Immunomodulators: Nursing pharmacology

00:00 / 00:00

Notes

IMMUNOMODULATORS, PART 1/2
DRUG NAME
peginterferon alfa-2a (Pegasys); interferon alfa-2b; interferon beta-1a (Avonex); interferon beta-1b (Betaseron, Extavia)
aldesleukin (Proleukin)
*High Alert Medication*

CLASS
Interferons
Interleukin
MECHANISM of ACTION
  • Inhibit viral replication
  • Antitumoral effect
  • Enhanced immune response
  • Stimulate cellular immunity
  • Antitumoral effect
  • Increased platelet count 
INDICATIONS
  • Treatment of chronic hepatitis C and B (rarely used)
  • Treatment of multiple sclerosis in adults
  • Treatment of hairy cell leukemia, AIDS-related Kaposi sarcoma
  • Treatment of metastatic renal carcinoma and melanoma (aldesleukin)
ROUTE(S) of ADMINISTRATION
  • All: SubQ
  • Interferon beta-1b: IM
  • Aldesleukin: IV
SIDE EFFECTS
All: 
  • Neurotoxicity (headache, fatigue, anxiety, depression, suicidal ideation) 
  • GI toxicity (nausea, vomiting, diarrhea, abdominal pain)
  • Dermatological toxicity (rash, pruritus, alopecia)
  • Fever
  • Flu-like symptoms
  • Musculoskeletal pain
  • Injection site reactions
Interferon alpha 2b and peginterferon alpha 2a:
  • Boxed warning: aggravating life-threatening neuropsychiatric, autoimmune, infectious and ischemic conditions
  • Boxed warning: capillary leak syndrome
  • GI toxicity 
  • Fever
  • Coughing, dyspnea
  • Rash, pruritus
  • Cardiac SE: tachycardia, arrhythmia, edema

CONTRAINDICATIONS & CAUTIONS
  • Pregnancy
  • Breastfeeding
Caution in clients with prior cardiac disease, severe renal or hepatic impairment, myelosuppression, and compromised CNS function
Caution in clients with cardiac arrhythmias, respiratory disorders, renal or hepatic impairment
IMMUNOMODULATORS, PART 2/2
DRUG NAME
trastuzumab (Herceptin); infliximab (Remicade);
rituximab (Rituxan)
*High Alert Medications*

imatinib (Gleevec);
dasatinib (Sprycel)
*High Alert Medications*

CLASS
Monoclonal antibodies
Small-molecule inhibitors
MECHANISM of ACTION
Bind to specific antigens on the cell surface, signalling the immune system to attack and destroy targeted cells
Bind to and inhibit extracellular and intracellular proteins involved with cell growth and death
INDICATIONS
  • Targeted therapy for various cancers
  • Treatment of certain inflammatory disease
  • Targeted therapy for various cancers
ROUTE(S) of ADMINISTRATION
All: IV
All: PO
SIDE EFFECTS
All:
  • Fever
  • Fatigue
  • Headache
  • Insomnia
  • Cardiovascular (hypertension, flushing, edema)
  • Dermatological (rash, exfoliative dermatitis, pruritus)
  • GI toxicity (nausea, diarrhea, abdominal pain, stomatitis)
  • Respiratory toxicity (coughing, dyspnea)
  • Hematologic disturbances (anemia, leukopenia, thrombocytopenia)
  • Muscle and joint pain

trastuzumab:
  • Boxed warnings: cardiomyopathy, infusion reactions, pulmonary toxicity, pregnancy
  • Decreased left ventricular ejection fraction
  • Infections

rituximab:
  • Boxed warnings: infusion-related reactions; mucocutaneous reactions; hepatitis B virus reactivation → fulminant hepatitis; progressive multifocal leukoencephalopathy

infliximab:
  • Boxed warnings: increased risk of serious infections; risk of secondary malignancy
  • Hepatotoxicity
  • Fever
  • Edema
  • GI toxicity
  • Dermatological reactions (rash, pruritus, alopecia)
  • Muscle and joint pain
  • CNS dysfunction
  • Cardiac toxicity
  • Interstitial lung disease
  • Bone marrow suppression

CONTRAINDICATIONS & CAUTIONS
  • Pregnancy
  • Breastfeeding

Caution:
  • Geriatric population
  • Renal impairment
  • Treat active infections before starting therapy
  • imatinib: use with caution in people with thyroid disease; gastric surgery in the past
NURSING CONSIDERATIONS for IMMUNOMODULATORS
ASSESSMENT & MONITORING
Assessment and monitoring: interferon alpha-2b

Assessment
  • Vital signs
  • Assess skin and mucous membranes
  • Laboratory test results: CBC, glucose, TSH levels, and  liver and renal function tests

Monitoring
  • Side effects
  • Evaluate the therapeutic effect of their medication: improvement in Kaposi sarcoma
CLIENT EDUCATION
  • Purpose of medication: interferes with the development of Kaposi sarcoma
  • Take consistently three times each week
    • In the evenings just before bedtime
    • Subcutaneous injection
    • Missed dose
      • Take as soon as they remember
      • Do not take two days in a row or take a double dose
      • Contact their healthcare provider right for questions about what to do
    • Store vials in the refrigerator; allow it to come to room temperature before administration
    • Injection technique
    • Proper syringe disposal
    • Stay well hydrated
  • Side effects
    • Injection site for irritation
      • Cool compresses can help reduce swelling or pain
    • Report
      • Mental status changes: confusion, depression, hallucinations, suicidal thoughts
      • Hepatotoxicity: fatigue, anorexia, abdominal pain, dark urine, yellowing of the skin or eyes
      • Endocrine problems: hyperglycemia, hyperthyroidism

Transcript

Watch video only

Immunomodulators are medications that modify the body’s immune response. According to their main effect, immunomodulators can be subdivided into immunostimulants, which are used to enhance the immune response against a specific pathogen or cancer cell; and immunosuppressants, which include monoclonal antibodies used in the targeted treatment against certain types of cancer; and tyrosine kinase inhibitors used for diseases such as leukemias and gastrointestinal tumors.

Now, let’s begin with immunostimulants, which include interferons and interleukins, among other agents. Interferon medications mimic the effects of natural interferons, which are tiny proteins released by virally infected cells. As their name implies, they “interfere” with viral replication, thereby helping cells fight off viral infections. Additionally, they inhibit tumor growth and enhance the immune response.

Interferon medications can be administered subcutaneously or intramuscularly, and they include interferon alpha-2b, which can be used for the treatment of disorders like hairy cell leukemia or AIDS-related Kaposi sarcoma, as well as interferon beta-1a and interferon beta-1b, which can be used for the treatment of relapsing multiple sclerosis.

Moving on, interleukins are tiny signaling proteins that are similar to interferons; they communicate between cells to stimulate cellular immunity, inhibit tumor growth, and increase the production of platelets. One medication called aldesleukin is a human recombinant interleukin 2 agent, which means it acts like interleukin 2 would, promoting the proliferation and activity of various types of lymphocytes. Aldesleukin is administered intravenously, and can be used for treatment of metastatic melanoma or metastatic renal cancer.

Elsevier

Copyright © 2024 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Cookies are used by this site.

USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.

RELX