Ch 34 Drugs Affecting The Immune Response

The best response is "It is given in the evening with something to help you sleep so you will not feel the minor discomforts that the drug can cause." This response explains that diphenhydramine is given in the evening to help the patient sleep and minimize any discomfort that may be caused by interferon alfa-2a. It provides a clear and concise explanation for the timing and purpose of the medication.

The correct answer is "They are both from the same class of drugs, so the names sound alike, but the drugs are not used for the same purposes." This response addresses the patient's concern by explaining that although the names of the drugs may sound similar, they belong to the same class of drugs but are used for different purposes. It reassures the patient that there is no indication of having cancer based solely on the similarity in drug names.

The correct answer is "Cyclosporine can cause damage to your kidneys." This response is the best because it directly addresses the patient's concern about why the clinic is interested in their kidneys. Cyclosporine is a medication commonly prescribed after organ transplantation to prevent rejection, but it can have side effects on the kidneys. By providing this information, the healthcare provider acknowledges the patient's concern and educates them about the potential risk associated with their medication.

Mixing cyclosporine with grapefruit juice is incorrect because grapefruit juice can interact with cyclosporine and increase its concentration in the blood, leading to potential toxicity. It is important to avoid grapefruit juice while taking cyclosporine to prevent adverse effects.

The patient teaching for a patient receiving interferon alfa-2a to treat Kaposi sarcoma related to AIDS should include all of the above options. Teaching the patient how to give a subcutaneous (SC) injection is important to ensure proper administration of the medication. Additionally, teaching the patient how to avoid infections is crucial as individuals with AIDS are more susceptible to infections. Lastly, instructing the patient on when to return for blood tests is necessary to monitor the effectiveness and potential side effects of the medication.

Before administering rituximab (Rituxan), the nurse should check the prescriber's orders for premedications to reduce the severity of infusion reactions. Infusion reactions are common with rituximab and can range from mild to severe. Premedications such as antihistamines, corticosteroids, and acetaminophen may be prescribed to help prevent or minimize these reactions. By checking the prescriber's orders for premedications, the nurse ensures that the patient receives the appropriate medications to reduce the severity of infusion reactions and promote a safer administration of rituximab.

Interferon alfa-2a is a protein-based medication that is not suitable for oral administration (PO) because it would be broken down by the digestive system before it can be absorbed into the bloodstream. Therefore, IV (intravenous), IM (intramuscular), and SC (subcutaneous) routes are more appropriate for administering interferon alfa-2a as they allow direct absorption into the bloodstream, ensuring its therapeutic effects.

Interferon alfa-2a (Roferon-A) is a medication that is commonly used to treat hairy cell leukemia. However, it can also be used to treat Kaposi sarcoma, a type of cancer that affects the skin and mucous membranes. This cancer is often seen in individuals with weakened immune systems, such as those with HIV/AIDS. Therefore, interferon alfa-2a may be prescribed to help manage the symptoms and progression of Kaposi sarcoma. It is not typically used as a treatment for breast cancer, lung cancer, or Hodgkin's disease.

Rituximab is known to cause infusion-related reactions such as fever, chills, and hypotension. By administering the cefamandole either 2 hours before or after the rituximab, it helps to minimize the risk of potential drug interactions and infusion-related reactions. This allows for the safe administration of both drugs without compromising their effectiveness. Infusing both drugs at the same time or piggybacking the cefamandole into the rituximab may increase the risk of adverse reactions and should be avoided.

Cyclosporine is known to have a common yet serious adverse effect on the renal system. This means that it can negatively affect the kidneys and their functions. It is important to monitor renal function closely when using cyclosporine to prevent any potential damage or complications in the kidneys.

Patients receiving interferon-2a should have monthly lab testing to monitor their health and detect any potential side effects or complications. This includes a complete blood count (CBC) to assess red and white blood cell levels, a white cell differential to evaluate different types of white blood cells, and liver and kidney function tests to assess the functioning of these organs. However, urinalysis is not typically necessary for monitoring patients receiving interferon-2a, as it primarily focuses on assessing the urine for abnormalities and may not provide relevant information for this specific treatment.

Patients receiving rituximab may experience infusion-related reactions, including hypertension. Therefore, it is important to avoid administering antihypertensive medication for 12 hours before and 12-24 hours after rituximab administration. This allows the patient's blood pressure to be monitored closely during the infusion and ensures that any potential hypertensive reactions can be managed effectively.

The correct answer is ventricular tachycardia, supraventricular tachycardia, angina, hypotension, and hypertension. These symptoms are indicative of infusion reaction syndrome, which can occur in patients receiving rituximab. Ventricular tachycardia and supraventricular tachycardia are abnormal heart rhythms that can be caused by the medication. Angina, hypotension, and hypertension are also potential side effects of rituximab infusion. It is important for the nurse to assess the patient for these symptoms in order to monitor their condition and provide appropriate interventions if necessary.

The nurse should not administer antihypersensitive medications immediately after the rituximab infusion is completed. This is because rituximab is known to cause infusion-related reactions, such as hypersensitivity reactions. Administering antihypersensitive medications immediately after the infusion can mask the symptoms of these reactions and potentially delay appropriate treatment. It is important to closely monitor the patient during the infusion and hold administration of antihypersensitive medications for 12 hours before rituximab administration to minimize the risk of adverse reactions.

