What is Erythopoiesis?

_______ are involved in blood coagulation.

What is the formation of granulocytes called?

What is myelopoiesis stimulated by?

What cells are produced in response to infection, inflammation, and tissue damage or necrosis.

The activating the nonspecific inflammatory reaction includes activation of:

granulocytes and macrophages

to destroy foreign antigens and repair tissue damage

neutrophils 

This rise in neutrophils includes both mature and immature (bands)

What is neutropenia an indication of?

the patient is at greater risk for infection.

a specific immune response involving T and B lymphocytes is initiated.

What is hematopoietic failure?

the inadequate production of cells to meet the body’s need for oxygen transportation, blood coagulation, and/or prevention of infection.

What can Anemia be caused by?

lack of folic acid, iron, erythopoietin or bone marrow suppression.  Or, anemia can be the result of red blood cell hemolysis or through the loss of blood volume.  

Anemia caused by the lack of

erythropoietin can be treated with: 

exogenous erythropoietin or epoetin alfa.

What is the 2nd pathophysiologic consequence of hematopoietic failure?

decreased bone marrow activity and

reduces neutrophil survival.  

drug therapy such as antineoplastic agents.

What is the final pathophysiologic consequence

of hematopoietic failure?

a condition that involves a low platelet count

a result of decreased production, shortened survival, or loss of platelets

What is Epoetin alfa commonly used to treat?

zidovudine theripy

(Zidovudine is an antiviral medication that prevents human immunodeficiency virus (HIV) cells from multiplying in your body.)

chemotherapy induced anemia in cancer

 and patients who are high risk for substantial surgical blood loss.

How is Epoetin alfa Eliminated?

Epoetin alfa has the same effect on the body as endogenous erythropoietin.

True or Fales?

What type of pts should not use epoetin alfa?

uncontrolled hypertension

patients with hypersensitivity to mammalian cell-derived products or human albumin

patients with chronic renal 

Why should the use of epoetin alfa  be avoided in

patients with chronic renal failure?  

to iron or folate deficiency, hemolysis, or bleeding.

As these anemias are treated differently.

Why should a nurse determine the patient’s iron status before starting epoetin?

iron is needed to support erythropoiesis.

To maximize therapeutic effect and maintain the biologic activity of epoetin alfa, it is important that the nurse knows this about epoetin alfa?

Vigorous _____ of epoetin alfa can denature the glycoprotein, which makes it biologically inactive.

shaking

preservatives 

so it is important to discard any unused portion.

hematocrit

blood pressure for hypertension 

purpose of the drug 

the need for follow-up hematocrits

increase iron intake to aid in the effectiveness of the drug 

iron is best absorbed with ascorbic acid

iron should not be taken with phosphate binders.

Filgrastim or (Neupogen)

cancer patients to increase their neutrophil counts

patients with non-myeloid malignancies and who are receiving meylosuppressive chemotherapy

as a single daily subcutaneous injection,

short intravenous infusion (over 15-30 minutes) or

by continuous subcutaneous or intravenous infusion.

What is the only consistently reported adverse  

side effect of filgastrim?

To maximize the therapeutic effects of filgastrim it is important for the nurse to keep the medication atroom temperature  and allow the drug to reach refrigerated temperature before administration. 

True or Fales?

Fales.

To maximize the therapeutic effects of filgastrim it is important for the nurse to keep the medication refrigerated and allow the drug to reach room temperature before administration. 

5% dextrose with albumin to prevent absorption by plastic materials.

Absorption into plastic materials such as IV container and tubing. 

Filgastrim is preservative free and requires that the nurse discard any vial that has been at room temperature for more than 24 hours.

True or Fales? 

filgastrim is a multi-dose vial and that unused medication should be refrigerated.  

True of Fales?

Fales

filgastrim is a single-dose vial and that unused medication should be discarded.

filgastrim

patient and family education :

Neutropenic patients are at extreme risk for infection

importance of frequent handwashing, avoiding crowds and avoiding people with illnesses.

temperature- may indicate an infection

white blood cell count - to evaluate relative risk of infection and effectiveness of treatment.

platelet

and is the prototype for interleukins

platelet transfusions (FFP)

for patients with

myelosuppressive chemotherapy 

nonmyeloid malignancie

to stimulate the production of megakaryocytes and thrombopoietin, both of which stimulate the production of platelets.

hypersensitivity to the drug or any of its components.

fluid retention -weight gain, peripheral edema, dyspnea, hemodilution, and an increased incidence of pleural effusion

Fluid overload- can lead to cardiovascular complications such as tachycardia, palpitations, syncope, and atrial dysrythmias.

cardiac status

(atrial fibrillation and flutter )

True or Fales?

It is important for the nurse to keep

the powdered drug (oprelvekin) and diluent refrigerated.

it is important to keep oprelvekin out of direct light

True or fales?

preservative free, sterile water for injection diluent

that is provided with the drug.  

Why must the nurse not shake or

agitate the vial of Oprelvekin?

.  The nurse should gently swirl the vial or slowly roll vial between hands.

Why is it important for the nurse not to reenter or

reuse single dose oprelvekin?

because neither the drug nor the sterile water used to dilute the medication contains preservative

it will go bad 

when must oprelvekin be administed by

after reconstitution?

What must the nurse to closely monitor through Oprelvekin

  treatment?

platelet count - until greater than or equal to 50,000 cells/mm3.

bleeding- include petichiae, echymosis and guiac positive stools

How are Biologic modulators or modifiers classified?

What are Cytokines?

What is the prototype cytokine drug?

What is interferon alfa-2a, brand name Roferon-A

used for?

used to treat certain leukemia and autoimmune disorders.

