McKenna's Pharmacology for Nursing, 2e

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P A R T 3  Drugs acting on the immune system

When synthetic interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity and in the number of circulating platelets. See Table 17.1 for usual indications. Pharmacokinetics The interleukins are rapidly distributed after injection. Aldesleukin, given IV, reaches peak levels in 13 minutes and has a half-life of 85 minutes. This drug is primarily cleared from the body by the kidneys. Contraindications and cautions Interleukins are contraindicated in the presence of any allergy to an interleukin or E. coli –produced product. They were shown to be embryocidal and teratogenic in animal studies and should not be used during preg- nancy. Use of barrier contraceptives is recommended for women of childbearing age who require one of these drugs. It is not clear whether the drugs cross into breast milk, but it is recommended that they not be used during breastfeeding; if they must be used, another method of feeding the baby must be chosen because of the potential for adverse effects in the baby. Caution should be used with renal, liver or cardiovascular impairment because of the adverse effects of the drugs. Interleukins are also contraindicated in individuals with evidence of active infection requiring antibiotic therapy. Adverse effects The adverse effects associated with the interleukins can be attributed to their effect on the body during Prototype summary: Aldesleukin (not available in Australia) Indications: Metastatic renal cell carcinoma in adults; treatment of metastatic melanomas (orphan drug use). Actions: Activates human cellular immunity and inhibits tumour growth through increases in lymphocytes, platelets and cytokines. Pharmacokinetics: Route Onset Peak Duration IV 5 mins 13 mins 3–4 hours T 1/2 : 85 minutes; metabolised in the kidney and excreted in the urine. Adverse effects: Mental status changes, dizziness, hypotension, sinus tachycardia, arrhythmias, pruritus, nausea, vomiting, diarrhoea, anorexia, gastrointestinal (GI) bleed, bone marrow suppression, respiratory difficulties, fever, chills, pain.

inflammation (flu-like effects: lethargy, myalgia, arthral- gia, fatigue, fever). Respiratory difficulties, CNS changes and cardiac arrhythmias have also been reported, and the person should be monitored for these effects and the drug stopped if they do occur. Clinical Important drug–drug interactions There are no reported drug–drug interactions with interleukins.

Care considerations for people receiving immune stimulants

Assessment: History and examination

■ ■ Assess for contraindications and cautions: known allergies to any of these drugs or their components to prevent hypersensitivity reactions ; current status related to pregnancy or breastfeeding to avoid serious adverse effects on the fetus or baby ; history of hepatic, renal or cardiac disease, bone marrow depression and CNS disorders, including seizures, all of which could be exacerbated by the effects of these drugs . ■ ■ Perform a physical assessment to determine baseline status before beginning therapy and for any potential adverse effects ; inspect for the presence of any skin lesions to detect early dermatological effects ; obtain weight to monitor for fluid retention ; monitor temperature to detect any infection ; check heart rate and rhythm and blood pressure to monitor for any cardiac effects of the drug ; assess level of orientation and reflexes to evaluate CNS effects of the drug . ■ ■ Obtain a baseline electrocardiogram (ECG) to evaluate cardiac function and monitor adverse effects of the drugs . ■ ■ Assess the person’s renal and liver function, including renal and liver function tests, to determine the appropriateness of therapy and to determine the need for possible dose adjustment and toxic drug effects . ■ ■ Monitor the results of laboratory tests such as full blood count (FBC) to identify changes in bone marrow function . Implementation with rationale ■ ■ Arrange for laboratory tests before and periodically during therapy, including FBC and differential, to monitor for drug effects and adverse effects . ■ ■ Administer drug as indicated; instruct the person and a significant other if injections are required to ensure that the drug will be given even if the person is not able to administer it .