Week 5
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Dec 6, 2023
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Pharm 3 Week 5
Cyclosporine
Classification
: Immunosuppressant
Therapeutic Effects
: autoimmune disorders
MOA
: inhibits the function of calcineurin - a protein phosphatase 3 which
activates T Cells of the immune system. Works in bone marrow
Adverse Effects
: nephrotoxicity, HTN, tremor, hirsutism, liver impairment, HA,
bleeding gums, leukopenia, thrombocytopenia
Interactions
: CYP - many drug interactions
Contraindications
: thrombocytopenia, neutropenia, hepatic impairment requires
dose adjustment, active infections, HTN can worsen with therapy
Nursing
Considerations
: draw baseline RFP/LFT and throughout treatment, CBC
and hold if leukocytes less than 4,000, platelets less than 7,500, concern for
malignancy with long term use, watch for reactivation for dormant viruses and
avoid direct sun exposure
Methotrexate
Classification
: Immunosuppressant
Therapeutic
Effects
: autoimmune disorders
MOA
: interferes with the specific S phase cycle of cell replication by blocking the
enzyme which converts folic acid to folate
Adverse
Effects
: N/V, hepatotoxic, PCP pneumonia and opportunistic infections
Interactions
: many drug interactions, food delays absorption of PO form,
echinacea increases risk of hepatotoxicity, caffeine may decrease effects of MTX
when taken for RA
Contraindications
: NSAIDS
, UC, stomatitis, diarrhea, pancytopenia, impared renal
or hepatic functions, active infections, pregnancy and lactation
Nursing
Considerations
: leucovorin rescues the cells from overdose or potential
harm when the body is unable to clear MTX, the normal cells allow leucorvin to
enter their cells thus replication of “good” cells as cancer dies, long time use can
cause liver cirrhosis, baseline CBC/LFT/RFP and throughout treatment
Hydroxychloroquine
Classification
: Antirheumatic / Animalarial / DMARD
Therapeutic
Effects
: autoimmune disorders, RA
MOA
: reduces the movement of neutrophils and eosinophils which causes
swelling and destruction, may inhibit synthesis of histamines and prostaglandins
Adverse
Effects
: N/V, weight loss, blurred vision, photophobia, black-out-areas,
fatigue, anxiety, vertigo, bleaching or hair loss, HA, mood changes
Interactions
: magnesium/aluminum antacids decrease the absorption, increased
liver damage when given with other hepatotoxic drugs, refrain from alcohol,
digoxin
Contraindications
: administering concurrent with cimetidine, may cause digoxin
toxicity, hepatic impairment, renal insufficiency, metabolic acidosis
Nursing
Considerations
: baseline ophthalmology exam and follow up annually,
baseline RFP/LFT and throughout treatment, refrain from drinking alcohol, can
cause GI upset give with food or milk
Etanercept, Infliximab, Adalimumab
Classification
: TNF Blockers/ TNF Inhibitor
MOA:
Neutralizes and prevents the action of tumor necrosis factor
Adverse
Effects
: injection site swelling, bruising, upper respiratory infections,
neutropenia
, can cause or worsen HF, risk for malignancy
Etanercept
: SubQ twice a week (concurrent with sulfasalazine, can cause
leukopenia)
Infliximab
: IV infusion over several hours with MTX for RA followed by SubQ
injections week 2, 6, 8 and every 8 thereafter, premedicate with Tylenol and
benadryl to decrease chest pain/tachycardia/SOB/lightheadedness
Adalumumab
: SubQ twice a week, rotate sites, give at 45 degree angle
Nursing
Considerations
: RARE - can cause MS, risk for infection and malignancy,
TB test prior to administration
Gabapentin
Classification
: GABA analogs
Therapeutic
Effects
: autoimmune disorders
MOA
: unknown (believed to affect calcium channels)
Adverse
Effects
: CNS- drowsiness, fatigue, dizziness, nystagmus, suicidal ideations
Interactions
: concurrent use with morphine sulfate/hydromorphone increases
CNS depression
Contraindications
: during pregnancy or lactation, renal impairment
Nursing
Considerations
: can cause emotional lability, aggression, hostility,
impaired cognition, discontinue slowly to minimize withdrawal associated with
seizures, overdose may cause dyspnea, slurred speech, sedation, double vision,
avoid giving/monitor closely with patients with suicidal ideations
Pregabalin
Classification
: GABA Analogs
Therapeutic
Effects
: autoimmune disorders
MOA
: unknown (thought to increase GABA levels by reducing the calcium
channels functions of the neurons in the brain)
Adverse
Effects
: dizziness, drowsiness, blurred vision, lethargy, dry mouth,
peripheral edema, weight gain, decreased attention span, sui
cidal ideations
Interactions
: few
Contraindications
: cautious use in patients with renal impairment
Nursing
Considerations
: renal impaired patients require reduction to minimize
toxicity, schedule 5 medication which has increased risk for dependence,
discontinued over one week, with or without meals, avoid giving/monitor closely
with patients with suicidal ideations
Betaseron / Interferon Beta 1b
Classification
: Immunomodulator, immune modifier, anti-multiple sclerosis agent
Therapeutic
Effects
: MS
MOA
: unknown (thought to suppress T Cells and cytokines inflammatory
response) - minimizes inflammatory response
Adverse
Effects
: flu-like symptoms (body aches, feverish), injection site reactions
common, leukopenia, HA, insomnia, rash, increased liver enzymes, peripheral
edema
Interactions
: Zidovudine (AZT), levels can become toxic with concurrent
treatment
Contraindications
: sensitivity, albumin, mannitol
Nursing
Considerations
: monitor for signs of suicidal thoughts/depression
,
injection site inflammation can develop into necrosis, baseline LFT and throughout
treatment, given Subcut, reconstituted, if refrigerated: allow it return to room
temp prior to administration.
Cyclobenzaprine
Classification
: Skeletal Muscle Relaxant / Central Acting Antispasmodic
Therapeutic
Effects
:
MOA
: increases norepinephrine activity by blocking reuptake
to produce an anticholinergic effect
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