The correct answer is "I will drink plenty of water" because rituximab is known to cause dehydration as a side effect. Drinking plenty of water can help prevent this side effect and maintain proper hydration levels. The other responses are unrelated to the instructions given after the administration of rituximab.

The correct answer is to administer the 15 mg/kg/day as ordered. This is because the postoperative orders specifically state to give 15 mg/kg/day PO beginning tomorrow. It is important to follow the physician's orders and administer the correct dosage as prescribed. Assuming it was a transcription error or contacting the physician for a new order without clarification would not be appropriate in this situation. Requesting a different medication, Neoral, is also not necessary as the current medication, Sandimmune, is already being used.

Patients being treated with interferon alfa-2a for hairy cell leukemia should be monitored for hypothyroidism. Interferon alfa-2a can affect the function of the thyroid gland, leading to reduced production of thyroid hormones. Hypothyroidism can cause symptoms such as fatigue, weight gain, cold intolerance, and dry skin. Monitoring for hypothyroidism allows for early detection and appropriate management of the condition.

A significantly elevated blood urea nitrogen (BUN) level should be the most concerning finding while the patient receives cyclosporine. Cyclosporine can have nephrotoxic effects, meaning it can cause damage to the kidneys. An elevated BUN level indicates impaired kidney function and can be a sign of kidney damage. Monitoring BUN levels is important to ensure the drug is not causing harm to the kidneys. Therefore, a significantly elevated BUN level should be a cause for concern and may require adjustments to the cyclosporine dosage or additional interventions to protect the kidneys.

Cyclosporine is a medication that is known to suppress the immune system. It specifically targets and inhibits the activity of T lymphocytes, which are a type of white blood cell involved in cell-mediated immune responses. These responses are responsible for coordinating the immune system's attack on infected or abnormal cells. By suppressing cell-mediated immune reactions, cyclosporine helps to prevent the immune system from attacking healthy cells and tissues, making it an effective treatment for various autoimmune diseases and preventing organ rejection in transplant patients.

The correct answer is that these are the expected symptoms that occur with approximately 80% of patients. This is because rituximab, a monoclonal antibody used to treat certain types of cancer and autoimmune diseases, is known to cause infusion-related reactions. These reactions can include fever, flushing, chills, and rigors. It is important for healthcare providers to be aware of these potential side effects and to monitor patients closely during rituximab infusions. Stopping the drug immediately may not be necessary unless the reaction is severe or life-threatening.

The most frequent adverse effects of interferon alfa-2a therapy are confusion, lethargy, and flu-like symptoms. These symptoms are commonly reported by patients undergoing this therapy. Confusion and lethargy can be attributed to the effects of interferon on the central nervous system, while flu-like symptoms such as fever, chills, muscle aches, and fatigue are typical side effects of interferon treatment.

The central nervous system should assume priority for the patient receiving rituximab because this medication has been associated with the development of serious central nervous system adverse reactions, including severe infections and progressive multifocal leukoencephalopathy. It is important to assess for any signs or symptoms of these adverse reactions, such as changes in mental status, confusion, difficulty speaking or understanding speech, weakness, or loss of coordination. Prompt recognition and management of these adverse reactions is crucial to ensure patient safety.

During administration of aldesleukin, monitoring the level of consciousness is important because aldesleukin can cause central nervous system toxicity. This can manifest as confusion, disorientation, agitation, and even coma. Monitoring the level of consciousness allows the nurse to detect any changes and take appropriate action to prevent further complications. Monitoring blood pressure, cardiac rhythm, and heart rate are also important, but the level of consciousness is specifically mentioned as a priority in this case.

The patient's symptoms of fever, flushing, and feeling cold suggest an infusion reaction to rituximab. Turning off the infusion is the best initial response to prevent further adverse reactions and assess the patient's condition. Providing warm blankets and ice chips may help with comfort, but it does not address the underlying cause of the reaction. Seeking an order for acetaminophen may be appropriate to manage the fever, but it does not address the infusion reaction itself. Turning down the rate of infusion may not be sufficient to prevent or manage the reaction, so turning off the infusion is the most appropriate action.

Patients taking interferon alfa-2a should be carefully assessed for depression because this medication is known to have psychiatric side effects. Interferon alfa-2a can cause mood changes, including feelings of sadness, irritability, and even suicidal thoughts. Therefore, it is important to monitor patients closely for signs of depression and provide appropriate support and treatment if necessary.

Bevacizumab is a monoclonal antibody that targets the protein responsible for stimulating new blood vessel formation. This protein is called vascular endothelial growth factor (VEGF), and it plays a crucial role in angiogenesis, the process by which new blood vessels are formed. Bevacizumab binds to VEGF, preventing it from binding to its receptors on blood vessel cells and inhibiting the formation of new blood vessels. This can be beneficial in treating certain types of cancer, as tumors rely on the formation of new blood vessels to receive nutrients and oxygen for growth.

Administering the drug by IV infusion using a pump is the correct answer because it allows for precise control of the infusion rate, which can help minimize adverse effects. Rituximab is known to cause infusion-related reactions such as fever, chills, and rigors. By using a pump, the drug can be delivered at a controlled rate, reducing the risk of these adverse effects. Antipyretics may be administered if needed to manage any fever that occurs during or after the infusion. There is no mention of administering a high dose initially and then tapering the dose, so this option can be ruled out.