Download Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 51Immunostimulant Drugs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types and Functions of Blood Cells
• Red blood cells (erythrocytes)-supply oxygen
• White blood cells (leukocytes)-protect against
microorganisms
• Platelets (megakaryocytes)-control bleeding
• Kidney disease can cause hematologic failure
– *anemia, bleeding and infection may result
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Drugs Used in Treatment of Anemia, Bleeding
and Prevention of Infection
• Colony-stimulating drugs
• Oprelvekin
• Erythropoiesis-stimulating agents
– Glycoproteins that stimulate and regulate the
production of erythrocytes
• Iron
• Folic Acid
• Vitamin B12
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Drugs used to Stimulate White Blood Cells:
Actions and Uses
• Colony stimulating factors (CSF) glycoproteins act
on hematopoetic cells to stimulate proliferation,
differentiation, and maturation of white blood cells
– *Used in chemotherapy-induced neutropenia
• Filgastim-used after a cycle of chemotherapy
• Pegfilgastim-used as single dose between
chemotherapy cycle
• Sargramostim-used following BMT, induction
chemotherapy used with leukemia, and to stimulate stem
cells for harvest.
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Drugs used to Stimulate White Blood Cells:
Adverse Reactions
• Bone pain
• Hypertension
• Nausea and vomitting
• Alopecia
• Hypersensitivity or allergic reactions
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Drugs used to Stimulate White Blood Cells:
Contraindications, Precautions and Interactions
• Contraindicated in patients with hypersensitivity
• Pregnancy category (C), caution when breast
feeding
• Filgrastim-caution with hyporthyroid disease
• Pegfilgrastim-cause sickle cell crisis
• Can stimulate cancer cell growth
• Increased netrophil when used with Lithium
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Drugs used to Stimulate Blood Platelets:
Actions and Uses
• Oprelvekin-acts to stimulate thrombopoiesis
-reduces need for multiple platelet transfusion
-used to treat or prevent thrombocytopenia
associated with chemotherapy for solid tumor
cancer treatments
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Drugs used to Stimulate Blood Platelets:
Adverse Reactions
• General reactions:
-fluid retention, peripheral edema, dyspnea,
syncope, fever, allergic reaction
• Cardiovascular reactions:
-tachycardia, palpitations, atrial fibrillation,
arrhythmias resulting in stroke and pulmonary edema,
capillary leak syndrome
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Drugs used to Stimulate Blood Platelets:
Contraindications, Precautions and Interactions
• Contraindicated to patient hypersensitivity and not
used with chemotherapy that is extremely
myelosuppressive.
• Use cautiously in patients with renal, heart failure or
atrial arrhythmias
• Low potassium (hypokalemia) can occur with cancer
chemotherapy agent, ifosfamide
• Pregnancy category (C) and stop breast feeding
• Anaphylactic-type reactions discontinue use
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Drugs Used in Treating Anemia
Associated With Chronic Illness: Actions
and Uses
• Epoetin alfa: Drug that stimulates
erythropoiesis
– Used to treat anemia associated with:
Chronic renal failure; chemotherapy for
cancer treatment; zidovudine therapy for
human immunodeficiency virus;
postsurgical blood replacement in place of
allogeneic transfusions
• Darbepoetin alfa an erythropoiesis-stimulating
protein: Used to treat anemia
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Drugs Used in Treating Anemia
Associated With Chronic Illness: Adverse
Reactions
• Adverse reactions:
– Hypertension; headache; nausea;
vomiting; diarrhea; rashes; fatigue;
arthralgia; skin reaction at injection site
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Drugs Used in Treating Anemia
Associated With Chronic Illness:
Contraindications and Precautions
• Epoetin alfa: Contraindicated in patients with
uncontrolled hypertension; those needing
emergency transfusion; those with
hypersensitivity to human albumin
• Darbepoetin alfa: Contraindicated in patients
with uncontrolled hypertension, those allergic to
drug
• Epoetin alfa darbepoetin alfa: Used with caution
in patients with hypertension; heart disease;
congestive heart failure; history of seizures
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Drugs Used in Treating Iron Deficiency
Anemia: Actions and Uses
• Iron preparations:
– Act by elevating serum iron
concentration, which replenishes
hemoglobin and depleted iron stores
• Parenteral iron:
– Used when patient cannot take oral drugs
or when patient experiences
gastrointestinal intolerance to oral iron
administration; treating iron deficiency
anemia
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Drugs Used in Treating Iron Deficiency
Anemia: Adverse Reactions,
Contraindications
• Adverse reactions: Gastrointestinal
reactions: GI irritation, vomiting,
constipation, diarrhea, darker stools;
Generalized system reactions-fatigue with
Feosol/ferrous sulfate
• Iron supplements: Contraindicated in
patients with known hypersensitivity to drug,
or any component of the drug
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Drugs Used in Treating Iron Deficiency
Anemia: Contraindications, and Precautions
• Iron compounds
– Contraindicated in patients with
hemochromatosis or hemolytic anemia
– Used cautiously in patients with
hypersensitivity to aspirin
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Drugs Used in Treating Iron Deficiency
Anemia: Interactions
Interactant Drug
Effect of Interaction
Antibiotics
Decreased GI absorption
of the antibiotic
Levothyroxine
Decreased absorption of
levothyroxine
Levodopa, methyldopa
Decreased effect of
Parkinson’s medication
Ascorbic acid (vitamin
C)
Increased absorption of
iron
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Drugs Used in Treating Folic Acid
Deficiency Anemia: Action and Uses
• Folic acid: Used in treating megaloblastic
anemia; for women of childbearing age to
decrease incidence of neural tube defects
• Leucovorin: Used to diminish hematologic
effects of methotrexate
