biologic response–modifying and antirheumatic drugs

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Biologic ResponseModifying and Antirheumatic Drugs. Immunomodulators (IMs). Include drugs from several classes Immunosuppressants Immunizing drugs Biologic response modifiers (BRMs) Hematopoietic drugs Immunomodulating drugs. Immunomodulating Drugs. - PowerPoint PPT Presentation

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  • Biologic ResponseModifying and Antirheumatic Drugs *Winter 2013

  • Immunomodulators (IMs)Include drugs from several classesImmunosuppressantsImmunizing drugs

    Biologic response modifiers (BRMs)Hematopoietic drugsImmunomodulating drugs*Winter 2013

  • Immunomodulating DrugsMedications that therapeutically alter a patients immune response to malignant tumor cells

    Drugs that modify the bodys own immune response so that it can destroy various viruses and cancerous cells*Winter 2013

  • Biologic Response Modifiers (BRMs)Fourth part of cancer therapy, in addition to:SurgeryChemotherapyRadiation

    Also used for other diseasesAutoimmuneInflammatoryInfectious*Winter 2013

  • BRMs: SubclassesHematopoietic drugsInterferons (IFNs)Monoclonal antibodiesInterleukin receptor agonists and antagonistsDisease-modifying antirheumatic drugsMiscellaneous drugs*Winter 2013

  • Therapeutic Effects of BRMsRegulation or enhancement of the immune response

    Cytotoxic or cytostatic activity against cancer cells

    Inhibition of metastases, prevention of cell division, or inhibition of cell maturation*Winter 2013

  • Hematopoietic Drugs HDs promote the synthesis of various types of major blood components by promoting the growth, or differentiation, and function of their precursor cells in the bone marrow

    Produced by rDNA technology

    *Winter 2013

  • Hematopoietic Drugs (contd)HDs are used to: Decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopeniaEnable higher doses of chemotherapy to be givenOther uses*Winter 2013

  • Hematopoietic Drugs (contd)Erythropoietic drugsepoetin Alpha (Epogen, Procrit)darbepoetin Alpha (Aranesp)Colony-stimulating factors (CSFs)filgrastim (Neupogen)pegfilgrastim (Neulasta)sargramostin (Leukine)Platelet-promoting drugsoprelvekin (Neumega)

    *Winter 2013

  • Hematopoietic Drugs (contd)epoetin Alpha (Epogen, Procrit)Synthetic derivative of the hormone erythropoietinPromotes the synthesis of RBCs by stimulating RBC precursors*Winter 2013

  • Hematopoietic Drugs (contd)darbepoetin Alpha (Aranesp)Longer-acting form of epoetin AlphaAlso used to stimulate RBC production*Winter 2013

  • Hematopoietic Drugs (contd)filgrastim (Neupogen)Granulocyte colony-stimulating factor (G-CSF)Stimulates precursor cells for the type of WBCs known as granulocytespegfilgrastim (Neulasta)Longer-acting form of filgrastim*Winter 2013

  • Hematopoietic Drugs (contd)sargramostim (Leukine)Stimulates bone marrow precursor cells that make both granulocytes and phagocytic (cell-eating) cells; known as monocytesGranulocyte-macrophage colony-stimulating factor (GM-CSF)*Winter 2013

  • Hematopoietic Drugs (contd)oprelvekin (Neumega)Also classified as an interleukin (IL-11)Stimulates bone marrow cells (megakaryocytes) that eventually become platelets*Winter 2013

  • Hematopoietic Drugs:IndicationsUsed in patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemotherapy

    *Winter 2013

  • Hematopoietic Drugs:Indications (contd)Decrease the duration of low neutrophil counts, thus reducing the incidence and duration of infections

    Enhance the functioning of mature cells of the immune system, resulting in greater ability to kill cancer cells as well as viral- and fungal-infected cells

    *Winter 2013

  • Hematopoietic Drugs:Indications (contd)Also enhance RBC and platelet counts in patients with bone marrow suppression resulting from chemotherapy

    Allow for higher doses of chemotherapy, resulting in the destruction of a greater number of cancer cells*Winter 2013

  • Hematopoietic Drugs:Adverse EffectsUsually mildFeverMuscle achesBone painFlushingOthers

    *Winter 2013

  • Hematopoietic Drugs: EpoetinFDA warningIncreased adverse effects when used by patients with higher-than-normal hemoglobinHeart attackHeart failureStrokeDeath

    *Winter 2013

  • Hematopoietic Drugs:InteractionsFilgrastim and sargramostim should not be given within 24 hours of myelosuppressive antineoplastic therapy

    These two types of drugs will directly antagonize each other*Winter 2013

  • Interferons (IFNs)Proteins with three basic propertiesAntiviralAntitumorImmunomodulatingUsed to treat certain viral infections and cancer*Winter 2013

  • Interferons (contd)Manufactured from Escherichia coli bacteria with rDNA technology

    Also obtained from pooled human leukocytes that have been stimulated by synthetic and natural antigens*Winter 2013

  • Interferons (contd)Recombinantly made IFNs are identical to the IFNs that are present within the human body and have the same properties

