NURS 133 Avonex (Interferon Beta 1A) and Glatiramer Acetate (Copaxone)

jasmine's version from 2016-06-07 23:59

Section 1

Question Answer
Interferon beta-1a (Avonex) Anti-multiple sclerosis agents; Immune modifiers; Anti-inflammatory; Interferons; Pregnancy category C; Relapsing forms of multiple sclerosis;
Avonex actions Anti-viral and immune-regulatory properties produced by interacting with specific receptor sites on cell surfaces may explain beneficial effects; Produced by recombinant DNA technology
Avonex therapeutic uses Reduce incidence of relapse (neurologic dysfunction) and slow physical disability; Used to treat multiple sclerosis (MS)
Elimination/Excretion of Avonex Unknown
Adverse/Side Effects of Avonex Seizures (increase with interferon beta-1a), depression, dizziness, fatigue, headache, insomnia; Sinusitis; Constipation, nausea, vomiting abdominal pain; Cystitis; Rashes; Menstrual disorders; Neutropenia; Injection-site reactions; Myalgia; anaphylaxis, chills, fever, flu-like symptoms, pain
Contraindications of Avonex Hypersensitivity to natural or recombinant interferon beta or human albumin
Use Avonex cautiously in History of suicide attempt or depression; History of seizures (interferon beta-1a); cardiovascular disease; congestive HF (may worsen HF); Liver disease (interferon beta-1a); History of alcohol abuse (interferon beta-1a); Patients with child-bearing potential; OB: May increase risk of spontaneous abortion; use only if potential maternal benefit outweighs potential fetal risk; Lactation: Safety not established; Pedi: Safety not established
Drug/Food interactions of Avonex All following interactions for interferon beta-1b (Betaseron, Extavia): Increase myelosuppression may occur with other myelo-suppressives including anti-neoplastics; Concurrent use of hepatotoxic agents may increase the risk of hepatoxicity (increase liver enzymes); Avoid concomitant use with immune-modulating natural products such as astragalus, Echinacea, and melatonin
Medication administration of Avonex IM; Subcut
Nursing interventions of Avonex Assess frequency of exacerbations of symptoms of multiple sclerosis periodically during therapy; Monitor patient for signs of depression during therapy. If depression occurs, notify health care professional immediately-discontinuation therapy should be considered; Lab test considerations: Monitor hemoglobin WBC, platelets, and blood chemistries including liver function tests prior to and 1, 3, and 6 months after initiation of therapy and periodically thereafter; Therapy may be temporarily discontinued if the absolute neutrophil count is less than 750/mm^3, if AST or ALT exceeds 10 times the upper limit of normal, or if serum bilirubin exceeds 5 times the upper limit of normal; Once the absolute neutrophil count is greater than 750/mm^3 or the hepatic enzymes have returned to normal, therapy can be restarted at 50 percent of the original dose; Thyroid function tests should be monitored every 6 months, especially in patients with a history of thyroid abnormalities
Client education of Avonex Home care issues: Instruct patient in correct technique for injection and care and disposal of equipment; Caution patient not to reuse needles or syringes and provide patient with a puncture proof resistant container for disposal; Instruct patient to take medication as directed; Patients should receive medication guide with each product; Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur; Inform patient that flu-like symptoms (fever, chills, myalgia, sweating, malaise) may occur during therapy-Acetaminophen may be used for relief of fever and myalgias; Advise patient to notify health care professional if pregnancy is planned or suspected-may cause spontaneous abortion
Evaluation/Desired outcomes of Avonex Decrease in the frequency of relapse (neurologic dysfunction) in patients with relapsing-remitting multiple sclerosis
Potential nursing diagnoses of Avonex Deficient knowledge, related to medication regimen (patient/family teaching)

