Biologic agents: Nursing pharmacology

Biologic agents are a group of medications used to treat various inflammatory conditions, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis, and Crohn’s disease.

Now, biologic agents can be broken down into two main classes: tumor necrosis factor, or TNF blockers, which include etanercept, infliximab, and adalimumab; and interleukin inhibitors, which include interleukin- 1 or IL-1 inhibitors, like anakinra, interleukin- 6, or IL-6 inhibitors, like tocilizumab, and interleukin- 17A, or IL-17A inhibitors, like secukinumab.

These biologic agents are administered subcutaneously, and as their names suggest, the way they work is by inhibiting their respective inflammatory cytokines, so TNF, IL-1, IL-6, or IL-17A, ultimately preventing them from attaching to their receptors.

As a result, these medications help suppress the immune response in clients with inflammatory conditions.

Now, clients on biologic agents might develop a skin rash or injection site reactions, such as erythema, mild pain, and discomfort.

A major side effect of biologic agents is bone marrow suppression, which can put the client at increased risk of infection.

In fact, most TNF blockers have a boxed warning for the development of severe infections, such as tuberculosis, as well as lymphoma and other neoplastic diseases.

Additionally, TNF blockers have been associated with headaches and demyelination of the nervous system, as well as myocardial infarction, heart failure, stroke, hypotension, and some clients may develop hypersensitivity reactions, such as Stevens Johnson syndrome or toxic epidermal necrolysis.

In contrast, interleukin inhibitors might lead to arthralgia and gastrointestinal disturbances, such as nausea, vomiting, or diarrhea.

As far as contraindications go, biologic agents should be used with caution during pregnancy and breastfeeding, as well as in children and elderly clients.

In addition, they are contraindicated in clients with an active infection or sepsis. In particular, most of these medications have a boxed warning for use in clients with infections like tuberculosis, hepatitis B, and invasive fungal infections.

TNF blockers should also be used with caution in clients with seizures or demyelinating disorders like multiple sclerosis, and are contraindicated in those with heart failure; while interleukin inhibitors should be used with caution in clients with hepatic or renal disease, immunosuppression, or neoplastic disease.

Now, if a client with an inflammatory condition, such as Crohn’s disease, is prescribed a biologic agent, such as the TNF blocker infliximab, first perform a baseline assessment of their current symptoms, bowel habits, and nutritional status.

Next, assess your client’s weight, vital signs, and SpO2. In addition, review their laboratory test results, including CBC, liver function tests, BUN, creatinine, and antinuclear antibody or ANA titer; also, be sure to confirm that the client doesn’t currently have an active infection, especially tuberculosis, hepatitis B, and invasive fungal infections.

Lastly, review their medical record to ensure all of their immunizations are up to date before administering a biologic agent.

Before administration, explain to your client how the medication works to help decrease their inflammatory symptoms, such as bowel pain and cramping for those with Crohn disease.

Then, ensure emergency equipment is readily available in case a hypersensitivity reaction to the medication occurs.

Calculate the prescribed dose in mL/hr, confirm your IV tubing has an in-line 1.2 micron filter, and start an infusion of 0.9% normal saline.