Miscellaneous Immunomodulating Drugs work by specific and nonspecific mechanisms Drug bexarotene (Targetin) BCG vaccine etanercept (Enbrel)

) leflunomide (Arava) levamisole (Ergamisol) mitoxantrone (Novantrone) pegademase bovine (Adagen) thalidomine (Thalomid) tretenoin (Vesanoid) Classification Retinoid receptor antagonist Live virus vaccine, adjuvant Tumor necrosis factor receptor antagonist Antimetabolite Immunostimulant, adjuvant Anthracycline antibiotic Immunostimulant Immunostimulant Retinoid receptor antagonist Indications Cutaneous T-cell lymphoma Localized bladder cancer Rheumatoid arthritis, psoriatic arthritis Rheumatoid arthritis Dukes stage C colon cancer (given w/ fluorouracil) Multiple sclerosis Severe combined immunodefieciency disease Erythremia nodosum Acute promyelocytic leukemia

Adjuvant immunostimulant drugs that work by a nonspecific mechanism

Nursing Considerations
Hematopoietic BRMs -Erythropoietin and similar drugs: o o o Erythropoietin and similar drugs can exacerbate hypertension, seizures, thrombosis, and chest pain. Assess for these. Evaluate renal function. Asses iron stores by measuring transferring saturation which must be less than 20%. Ferritin level must be at 100ng/mL. These allow appropriate erythropoietin stimulation.

-Colony stimulating factors: o Any joint or bone pain should be documented because of the possible adverse effect of mild, moderate, or severe bone pain with filgrastim.

Interferons o CBC should be assessed because long-term therapy with IFNs may lead to bone marrow suppression.

Interleukins o Document baseline VS, neurologic functioning, bowel status, and results of renal and liver studies before using aldesleukin because of possible drug-related impaired renal and liver functioning. Capillary leak syndrome is associated with interleukin drugs so document any edema and baseline VS. Assess for symptoms of capillary leak syndrome. Interleukins are not administered to patients with cardiac diseases or symptoms (hypotension, hypertension, angina) Allergies to proteins of E.coli should be noted because of cross-sensitivity to IFNs. These drugs are not usually given at the same time as antineoplastics, instead they are given at least 24hrs after chemo.

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