NURS 133 Etanercept and Belimumab

jasmine's version from 2016-06-07 23:51

Section 1

Question Answer
Etanercept Anti-rhematics; Anti-TNf agents; Pregnancy category B; To decrease progression, signs and symptoms of rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, psoriatic arthritis or plaque psoriasis when response has been inadequate to other disease-modifying agents; *May be used with other agents
Etanercept actions Binds to tumor necrosis factor (TNF), making it inactive; TNF is a mediator of inflammatory response
Etanercept therapeutic uses Decreased inflammation and slowed progression of arthritis, spondylitis, or psoriasis
Elimination/Excretion of Etanercept Unknown
Adverse/Side Effects of Etanercept Headache; Rhinitis; Upper respiratory tract infection; Injection site reactions; Infections (including reactivation tuberculosis and other opportunistic infections due to bacterial, invasive fungal, viral, mycobacterial, and parasitic pathogens); Malignancy (including lymphoma, Hepatosplenic T-Cell Lymphoma (HSTCL), leukemia, and skin cancer); Sarcoidosis (chronic disease of unknown cause characterized by the enlargement of lymph nodes in many parts of the body and the widespread appearance of granulomas derived from the reticuloendothelial system
Contraindications of Etanercept Hypersensitivity; Active infection (including localized); Lactation: Lactation; Untreated infections; Granulomatosis with polyangiitis (receiving immunosuppressive agents) (Polyangiitis: ill-defined autoimmune disease characterized by a systemic, pauci-immune, necrotizing, small-vessel vasculitis without clinical or pathological evidence of necrotizing granulomatous inflammation); Concurrent cyclophosphamide or anakinra (interleukin 1 receptor antagonist)
Use Etanercept cautiously in History of chronic or recurrent infection or underlying illness/treatment predisposing to infection (including advanced or poorly controlled diabetes); History of exposure to tuberculosis; History of opportunistic infection; Patients residing, or who have resided, where tuberculosis, histoplasmosis, coccidioidomycoses, or blastomycosis is endemic; Preexisting or recent demyelinating disorders (multiple sclerosis, myelitis, optic neuritis); Latex allergy (needle cover of diluent syringe contains latex); geri: May have increased risk of infection; Pedi: Children with significant exposure to varicella virus (temporarily discontinue etanercept; consider varicella zoster immune globulin); Increased risk of lymphoma (including hepatosplenic T-cell lymphoma (HSTCL), leukemia, and other malignancies; OB: Use only if needed
Drug/Food interactions of Etanercept Concurrent use with anakinra increase risk of serious infections (not recommended); concurrent use of cyclophosphamide may increase risk of malignancies; Concurrent use with azathioprine and/or methotrexate may increase risk of HSTCL; May decrease antibody response to live-virus vaccine and increase risk of adverse reactions (do not administer concurrently)
Medication administration of Etanercept Subcut
Nursing interventions of Etanercept Assess range of motion, degree of swelling, and pain in affected joints before and periodically during therapy; Assess patient for injection site reaction (erythema, pain, itching, swelling); Monitor patients who develop a new infection while taking etanercept closely. Discontinue therapy in patients who develop a serious infection or sepsis. Do not initiate therapy in patients with active infections; Assess for signs and symptoms of systemic fungal infections (fever, malaise, weight loss, sweats, cough, dyspnea, pulmonary infiltrates, serious systemic illness with or without concomitant shock). Ascertain if patient lives in or has traveled to areas of endemic mycoses. Consider empiric antifungal treatment for patients at risk of histoplasmosis and other invasive fungal infections until the pathogens are identified. Consult with an infectious diseases specialist. Consider stopping etanercept until the infection has been diagnosed and adequately treated; Lab test considerations: Monitor CBC with differential periodically during therapy. May cause leukopenia, neutropenia, thrombocytopenia, and pancytopenia. Discontinue etanercept if symptoms of blood dyscrasias (persistent fever) occur
Implementation of Etanercept Administer a tuberculin skin test prior to administration of etanercept-patients with active latent TB should be treated for TB prior to therapy; Needle cover of the prefilled syringe contains latex and should not be handled by people with latex allergies; *Do not mix with other solutions or dilute with other diluents
Client education of Etanercept Instruct patient on self-administration technique, storage, and disposal of equipment; First injection should be administered under the supervision of health care professional; Provide patient with a puncture proof container for used equipment; Advise patient not to receive live vaccines during therapy; Parents should be advised that children should complete immunizations to date before initiation of etanercept; Patients with significant exposure to varicella virus (chicken pox) should temporarily discontinue therapy and varicella immune globulin should be considered; Advise patient that mathotrxate, analgesics, NSAIDs, corticosteroids, and salicylates may be continued during therapy; Instruct patient to notify health care professionals if upper respiratory or other infections occur. Therapy may need to be discontinued if serious infection occurs; Advise patient of risk of malignancies such as hepatospolenci T-cell lymphoma. Instruct patient to report signs and symptoms (splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, weight loss) to health care professional promptly
Evaluation/Desired outcomes of Etanercept Reduction in symptoms of rheumatoid arthritis; Symptoms may return within 1 month of discontinuation of therapy
Potential nursing diagnoses of Etanercept Impaired physical mobility (indications); Acute pain (indications)

