Pharm 236 Ch 40

Front 1

Adequate blood cell production and development are defined as ____________

Back 1

Hematopiesis

Front 2

Immune system function is defined as _______--

Back 2

Immunocompetence

Front 3

Efforts to enhance a persons own body systems to fight disease include the development of drugs to stimulate ___________ and immune function.

Back 3

Hematopsis

Front 4

Drugs that stimulate immune function are called ________, biologic response modifiers, and immunomodulators.

Back 4

Immunostimulants

Front 5

Antiviral drugs are more accurately called ________________ because they help a compromised immune system regain normal function rather than stimulating "supranormal" function.

Back 5

Immunorestoritives

Front 6

A suspension of weaked Mycobacterium bovis long used as an immunizing agent against tuberculosis.

Back 6

Bacillus Calmette - Guerin vaccine

Front 7

A recombinant DNA version of interleukin 2 (IL-2); activates cellular immunity; produces tumor necrosis factor, interleukin -1 (IL-1) and interferon gamma; and inhibits tumor growth.

Back 7

Aldesleukin (Proleukin)

Front 8

Approved for treatment of chronic hepatitis C, a condition that can lead to liver failure and liver cancer

Back 8

Interferon alfa -n1 and alfacon -1

Front 9

Drug formulations of erythropoietin, a hormone from the kidney that stimulates bone marrow production of red blood cells.

Back 9

Darbepoetin alfa (aranesp) and epoetin alfa (Epogen, Procrit)

Front 10

Recombinant IL- 11, which stimulates platelet production; used to prevent thrombocytopenia and to reduce the need for platelet transfusions in patients with cancer who are receiving myelosuppressive chemotherapy.

Back 10

Oprevekin (Neumega)

Front 11

Exogenous drug preparations have the same mechanisms of action as the endogenous products. Describe the mechanism of action.

Back 11

Exogenous drug preparations have the same mechanisms of action as the endogenous products. CSF binds to receptors on the cell surfaces of immature blood cells in the bone marrow and increases the number, maturity, and functional ability of the cells. Interferons called alfa, beta, or gamma according to specific characteristics also bind to specific cell surface receptors and alter intracellular activities. In viral infections they induce enzymes that inhibit protein synthesis and degrade viral ribonucleic acid. As a result, viruses are less able to enter uninfected cells reproduce and release new viruses.

Front 12

Describe the antiproliferative and immunoregulatory activities of interferons.

Back 12

In addition to their antiviral effects interferons also have antiproliferative and immunoregulatory activities. They can increase expression of the major histocompatibility complex (MHC) molecules; augment the activity of natural killer (NK) cells; increase the effectiveness of antigen presenting cells in inducing the proliferation of cytotoxic T cells to target cells; and inhibit angiogenesis (formation of blood vessels). Because of these characteristics, the interferons are used mainly to treat viral infections cancers.

Front 13

Why are exogenous cytokines given only by a subcutanious (Sub - Q) or intravenous (IV) injection?

Back 13

Exogenous cytokines are given by subcutanous (Sub - Q) or intravenous (IV) injection because they are proteins that would be destroyed by digestive enzymes if given orally.

Front 14

What is the function of erythropoietin in the human body?

Back 14

Erythropoietin is a hormone from the kidney that stimulates the bone marrow production of read blood cells.

Front 15

How do antiviral drugs improve the health of clients with the diagnosis of AIDS?

Back 15

In AIDS the human immunodeficiency virus (HIV) causes severe immune system dysfunction, so the antiviral drugs indirectly improve immunologic function.

Front 16

How does epoetin alfa work? How long will the patient have to take it?

Back 16

Epoetin alfa is a drug formulation of a hormone erythropoiesis, from the kidneys that stimulates bone marrow production of red blood cells. Erythropoiesis stimulating drugs have been used to raise the hemoglobin level and reduce the need for blood transfusions in many patients with anemia. Epoetin is prescribed a the lowest dose that is effective in raising hemoglobin levels just enough to avoid the need for blood transfusion. The hemoglobin levels must be regularly monitored until the stabilize.

