NURS-106 Final Exam Questions With Accurate
Complete Solutions
Which |cells |are |involved |in |cellular |immunity?
T-cells |AKA |T-lymphocytes
Why |would |we |want |to |use |an |immunosuppressant |on |someone?
When |are |they |contraindicated?
• |prevent |rejection |of |transplant
• |auto-immune |diseases
• |some |chronic |conditions
Contraindicated: |
• |renal |failure
• |hepatic |failure
• |HTN
• |concurrent |radiation |therapy
• |caution |in |pregnancy
• |NO |live |vaccines!
**regardless |of |contraindications, |patient |may |need |an |immunosuppressant |anyway**
How |do |cellular |immunosuppressants |work?
they |inhibit |T-cells
remember |that |corticosteroids |do |this |too |and |are |considered |immunosuppressants |as |well
What |are |the |common |black |box |warnings |for |immunosuppressants?
They |have |many |black |box |warnings! |
The |most |common |one |is |bone |marrow |suppression |which |includes |many |AEs |on |its |own: |
,• |suppress |RBCs, |prone |to |anemia
• |suppress |WBC, |prone |to |infection
• |decrease |platelets, |prone |to |bleeding
Immediately |associate |bone |marrow |suppression |with |immunosuppressants!
• |increased |risk |for |cancer, |especially |skin |cancer
---teaching: |avoid |UV |light, |wear |hats, |sunscreen, |protective |clothing, |have |frequent |skin |
inspections
• |new |onset |diabetes |risk
----teaching |s/sx |diabetes, |BG |screening
• |hepatic |impairment
---assess |jaundice, |ascites, |platelet |count, |discolored |urine, |labs
• |renal |impairment
---monitor |urinalysis, |bedside |urine |dipsticks, |output
• |fatal |infections
General |AEs |for |most |immunosuppressants?
Remember |lots |of |black |box |warnings |(on |their |own |card)
• |risk |for |opportunistic |infections
-----often |fungal |(UTI, |yeast |infection, |thrush)
-----opportunistic |cancer
• |HTN
• |fluid |retention
• |pulmonary |edema
• |hepatotoxicity
• |nephrotoxicity
• |neurotoxicity |including |tremors
,• |leukopenia, |thrombocytopenia
more |on |p |758 |- |table |48.2, |these |are |the |ones |she |explicitly |mentioned
General |interactions |for |immunosuppressants?
Remember |increased |risk |for |interactions |because |patients |are |on |these |for |a |lifetime
• |narrow |therapeutic |window
• |grapefruit!! |can |inhibit |metabolism, |increasing |level |of |drug |in |blood |= |toxic!
• |St |John's |Wort |can |cause |organ |rejection |by |reducing |therapeutic |levels
• |Cat's |claw |and |echinacea |work |against |by |boosing |immune |system
Teaching |for |immunosuppressants
• |MUST |be |taken |exactly |as |ordered
• |EXACT |time |each |day |with |exact |foods |as |ordered
• |NEVER |stop |immunosuppressants
• |NURSE: |never |be |late |on |these |with |med |admin!
• |usually |a |complex |regimen |with |multiple |medications |that |may |be |taken |at |different |times |
each |day, |lots |of |planning
• |do |not |interchange |brand |names |or |dosage |forms
What |is |cytokine |release |syndrome?
What |drug |class |is |this |a |worry |for?
• |allergy-like |reaction, |can |be |severe |up |to |anaphylaxis
, • |if |we |know |there |is |risk |for |this, |we |will |premedicate |with |antihistamines |and/or |steroids |as |
prophylaxis
S/sx:
• |fever
• |dyspnea
• |tachycarida
• |sweating
• |chills
• |headache
• |N/V/D
• |muscle |pain
• |joint |pain
• |general |malaise
Immunosuppressants |= |risk |for |cytokine |release |syndrome
Cyclosporine |(Sandimmune)
Class?
Used |for?
Important |to |remember?
Black |box?
AEs?
Admin/teaching?
Immunosuppressant
Tx |of |some |immunologic |disorders |like |psoriasis, |rheumatoid |arthritis, |IBD
NOT |interchangeable |between |brand |names!
Remember: |
• |Narrow |therapeutic |range |- |monitor |serum |drug |level
• |increased |risk |of |skin |cancer
• |increased |risk |of |fatal |infection
Complete Solutions
Which |cells |are |involved |in |cellular |immunity?