Section 2

Question Answer
Belimumab (Benlysta) Immuno-suppressants; Monoclonal antibodies; Pregnancy category C; Treatment of active autoantibody-positive systemic lupus erythematosus (SLE) in patients currently receiving standard therapy; SLE is a autoimmune disease in which the body’s immune system mistakenly attacks health tissue-it can affect the skin, joints, kidneys, brain, and other organs; Symptoms vary from person to person, and may come and go; Almost everyone with SLE has joint pain and swelling. Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often affected. Other common symptoms include chest pain when taking a deep breath, fatigue, fever with no other cause, general discomfort, uneasiness, or ill feeling (malaise), hair loss, mouth sores, sensitivity to sunlight, skin rash (butterfly rash in about half people with SLE, often seen over the cheeks and bridge of the nose, yet can be widespread and gets worse in sunlight), swollen lymph nodes, and other symptoms depend on which part of the body affected
Belimumab actions A monoclonal (forming a clone that is derived asexually from a single individual cell) antibody produced by recombinant DNA technique that specifically binds to B-lymphocyte stimulator protein (BLyS), thereby inactivating it
Belimumab therapeutic uses Decreased survival of B-cells, including auto-reactive ones and decreased differentiation into immunoglobulin-producing plasma cells; Result is decrease disease activity with lessened damage/improvement in muco-cutaneous, musculoskeletal and immunologic manifestations of SLE
Elimination/Excretion of Belimumab Unknown
Adverse/Side Effects of Belimumab Depression, insomnia, migraine; Nausea, diarrhea; Extremity pain; Anaphylaxis, infection, infusion reactions, fever
Contraindications of Belimumab Hypersensitivity; Concurrent use of other biologicals or cyclophosphamide; Concurrent use of live vaccines; Lactation: Breast feeding not recommended
Use Belimumab cautiously in Infections (consider temporary withdrawal for acute infections, trat aggressively); Previous history of depression or suicidal ideation (may worsen); Geri: May be more sensitive to drug effects, consider age-related changes in renal, hepatic and cardiac function, concurrent drug therapy and chronic disease states; OB: Use during pregnancy only if potential maternal benefit outweighs potential fetal risk; Women with childbearing potential should use adequate contraception during and for 4 months following therapy
Drug/Food interactions of Belimumab Increased risk of adverse reactions and decreased immune response to live vaccines-Should not be given concurrently
Medication administration of Belimumab PO
Nursing interventions of Belimumab Monitor patient for signs of anaphylaxis (hypotension, angioedema, urticarial, rash, pruritus, wheezing, dyspnea, facial edema) during and following injection. Medications (anti-histamines, corticosteroids, epinephrine) and equipment should be readily available in the event of the event of a severe reaction. Discontinue belimumab immedicately if anaphylaxis or other severe allergic reaction occurs; Monitor for infusion reactions (headache, nausea, skin reactions, bradycardia, myalgia, headache, rash, urticaria, hypotension)-infusion rate may be slowed or interrupted if an infusion reaction occurs; Assess for signs of infection (fever, dyspnea, flu-like symptoms, frequent or painful urination, redness or swelling at the site of a wound), including tuberculosis, prior to injection. Belimumab is contraindicated in patients with active infection. New infections should be monitored closely; most common are upper respiratory tract infections, bronchitis, and urinary tract infections. Signs and symptoms of inflammation maybe lessened due to suppression from bellimumab. Infections may be fatal, especially in patients taking immunosuppressive therapy. If patient develops a serious infection, consider discontinuing belimumab until infection is controlled; Assess mental status and mood changes; Inform health care professional if patient demonstrates significant increase in depressed mood, anxiety, nervousness, or insomnia
Implementation of Belimumab Consider pre-medication for prophylaxis against infusion reactions and hypersensitivity reactions
Client education of Belimumab Instruct patient to read Medication Guide prior to each treatment session; Caution patient to notify health care professional immediately if signs of infection (fever, sweating, chills, muscle aches, cough, shortness of breath, blood in phlegm, weight loss, warm, read or painful skin or sores, diarrhea or stomach pain, burning on urination, urinary frequency, feeling tired), severe rash, swollen face, or difficulty breathing occurs while taking; Advise patient to report signs and symptoms of anaphylaxis to health care professional immediately; Advise patient, family, and caregivers to look for depression and suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide; new or worse depression or anxiety; agitation or restlessness; panic attacks; insomnia; new or worse irritability; aggressiveness; acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur; Caution patient to avoid receiving live vaccines for 30 days before and during belimumab therapy; Advise women of childbearing potential to use adequate contraception and to avoid breast feeding during and for at least 4 months after final treatment
Evaluation/Desired outcomes of Belimumab Improvement in muco-cutaneous, musculoskeletal, and immunologic disease activity in patients with SLE
Potential nursing diagnoses of Belimumab Risk for infection (adverse reactions)