Transcript Drugs for Modifying Biologic Response

Drugs for Modifying Biologic
Response
Lana Chase RN,MN,CS.
Biologic Modifiers
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Medications that are naturally occuring
proteins used to alter the body’s:
 Hemotologic and immunologic responses
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4 Types of Drugs
4 Classifications of Agents
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1. Hematopoietic Growth Factors
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epotin alpha (Epogen)
2. Cytokines
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3. Poly / Mono Clonal Antibodies
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interferon Alpha 2a (Roferon-A)
rutiximab (Rituxan)
4. Immune Modulators
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cylclsporine (Sandimmune)
Hematopoietic Cells
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Located in the bone marrow and produce:
 RBC’s- carry oxygen to cells (Hg)
 WBC’s-protect against infection
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granulocytes , monocytes, lymphocytes
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Platelets - assist in blood clotting
 Erythropoietin is produced in kidneys secondary
to hypoxia and acts in bone marrow on stem cells.
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Epogen has identical action
Barrier Defenses
Skin – 1st line of defense
 Mucus membranes
 GI Tract –acid protector
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If a pathogen gets past one of these, and
injures a cell, the body initiates a non
specific inflam. reaction.
Specific Immune Response
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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
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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
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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
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Weaken immune system:
 1. Neoplasms- mutant cell growth
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2. Viral invasion HIV-changes cell membrane
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3. Autoimmune Disease- making antibodies
against self cells
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4. Organ Transplantation- reaction to foreign cells
Hematopoietic Growth Factors
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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
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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)
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 Hairy Cell leukemia Karposi Sarcoma:
– inhibits growth of tumor cells, prevents their multiplication,
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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
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Rituximab: a monoclonal antibiody that
binds specifically to CD20 antigen on t;he
surface of Malignant B lymphocytes and
causes cell lysis
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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
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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