Front 17

Mrs. Cantons last hemoglobin level was 14grams per deciliter (g/dL). What might this indicate?

Back 17

Studies indicated an increased risk of serious cardiovascular problems (ex hypertension, thromboembolic events) and death in patients with chronic renal failure and an increased risk of tumor progression and death in patients with cancer. These problems became evident with the drugs were used to achieve normal hemoglobin levels of 12 to 14 grams per deciliter. A black box warning for this drug advises prescribers to avoid using Epogen in patients with hemoglobin values of 12g/dL or greater.

Front 18

Filgrastim and some interferons are conjugated with polyethylene glycol, in a process called ___________, to prolong drug actions.

Back 18

Pegylation

Front 19

Mr. Adler prescribed interferon. Which of the following is his diagnosis?

a. Hypertension

b. Viral hepatitis

c. Sepsis

d. Bacteremia

Back 19

b.

Rationale: Interferons are used mainly for viral hepatitis and certain types of cancer.

Front 20

Mr. Smith is diagnosed with severe neutropenia. The physician prescribes filgrastim. Which of the following is the desired effect?

a. To increase white blood cells

b. To increase red blood cells

c. To increase electrolytes

d. To decrease leukocytes.

Back 20

a.

Rationale: Filgrastim is used to increase white blood cells and decrease risks of infection in in patients who have or are at high risk for severe neutropenia.

Front 21

Adverse effects of epoetin and darbepoetin include in creased risks of which of the following conditions?

a. Hyperlipidemia

b. Diabetes mellitus type 2

c. Myocardial infraction

d. Cirrhosis of the liver.

Back 21

c.

Rationale: Adverse effects of epoetin and darbepoetin include increased risks of hypertension, myocardial infraction, and stroke, especially when used to increase hemoglobin above 12dL.

Front 22

Mr. Caisse receiving anticancer drug therapy that damaged his bone marrow. Which of the following medicaitons would you expect his physician to order?

a. Oprelvekin

b. Epoetin

c. Bacillus Calmette - Guerin vaccine

d. Simvastatin

Back 22

b.

Rationale: A drug formulation of erythropoietin is given to increase red blood cells in patients with anemia associated with chronic renal failure or bone marrow damage due to anticancer drug therapy.

Front 23

Mr. Bartholomew is self administering epoetin in the home. You encourage him to include which of the following supplements as part of his daily medication regimen?

a. Iron

b. Vitamin C

c. Vitamin A

d. Folic acid

Back 23

a

Rationale: Epoetin is not effective unless sufficient iron is present, and most patients need an iron supplement. When an iron preparation is prescribed the home care nurse may need to emphasize the importance of taking it.

Front 24

You are caring for Ms. Smith in the home. She is prescribed filgrastim. Which of the following would be included in your education plan?

a. Dietary restrictions

b. Exercise restrictions

c. Fall prevention

d. Techniques to reduce exposure infection.

Back 24

d.

Rationale: With filgrastim, the nurse may need to help the patient and family with techniques to reduce exposure to infection.

Front 25

Mr. brown is prescribed sargramostim. He is diagnosed with liver impairment. Which of the following would you expect the physician to do?

a. Monitor LFTs every 2 weeks.

b. Monitor BUN and creatinine every week.

c. Monitor CBC every other day

d. Monitor electrolytes weekly

Back 25

a.

Rationale: With preexisting hepatic impairment, sargramostim increase serum bilirubin and liver enzymes. Values decline to baseline levels when the drug is stopped or its dosage is reduced. Liver function tests are recommended every 2wks for clients with preexisting impairment.

Front 26

Mr. Cheshire is diagnosed with hepatitis B. The physician orders interferon alfa. Mr. Cheshire is at risk of developing which of the following?

a. Drug tolerance

b. Chronic flank pain

c. Drug resistance

d. Subclinical hepatitis B

Back 26

c.