What two type of Antibodies

  are there in drug theripy?

rituximab, brand name Rituxan.  

 Immune modulators are a group of several

drugs that are used for what?

cyclosporine

brand name: Sandimmune, Neoral and SangCya.

spleen, liver, lungs, gastrointestinal tract and brain

hemopoietic cells, such as lymphocytes, Leukocytes

 cytotoxic T cells

helper T cells

suppresor T cells

B cells-

 When the antibodies react with the foreign antigen, an antigen-antibody complex is forms which enables the complement to do what?

further destroy the foreign antigen.  

****This reaction also induces chemotaxis, which makes the foreign antigen more attractive for phagocytosis.

interferons-prevent viral replication and suppress malignant cells and tumor growth

interleukins- activates more T and B cells.

Initially, B lymphocytes, also called B cells, produce antibodies to attack a specific foreign antigen.  After this initial response, the B cells produce memory B cells that are able to immediately produce antibodies whenever a foreign antigen is encountered.  

This is referred to as what?

active immunity

***and is the basis of immunizationing against various viral infections.

malignancies: Kaposi sarcoma, chronic myelogenous leukemia. 

viral infections: hepatitis C and cytomeglovirus. 

subcutaneously or intramuscularly,

although intravenous administration is indicated in some instances.

by inhibiting the growth of tumor cells and by blocking the replication of a virus in the body.

a history of hypersensitivity to interferon or its components exists. 

 during pregnancy or lactation should be avoided.

What is a common side effect of interferon alfa 2A?

hypothyroidism, as it may occur in up to 10% of cases.

An increased incidence of theophylline toxicity occurs if the patient is taking interferon alfa 2A at the same time as theophylline.

**Theophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases

Interferon alfa-2A can cause toxicity when combined with drugs that are neurotoxic, hematotoxic and cardiotoxic.

what is this due to?

cardiovascular, pulmonary and neurological disorders,

as these conditions may exacerbate the adverse effects of this treatment. 

hypothyroidism (before and after)

Why is it  important to assess the patient’s blood glucose before/ during/ after  administering interferon alfa-2A?

glucose intolerance 

hypothyroidism- T3 T4 TSH

bone marrow suppression- CBC

 liver damage-  liver function tests

the nurse to obtain baseline blood counts and chemistries

prior to administering interferon alfa-2A

These include:

Why is isimportant for the nurse to ensure adequate sleep and proper nutrition for the pt on interferon alfa-2A?

It is important for the nurse to follow treatment guidelines such as premedicating patients with drugs to reduce the adverse side effects of the drug. 

Premedication drugs include:

acetaminophen-Tylenol 

diphenhydramine- Benadryl

*to reduce flu-like effects of interferon alfa-2A.

T/F

During treatment (interferon alfa-2A ) the patient should observe infection precautions.

rituximab

brand name Rituxan.

several different kinds of cancer and a variety of autoimmune disorders.

How is rituximab administrered?

hypersensitivity or anaphylaxis to the drug or any of its components

epecially murine proteins.

What are the infusion related adverse effects of rituximab?

respiratory distress and hypotension

occur in up to 80% of all patients

What patients are advised not to have of any type during treatment with rituximab?

Why?

 vaccines

because of potential drug interactions and risk for allergic and anaphylactic reactions.

Before stating rituximab what is important for the nurse to assess for in the  patient?

pre-existing cardiac

 respiratory problems 

***This drug should be administered cautiously in patients with these types pre-existing conditions

cardiac dysrythmias, angina, hypo and hypertension and worsening respiratory status.

Why should mixing Rituximab

 in a glass container be avoided?

the antibodies adhere to glass and alters the amount of drug administered.

All antibodies can produce allergic reactions.

True or fales

As a reslute of all antibodies can produce allergic reactions,

What are the usual

administration guidelines for  Rituximab?

premedicating: acetaminophen and diphenhydramine,

 emergency resusitation equipment: corticosteroids, and adrenaline readily available. 

It is important for patients with cardiac and respiratory risk factors to have continuous cardiac monitoring and frequent assessment during infusion.

What is the prototype for Immune modulators?

cyclosporine (Sandimmune and Neoral)

organ transplantation to prevent the body’s immune system from destroying the grafted foreign tissue, such as a transplanted kidney, and in

autoimmune disorders, in which the body attacks its own tissue.

hypersensitivity to castor oil

Kidny disfunctions- there is a significant risk for nephrotoxicity

What are the most common adverse side effects of cyclosporine?

renal damage, tremors, hirsutism, hypertension, and gingival or gum hyperplasia

risk for malignancies, especially that of skin cancer, is increased

Hirsutism is a condition where women have excess facial and body hair that is dark and coarse.  

hepatic and renal function

CBC and differential 

blood pressure 

tremors, seizures, mental status, visual disturbances

A high fat diet 

Therefore, it is important for the nurse to assess the patient’s fat intake.

The nurse should monitor blood levels of cyclosporine to avoid toxicity.

True or Fales? 

intravenously,

however, the oral form should be used as soon as possible to achieve steady blood levels

The nurse should never mix oral cyclosporine with  

any type of juice.

True or Fales?

Fales

The nurse should mix oral cyclosporine with a juice to increase the palatability

However, this medication should not be refrigerated or mixed with grapefruit juice

It is important for the patient to not take cyclosporine with foods, especially foods high in fat.

True or Fales?

Wah should the nurse do if the boold test of Cyclosporine

 comes bake high or there are sings of toxicity?

After the adminastation of Cyclosporine what are the interventions the nurse should have in place?

protect the patient from exposure to infection

assess the patient for neurotoxicity and hypertension.

Waht teaching should a nurse

give to a pt on Cyclosporine?