: released by WBC’s due to antigentic invasion of blood or tissues. Interferon alpha 2a (Roferon-A) Hairy Cell leukemia Karposi Sarcoma: – inhibits growth of tumor cells, prevents their multiplication, – – – – increases, host immune response, prevents viral replication. React with Theophyline,cimetidine,vinblastine Adverse: hypotension, dizziness , confusion Avoid infection, teach admin. & use within 30 days,get blood tests, avoid pregnancy & breastfeeding Nsg.- maintain nutrition, stomatitis care, anxiety r/t disorder Polyclonal Monoclonal Antibiodies Rituximab: a monoclonal antibiody that binds specifically to CD20 antigen on t;he surface of Malignant B lymphocytes and causes cell lysis – – – – Non Hodgkins Lymphoma treatment AR: fever , flushing , chills with infusion Given IV weekly x 4 wks. Do not give with vaccines, caution in Cardiac & Pulmonary pts. Immune Suppresant Cyclosporine (Sandimmune): prevent rejection after organ transplantation & bone marrow transplant by reducing the immune response by preventing lymphocytes from producing antibodies and killer T cells to attack foreign cells start immediately after transplant AV:tremor, hirsutism, hypertension, interactions:with vaccines decrease antibody response; some drugs can cause toxicity Nsg.: infection prevention, monitor renal function, mouth care for gum hyperplasia, nutiritonal consult, small meals or supplemental feedings Contraind.: fluid overload