Section 2

Question Answer
Glatiramer acetate (Copaxone) Immuno-modulator; Pregnancy category B; Used to treat relapsing forms of multiple sclerosis (MS); Composed of four amino acids found in myelin basic protein
Glatiramer acetate actions Stops body from damaging its own nerve cells (myelin); Immuno-modulatory effect of Glatiramer acetate to alter T-cell differentiation, promoting development of Th2-poloarized GA-reactive CD4 (+) T-cells, which may dampen neighboring inflammation within the central nervous system; also, exerts immune-modulatory activity on antigen presenting cells, which participate in innate immune responses (Weber, Hohlfeld, & Zamvil, 2007); May also be considered for selected patients with first attack who are at high risk for MS; May be useful in patients who do not respond adequately to or who do not tolerate interferon beta therapy (Copazone, 2016)
Glatiramer acetate therapeutic uses Used to reduce episodes of symptoms in patients with relapsing-remitting forms (course of disease where symptoms flare up from time to time) of multiple sclerosis disease in which the nerves do not function properly and people may experience weakness, numbness, loss of muscle coordination, and problems with vision, speech, and bladder control
Elimination/Excretion of Glatiramer acetate Substantial portion of sub-Q dose appears to be hydrolyzed locally at injection site to small oligopeptides and free amino acids (Copazone, 2016); Urinary excretion is major elimination pathway
Adverse/Side Effects of Glatiramer acetate Common adverse effects: Asthenia, back pain, flu-like syndrome, infection, pain, arthralgia; Anxiety, hypotonia; Chest pain, palpitations, vasodilation; Diarrhea, nausea,; Dyspnea, rhinitis; Rash, pruritus, sweating; Post-infection reaction (flushing, chest pain, palpitations, anxiety, dyspnea, constriction of throat, urticarial), injection site reactions (erythema, hemorrhage, pain, pruritus, urticarial, swelling), lymphadenopathy (Glatiramer Acetate, n.d.); Injection site reactions (e.g., pain, erythema, inflammation, pruritus, mass, edema, hypersensitivity, fibrosis, atrophy or lipoatrophy, necrosis), vasodilation, rash, dyspnea, chest pain; May cause fever, chills, sore throat, cough, stuffy nose, redness, pain, swelling, or painful urination; Development of IgG antibodies to glatiramer reported in most patients, however data to date indicate antibodies do not neutralize therapeutic effects (Copazone, 2016)
Contraindications of Glatiramer acetate Known hypersensitivity to glatiramer acetate or mannitol; History of asthma or other respiratory disorders; Lactation: Unknown-use with caution in nursing women; Pedi: Safety and efficacy not established in pediatric patients less than 18 years of age; Geri: Not studied in geriatric patients
Drug/Food interactions of Glatiramer acetate Natalizumab increases risk of a serious viral infection of the brain that can lead to disability or death-risk higher if have weak immune system or receiving certain medications
Medication administration of Glatiramer acetate Subcut
Nursing interventions of Glatiramer acetate Monitor for therapeutic effectiveness: indicated by longer remission periods and reduced frequency of attacks; Assess for systemic post-injections-assure patient reaction is self-limiting; Assess for local reactions at injection sites including erythema, itching, induration, and soreness; Monitor for S & S of compromised immune response (e.g., increasing frequency of infections) (Glatiramer Acetate, n.d.)
Client education of Glatiramer acetate Advise patients the importance of reading the manufacturer’s patient information prior to beginning therapy and re-reading it each time prescription is refilled; Instruct patient and family in proper injection techniques, and avoiding reuse of syringes and needles and proper disposal of such equipment in a puncture resistant container after use; Advise patient that glatiramer acetate may cause various symptoms after injection, including flushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, and urticarial-Inform patient symptoms are usually transient and self-limited and do not require specific treatment-Inform patient reactions may occur early or begin several months after initiation of treatment, and they may experience one or several episodes of symptoms; Advise patient that they may experience chest pain either as part of an immediate post-injection reaction or without other symptoms-inform pain should be transient (usually lasting only for a few minutes [30 seconds to 30 minutes]: May require no treatment); Advise patient to notify health care professional if experience chest pain of unusual duration or intensity; Advise patient about adverse/side effects, including instruct to withhold glatiramer acetate and notify health care professional immediately if hives, skin rash with irritation, dizziness, sweating, chest pain, breathing difficulty, or severe pain at the injection site occurs, and to seek emergency treatment if severe; Advise patient to follow proper injection technique and rotate injection areas and sites on a daily basis; Advise patient to notify health care professional if plan to become pregnant or breast feed; Advise patient to notify health care professional prior to adding unknown OTC drugs; Emphasize importance of regular exams to monitor for side effects (Copaxone, 2016)
Evaluation/Desired outcomes of Glatiramer acetate Decrease in the frequency of relapse (neurologic dysfunction) in patients with relapsing-remitting multiple sclerosis
Potential nursing diagnoses of Glatiramer acetate Deficient knowledge, related to medication regimen (patient/family teaching)