Immunosuppressants for autoimmune diseases: Nursing pharmacology

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Notes

Notes

IMMUNOSUPPRESSANTS TO TREAT AUTOIMMUNE DISEASES
DRUG NAME
prednisone, dexamethasone
belimumab, azathioprine, methotrexate, hydroxychloroquine
CLASS
Systemic corticosteroids
Immunosuppressants
MECHANISM OF ACTION
Blunt inflammatory process → prevent and limit severity of flares → limit organ damage
INDICATIONS
Rheumatoid arthritis, systemic lupus erythematosus, other autoimmune diseases
ROUTE(S) OF ADMINISTRATION
  • PO
  • IM
  • IV
  • PO
  • IM
  • IV
  • SubQ
SIDE EFFECTS
  • Bone marrow suppression
  • Increased risk for infections
  • Drowsiness
  • Fatigue
  • Nausea
  • Injection site reactions
  • Acne
  • Mood changes
  • Muscle weakness
  • Hyperglycemia
  • Weight gain (face and trunk)
  • Osteoporosis, pathological fractures
  • Auditory and visual changes
  • Cardiotoxicity
  • Hepatotoxicity
  • Nausea, vomiting, diarrhea
  • Suicidal ideations
  • Alopecia
  • Photosensitivity
  • Hypersensitivity reactions (e.g., Stevens-Johnson syndrome)
CONTRAINDICATIONS AND CAUTIONS
  • Active infections
  • Bone marrow suppression
  • Glaucoma
  • Peptic ulcer disease
  • Heart failure
  • Diabetes mellitus
  • Osteoporosis
  • Certain psychiatric conditions
  • Active infections
  • Bone marrow suppression
  • Pregnancy (boxed warning for methotrexate)
  • Breastfeeding
NURSING CONSIDERATIONS:
IMMUNOSUPPRESSANTS TO TREAT AUTOIMMUNE DISEASES
DRUG NAME
hydroxychloroquine for SLE
ASSESSMENT AND MONITORING
Assessment
  • Vital signs, current symptoms
  • Laboratory test results: renal and hepatic function, CBC, ANA, ESR, CRP, urinalysis
  • Diagnostic test results: imaging studies, ECG, ophthalmologic exam

Monitoring
  • Periodic laboratory test results, ECG, ophthalmologic exam results
  • Evaluation: improvement in symptoms, a report of fewer disease flares, and decreased disease-related organ damage
CLIENT EDUCATION
  • Purpose of medication: help reduce pain and inflammation, decrease symptoms, decrease flares, reduce organ damage
  • Take their medication with food or milk
  • May take several weeks before they start to feel better
  • Take the medication exactly as prescribed; if dose is missed, do not double doses
  • Avoid alcohol during therapy
  • Side effects
    • Photophobia, photosensitivity
    • Urine to turn a rusty brown color
    • Immediately report changes to vision, hearing, skin; hematological problems
    • Routine ophthalmologic exams are required

Transcript

Autoimmune diseases occur when the immune system mistakenly attacks various tissues and organs around the body, such as in systemic lupus erythematosus and rheumatoid arthritis.

Often there are periods of illness, called flares, and periods of remission during which there are few or no symptoms. Unfortunately, autoimmune diseases can’t be cured, but their symptoms can be treated with a variety of systemic immunosuppressant medications.

Okay, immunosuppressants to treat autoimmune diseases include corticosteroids like prednisone or dexamethasone, monoclonal antibodies like belimumab, immunomodulators like azathioprine, antimetabolites like methotrexate, and antimalarials like hydroxychloroquine.

These medications can be taken orally, or injected as intravenously, intramuscularly, or less commonly, subcutaneously. Once administered, immunosuppressants primarily work by blunting the inflammatory process so that it can’t cause damage to healthy tissues, and preventing or limiting the severity of flares.

Unfortunately, some of these medications can also increase the risk of side effects like bone marrow suppression, which can lead to anemia, thrombocytopenia, and leukopenia, as well as increased risk for infections. Some clients may also experience drowsiness, fatigue, and gastrointestinal disturbances, such as anorexia, nausea, vomiting, and diarrhea.

Sources

  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
Elsevier

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