T-cells |AKA |T-lymphocytes
Why |would |we |want |to |use |an |immunosuppressant |on |someone?
When |are |they |contraindicated?
• |prevent |rejection |of |transplant
• |auto-immune |diseases
• |some |chronic |conditions
Contraindicated: |
• |renal |failure
• |hepatic |failure
• |HTN
• |concurrent |radiation |therapy
• |caution |in |pregnancy
• |NO |live |vaccines!
**regardless |of |contraindications, |patient |may |need |an |immunosuppressant |anyway**
How |do |cellular |immunosuppressants |work?
they |inhibit |T-cells
remember |that |corticosteroids |do |this |too |and |are |considered |immunosuppressants |as |well
What |are |the |common |black |box |warnings |for |immunosuppressants?
They |have |many |black |box |warnings! |
The |most |common |one |is |bone |marrow |suppression |which |includes |many |AEs |on |its |own: |
,• |suppress |RBCs, |prone |to |anemia
• |suppress |WBC, |prone |to |infection
• |decrease |platelets, |prone |to |bleeding
Immediately |associate |bone |marrow |suppression |with |immunosuppressants!
• |increased |risk |for |cancer, |especially |skin |cancer
---teaching: |avoid |UV |light, |wear |hats, |sunscreen, |protective |clothing, |have |frequent |skin |
inspections
• |new |onset |diabetes |risk
----teaching |s/sx |diabetes, |BG |screening
• |hepatic |impairment
---assess |jaundice, |ascites, |platelet |count, |discolored |urine, |labs
• |renal |impairment
---monitor |urinalysis, |bedside |urine |dipsticks, |output
• |fatal |infections
General |AEs |for |most |immunosuppressants?
Remember |lots |of |black |box |warnings |(on |their |own |card)
• |risk |for |opportunistic |infections
-----often |fungal |(UTI, |yeast |infection, |thrush)
-----opportunistic |cancer
• |HTN
• |fluid |retention
• |pulmonary |edema
• |hepatotoxicity
• |nephrotoxicity
• |neurotoxicity |including |tremors
,• |leukopenia, |thrombocytopenia
more |on |p |758 |- |table |48.2, |these |are |the |ones |she |explicitly |mentioned
General |interactions |for |immunosuppressants?
Remember |increased |risk |for |interactions |because |patients |are |on |these |for |a |lifetime
• |narrow |therapeutic |window
• |grapefruit!! |can |inhibit |metabolism, |increasing |level |of |drug |in |blood |= |toxic!
• |St |John's |Wort |can |cause |organ |rejection |by |reducing |therapeutic |levels
• |Cat's |claw |and |echinacea |work |against |by |boosing |immune |system
Teaching |for |immunosuppressants
• |MUST |be |taken |exactly |as |ordered
• |EXACT |time |each |day |with |exact |foods |as |ordered
• |NEVER |stop |immunosuppressants
• |NURSE: |never |be |late |on |these |with |med |admin!
• |usually |a |complex |regimen |with |multiple |medications |that |may |be |taken |at |different |times |
each |day, |lots |of |planning
• |do |not |interchange |brand |names |or |dosage |forms
What |is |cytokine |release |syndrome?
What |drug |class |is |this |a |worry |for?
• |allergy-like |reaction, |can |be |severe |up |to |anaphylaxis
, • |if |we |know |there |is |risk |for |this, |we |will |premedicate |with |antihistamines |and/or |steroids |as |
prophylaxis
S/sx:
• |fever
• |dyspnea
• |tachycarida
• |sweating
• |chills
• |headache
• |N/V/D
• |muscle |pain
• |joint |pain
• |general |malaise
Immunosuppressants |= |risk |for |cytokine |release |syndrome
Cyclosporine |(Sandimmune)
Class?
Used |for?
Important |to |remember?
Black |box?
AEs?
Admin/teaching?
Immunosuppressant
Tx |of |some |immunologic |disorders |like |psoriasis, |rheumatoid |arthritis, |IBD
NOT |interchangeable |between |brand |names!
Remember: |
• |Narrow |therapeutic |range |- |monitor |serum |drug |level
• |increased |risk |of |skin |cancer
• |increased |risk |of |fatal |infection
