McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 7  Immune modulators

TABLE 17.2

DRUGS IN FOCUS Antianginal agents (continued)

Drug name

Dosage/route

Usual indications

Monoclonal antibodies (continued) golimumab (Simponi)

50 mg SC once monthly

Management of moderate to severe active rheumatoid arthritis, progressive psoriatic arthritis, active ankylosing spondylitis Decreases signs and symptoms of Crohn’s disease in individuals who do not respond to other therapy; treatment of fistulating Crohn’s disease; also approved for use with methotrexate in the treatment of progressing moderate to severe rheumatoid arthritis Treatment of asthma with a very strong allergic component and seasonal allergic rhinitis not well controlled with traditional medications Prevention of serious RSV infection in high-risk children Treatment of wild type KRAS metastatic colorectal cancer Treatment of relapsed follicular B-cell non-Hodgkin lymphoma Relief of signs and symptoms of moderate to severe rheumatoid arthritis in adults Treatment of metastatic breast cancer with tumours that overexpress human epidermal growth factor receptor 2 (HER2) Treatment of recalcitrant plaque psoriasis in adults not responsive to traditional therapy

infliximab (Remicade)

5 mg/kg IV over 2 hours; may be repeated at 2 and 6 weeks

omalizumab (Xolair)

150–375 mg SC every 2–4 weeks

palivizumab (Synagis)

15 mg/kg IM as a single dose at the start of respiratory syncytial virus (RSV) season

panitumumab (Vectibix)

6 mg/kg IV every 2 weeks

rituximab (Mabthera)

375 mg/m 2 IV once weekly for four doses

tocilizumab (Actemra)

4–8 mg/kg IV every 4 weeks, with methotrexate

trastuzumab (Herceptin, Kadcyla)

4 mg/kg IV over 90 minutes, then 2 mg/kg IV once a week over at least 30 minutes

ustekinumab (Stelara)

45–90 mg by SC injection once a week, progressing to once a month, then once every 3 months as determined by individual condition and response

Contraindications and cautions The use of T- and B-cell suppressors is contraindicated in the presence of any known allergy to the drug or its components and during pregnancy and breastfeeding because of the potential serious adverse effects on the fetus or neonate. Caution should be used with renal or hepatic impairment, which could interfere with the metabolism or excretion of the drug , and in the presence of known neoplasms, which potentially could spread with immune system suppression . Adverse effects People receiving these drugs are at increased risk for infection and for the development of neoplasms due to their blocking effect on the immune system. Other potentially dangerous adverse effects include hepato­ toxicity, renal toxicity, renal dysfunction and pulmonary oedema. Individuals may experience headache, tremors and secondary infections such as acne, GI upset, diar- rhoea and hypertension.

Prototype summary: Cyclosporin Indications: Prophylaxis for organ rejection in kidney, liver and heart transplants (used with corticosteroids); treatment of chronic rejection in people previously treated with other immunosuppressants; treatment of rheumatoid arthritis and recalcitrant psoriasis. Actions: Reversibly inhibits immunocompetent lymphocytes; inhibits T helper cells and T suppressor cells, lymphokine production, and release of interleukin-2 and T-cell growth factor. Pharmacokinetics: Route Onset Peak PO Varies 3.5 hours IV Rapid 1–2 hours T 1/2 : 19 to 27 hours; metabolised in the liver and excreted in the bile and urine. Adverse effects: Tremor, hypertension, gum hyperplasia, renal dysfunction, diarrhoea, hirsutism, acne, bone marrow suppression.