Rationale: Hepatitis B become chronic in 5 to 10% of patients. Interferon alfa and lamivudine or other antiviral drugs may be used for treatment. Drug resistance may develop, and active hepatitis may resume when the drugs are discontinued.

Front 27

Because _______ can be given once per week and maintains constant blood levels it has largely replaced other interferons for both monotherapy and combination therapy for hepatitis C.

Back 27

peginterferon

Front 28

Before receiving a bone marrow transplant the patient immune system is ___________ by anticancer drugs or irradiation.

Back 28

suppressed

Front 29

Mr. Edward is diagnosed with superficial bladder cancer. They physician orders bacillus calmette gurerin. This drug is administered in which of the following ways?

a. Intravenously

b. Instilled into the urinary bladder

c. Orally

d. Intramuscular

Back 29

b

Rationale: Bacillus calmette guerin when instilled into the urinary bladder of patients with superficial bladder cancer causes remission in up to 82% of patients fro an average of 4yrs.

Front 30

Mr. Black is diagnosed with multiple myeloma. You would expect the physician to order a treatment regimen that includes which of the following?

a. Interferon alfa

b. bacillus calmette guerin

c. filgrastim

d. epoetin

Back 30

a

Rationale: Interferon alfa has demonstrated anti-tumor effects in multiple myeloma, renal cell carcinoma, and others.

Front 31

Mr. Carter id diagnosed with hairy cell leukemia. The physician orders interferon therapy to normalize his WBC. How long does therapy last with this drug?

a. 4 to 6 weeks

b. Indefinitely

c. Until the WBC count is normal for 3 months

d. 6 to 12 months.

Back 31

b

Rationale: In hairy cell leukemia interferons normalize WBC counts in 70 to 90% of patients. Drug therapy must be continued indefinitely to avoid relapse with usually develops rapidly after the drug is discontinued.

Front 32

After Mr. Gordon undergoes bone marrow transfusion, his physician administers sargramostim. When would your expect the first dose to be administered?

a. 30mins after the bone marrow infusion

b. 1hr after the bone marrow infusion.

c. Immediately after the bone marrow infusion

d. 2 to 4 hrs after the bone marrow infusion.

Back 32

d.

Rationale: When sargamostim is given to patients with cancer who have under gone bone marrow transplantation the drug should be stared 2 to 4hrs after the last dose of antineoplastic chemotherapy for 12 hrs after the last radiotherapy treatment.

Front 33

When filgrastim is given to prevent infection in neutropenic patients with cancer the drug should be stared at least _______ hrs after the last dose of the anti-neoplastic agent and continued during the period of bone marrow suppression and recovery.

Back 33

24

Front 34

Mr. Wilson is receiving darbepoetin. The laboratory report indicates that his hemoglobin level increased 2 g/dl in 2 weeks. You would expect the physician to do which of the following?

a. Increase the medicaiton

b. Reduce the medication

c. Maintain the current dose

d. Discontinue the medication.

Back 34

b

Rationale: With darbepoetin and epoetin, dosage is adjusted to achieve and maintain a hemoglobin value of no more than 12g/dL. Dosage should be reduced if the hemoglobin level approaches 12g/dl or increase by more than 1 g/dL in any 2week period.

Front 35

Mrs. Crumb is beginning darbepoetin therapy. How often will the hemoglobin be measured?

a. Weekly until stabilized

b. Twice weekly until stabilized.

c. Monthly until stabilized.

d. Every other day until stabilized.

Back 35

b.

Rationale: With darbepoeitin and epoetin iron stores should be measured before and periodically during treatment. Hemoglobin should be measured twice weekly until the level is stabilized and maintenance drug doses are established.

Front 36

For patients who experience severe adverse reactions with interferon alfa, dosage should be reduced by _________ or administration stopped until the reaction subsides.

Back 36

50%

Front 37

With most of the hematopoietic and immunostimulant drugs, a CBC with WBC differential and ______ should be done before and during treatment to monitor response and prevent avoidable adverse reactions.

Back 37

Platelet count