Drugs for Modifying Biologic Response

1. Drugs for Modifying Biologic Response Lana Chase RN,MN,CS.

2. Biologic Modifiers • Medications that are naturally occuring proteins used to alter the body’s: • Hemotologic and immunologic responses • 4 Types of Drugs

3. 4 Classifications of Agents • 1. Hematopoietic Growth Factors • epotin alpha (Epogen) 2. Cytokines • interferon Alpha 2a (Roferon-A) • 3. Poly / Mono Clonal Antibodies • rutiximab (Rituxan) • 4. Immune Modulators • cylclsporine (Sandimmune)

4. Hematopoietic Cells • Located in the bone marrow and produce: • RBC’s- carry oxygen to cells (Hg) • WBC’s-protect against infection • granulocytes , monocytes, lymphocytes • Platelets - assist in blood clotting • Erythropoietin is produced in kidneys secondary to hypoxia and acts in bone marrow on stem cells. • Epogen has identical action • .

5. Barrier Defenses • Skin – 1st line of defense • Mucus membranes • GI Tract –acid protector • If a pathogen gets past one of these, and injures a cell, the body initiates a non specific inflam. reaction.

6. Specific Immune Response • 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

7. Immunity • 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.)

8. Hemotologic Failure • 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

9. Immune Dysfunction • Weaken immune system: • 1. Neoplasms- mutant cell growth • 2. Viral invasion HIV-changes cell membrane • 3. Autoimmune Disease- making antibodies against self cells • 4. Organ Transplantation- reaction to foreign cells

10. Hematopoietic Growth Factors • 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

11. Other Hematopoietic Agents • 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

12. Chemical Mediators • Cytokines: released by WBC’s due to antigentic invasion of blood or tissues. • Interferon alpha 2a (Roferon-A) • Hairy Cell leukemia Karposi Sarcoma: • inhibits growth of tumor cells, prevents their multiplication, 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

13. Polyclonal Monoclonal Antibiodies • Rituximab: a monoclonal antibiody that binds specifically to CD20 antigen on t;he surface of Malignant B lymphocytes and causes cell lysis • 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.

14. Immune Suppresant • 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