    IFNs protect human cells from viruses and prevent cancer cells from dividing and replicating*Winter 2013

  • Interferons: IndicationsViral infectionsGenital warts, hepatitis

    CancerChronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposis sarcoma, malignant melanoma

    Autoimmune disordersMultiple sclerosis, others*Winter 2013

  • Interferons: Adverse EffectsFlulike effectsFever, chills, headache, myalgia

    Dose-limiting adverse effect is fatigue

    Other adverse effectsAnorexiaDizzinessNauseaVomitingDiarrhea

    *Winter 2013

  • Interferons (contd)Three major classes of IFNsAlphaBetaGamma*Winter 2013

  • Interferons (contd)Interferon alpha products: leukocyte interferonsproduced from human leukocytes

    Interferon Alpha-2a, Interferon Alpha-2bInterferon Alpha-n3, Interferon Alphacon-1Peginterferon Alpha-2aPeginterferon Alpha-2b*Winter 2013

  • Interferons (contd)Interferon beta productsIFN beta-1aIFN beta-1bInterferon gamma productsInterferon gamma-1b

    *Winter 2013

  • Monoclonal Antibodies (MABs)Used to target specific cancer cells

    Minimal effect on healthy cells

    Fewer adverse effects than traditional antineoplastic medications

    Used to treat cancers and rheumatoid arthritis*Winter 2013

  • *Winter 2013

  • Monoclonal Antibodies (MABs) (contd)Cancer treatmentalemtuzumab (Campath)bevacizumab (Avistatin)cetuximab (Erbitux)gemtuzumab ozogamicin (Mylotarg)

    Other disease processes, including rheumatoid arthritisadalimumab (Humira)infliximab (Remicade)natalizumab (Tysabri)*Winter 2013

  • Monoclonal Antibodies (MABs) (contd)Mechanisms of action and adverse effects vary with each drug

    Used for specific types of cancer and in organ transplantation

    Extremely specific drugs that target certain tumor cells and bypass normal cells*Winter 2013

  • Interleukins and Related DrugsBeneficial antitumor action

    Interleukin receptor agonistsaldesleukin (IL-2, Proleukin)oprelvekin (IL-11, Neumega)*denileukin diftitox (Ontak)

    IL-1 receptor antagonistanakinra (Kineret)

    *Also classified as an HD

    *Winter 2013

  • Interleukins (contd)Aldesleukin acts indirectly to stimulate or restore immune response

    Aids in causing T cells to multiply, including lymphokine-activated killer (LAK) cells

    LAK cells recognize and destroy only cancer cells, and ignore normal cells

    Used for metastatic renal cell carcinoma and malignant melanomaUnder study for use in other types of cancer*Winter 2013

  • Interleukins: Capillary Leak SyndromeSevere toxicity of aldesleukin therapyCapillaries lose ability to retain vital colloids in the blood; these substances are leaked into the surrounding tissues

    Result: massive fluid retentionRespiratory distressHeart failureMIDysrhythmias

    Reversible after interleukin therapy is discontinued*Winter 2013

  • Interleukins (contd)denileukin diftitox

    IL-2 receptor antagonist (IL-2Ra)Binds to cell-surface IL-2 receptors on normal as well as certain malignant cellsCauses cell death*Winter 2013

  • Interleukins (contd)anakinra (Kineret)

    IL-1 receptor antagonist Used to control symptoms of rheumatoid arthritis*Winter 2013

  • Rheumatoid ArthritisAutoimmune disorder causing inflammation and tissue damage in joints

    Diagnosis primarily symptomatic

    Treatment consists of NSAIDs and disease-modifying antirheumatic drugs *Winter 2013

  • Antirheumatoid Arthritis DrugsAlso known as disease-modifying antirheumatic drugs (DMARDs)

    Slow onset of actionseveral weeks

    May take 3 to 6 months to see full effects

    Can have much more toxic adverse effects than NSAIDs

    Antiinflammatory, antiarthritic, immunomodulating effects*Winter 2013

  • Antirheumatoid Arthritis Drugs (contd)Methotrexate

    etanercept (Enbrel)

    abatacept (Orencia)

    leflunomide (Arava)*Winter 2013

  • Antirheumatoid Arthritis Drugs (contd)etanercept (Enbrel)Used to treat rheumatoid arthritis (including juvenile RA) and psoriasis

    Patients must be screened for latex allergy (some dosage forms may contain latex)

    Onset of action: 1 to 2 weeks

    Contraindicated in presence of active infectionsReactivation of hepatitis and TB have been reported*Winter 2013

  • Antirheumatoid Arthritis Drugs (contd)abatacept (Orencia)Used to treat rheumatoid arthritis

    Caution if history of recurrent infections or COPD

    Patients must be up-to-date on immunizations before starting therapy

    May increase risk of infections associated with live vaccines

    May decrease response to vaccines*Winter 2013

  • Nursing Implications (contd)Teach patients to report signs of infection immediatelySore throatDiarrheaVomitingFever over 100 F*Winter 2013

    *****************************************