– Used in treating certain types of cancer
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Drugs Used in Treating Folic Acid
Deficiency Anemia: Contraindications and
Precautions and Interactions
• Folic acid, leucovorin: Contraindicated for
treating pernicious anemia, other anemias in
which vitamin B12 is deficient
• Used cautiously within RDA guidelines
• Pregnant women: With folate deficiency are at
increased risk for complications of pregnancy,
fetal abnormalities
• Signs of folate deficiency: Occur when
sulfasalazine administered concurrently
• Increase in seizure activity: Occur when folic
acid is administered with hydantoins
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Drugs Used in Treating Vitamin B12
Deficiency Anemia: Actions, Uses,
Adverse Reactions
• Vitamin B12 used to treat patients with a
vitamin B12 deficiency; also used to perform
the Schilling test
• Adverse reactions: Mild diarrhea, itching;
increase in RBC production; acne; peripheral
vascular thrombosis; congestive heart
failure; pulmonary edema
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Drugs Used in Treating Vitamin B12
Deficiency Anemia: Contraindications,
Precautions, and Interactions
• Contraindicated in patients allergic to
cyanocobalamin
• Administered cautiously during pregnancy, in
patients with pulmonary disease, anemia
• Alcohol, neomycin, colchicine decrease the
absorption of oral vitamin B12
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Nursing Process: Assessment
• Preadministration assessment:
– Obtain general health history, asks about
symptoms of anemia
– Take vital signs to provide baseline
during therapy
– Physical assessments: patient’s general
appearance and, in severely anemic
patient, evaluation of patient’s ability to
carry out activities of daily living
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Nursing Process: Assessment
• Ongoing Assessment:
– Monitor patient for adverse reactions;
reports any occurrence of adverse
reactions to primary health care provider
before next dose is due
– Inform patient that color of stool will
become darker or black
– Assess the patient for relief of symptoms
of anemia
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Nursing Diagnoses
• Fatigue- related to dilutional anemia caused by fluid
retention
• Imbalanced Nutrition: Less Than Body
Requirements- related to lack of iron, folic acid,
other (specify) in the diet
• Constipation- related to adverse reaction to iron
therapy
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Nursing Process: Planning
• The expected outcome include:
– Optimal response to therapy:
– Supporting the patient needs related to
the management of adverse reactions
– Understanding of and compliance with
prescribed treatment regimen
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Nursing Process: Implementation
• Promoting an optimal response to therapy:
– Iron: Check with hospital pharmacist
regarding simultaneous administration of
iron salts with other drugs; monitor:
patient for allergic response for at least 1
hour after test dose and before
administering remaining dose
– Vitamin B12: patients with vitamin B12
anemia are treated with vitamin
administered by parenteral route weekly
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Nursing Process: Implementation
• Promoting an optimal response to therapy
(cont’d):
– Epoetin alfa: Monitor blood pressure
closely; report any rise of 20 mm Hg or
more in systolic; diastolic pressure to
primary health care provider
– Monitor Hct**
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Nursing Process: Implementation
• Monitoring and managing patient needs:
– Altered nutrition: Recommend: Balanced
diet with emphasis on foods that are high
in iron, folic acid (collards, greens, salmon,
chicken, wheat bread)
– Constipation: Instruct patient to increase
fluid intake to 10 to 12 glasses of water
daily, eat a diet high in fiber, and increase
activity
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Nursing Process: Implementation
• Educating the patient and family:
– Explain medical regimen thoroughly to
patient and family
•Emphasize importance of following the
prescribed treatment regimen
– Iron:
•Take this drug with water on empty
stomach, if gastrointestinal upset
occurs, take drug with food or meals
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Nursing Process: Implementation
• Educating the patient and family:
– Iron (cont’d):
•This drug causes darkening of stools,
constipation, or diarrhea; if constipation
or diarrhea becomes severe, contact
primary health care provider
•Iron deficiency occurs: Cause must be
determined and therapy should be
under the care of a health care provider
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Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Epoetin alfa:
•Strict compliance with antihypertensive
drug regimen: Important in patients
with known hypertension during epoetin
alfa therapy
•Adverse reactions: Dizziness;
headache; fatigue; joint pain; nausea;
vomiting; diarrhea -Report adverse
reactions
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Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Leucovorin:
•Megaloblastic anemia: Adhere to diet
prescribed by the primary health care
provider
•If purchase of foods high in protein
becomes a problem, discuss this with
primary health care provider
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Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Vitamin B12:
•Nutritional deficiency of vitamin B12:
Eat a balanced diet that includes
seafood, eggs, meats, and dairy
products
•Pernicious anemia: Lifetime therapy is
necessary, avoid contact with
infections, report any signs of infection
to primary health care provider
immediately
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Nursing Process: Evaluation
• Therapeutic effect of the drug is achieved
• Patient has normal bowel movements
• An adequate nutritional intake is achieved
• Patient and family demonstrate an
understanding of the drug regimen
• Patient verbalizes the importance of
complying with the prescribed treatment
regimen
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