Pharmacology, part 52: Immune Medications - Immunosuppressants/DMARDs

Hi, I am Cathy, with Level Up RN. In this video, I'm going to begin my coverage of immune system medications. If you have our pharmacology second edition flashcards, definitely pull those out so you can follow along with me. Specifically in this video, I will be covering immunosuppressants, and at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts that I'll be covering in this video. So definitely stay tuned for that.

Before I get into specific medications, I want to talk to you a little bit about immunosuppressants in general, because any time we suppress a patient's immune system, it makes them more likely to get an infection because their immune system is not operating at full capacity, and it's not able to fight off those pathogens as well.

So in terms of nursing care of a patient who's on an immunosuppressant, we want to closely monitor their temperature, their white blood cell count. We want to limit visitors. We also want to limit fresh flowers or plants in the patient's room.

And then we want to provide teaching to the patient as well to help them prevent getting an infection. So they should have really good hand hygiene. They should avoid sick people and crowds. They should make sure they get their vaccinations, and they should avoid gardening and cleaning the cat litter box, and also make sure they cook their foods thoroughly. So this teaching and those nursing interventions will apply for all immunosuppressants, so definitely keep those key points in mind.

All right, let's get into specific medications starting with methotrexate, which is an anti-metabolite.

Methotrexate is used to treat autoimmune disorders such as psoriasis and rheumatoid arthritis. It is also used to treat certain types of cancer and to dissolve ectopic pregnancies.

So its mode of action is that it causes the death of rapidly replicating cells and also has an immunosuppressive effect in the body.

Due to that immunosuppressive effect, a key side effect with methotrexate is going to be infection. Other side effects include hepatotoxicity, bone marrow suppression, GI upset, stomatitis, which is painful ulcerations in the mouth.

Methotrexate also has a black box warning due to the risk for fetal death and fetal toxicity. So pregnant women are definitely not going to be taking methotrexate. We talked through some of the nursing care and patient teaching associated with protecting the patient from infection.

Other nursing care associated with methotrexate includes monitoring the patient's liver function because of that side effect of hepatotoxicity, and also monitoring the patient's CBC levels due to the risk for bone marrow suppression.

So the way we remember this medication and what it's for in our little cool chicken hint on this card, if you look at methotrexate, you see T-Rex in the name. So I think about a T-Rex who has to move around very slowly because it has rheumatoid arthritis, and so it needs methotrexate in order to treat its rheumatoid arthritis. So if you have an alternative idea or mnemonic to help everyone remember what this medication is for, definitely leave it in the comments so we can all benefit from it.

Next, we have cyclosporine, which is a cyclic polypeptide. It's used to prevent organ rejection in transplant patients. It's also used to treat autoimmune disorders such as ulcerative colitis, rheumatoid arthritis, and psoriasis.

It works by inhibiting the body's normal immune response.

So key side effects with cyclosporine include risk of infection because it's an immunosuppressive agent. Other side effects include hepatotoxicity nephrotoxicity, GI upset, hypertension, and tremor.

This medication carries a black box warning because it can cause the development of tumors. In terms of nursing care, of course, we're going to do all the teaching and care to help prevent infection in the patient. We're also going to closely monitor their liver function and their kidney function because of the side effects of hepatotoxicity and nephrotoxicity. Also, if the patient is taking this because they received a transplant, they need to know that they will need to take cyclosporine for the rest of their lives. So it's not going to be a short-term-type therapy.

The last medication I'm going to cover in this video is hydroxychloroquine, which became kind of famous during the COVID-19 pandemic.

Hydroxychloroquine is used to treat autoimmune disorders such as rheumatoid arthritis and lupus. It is also used to treat malaria.

The side effects of this medication include GI upset, vision changes, seizures, and agranulocytosis, which is a reduction in the number of granulocytes in the body, which is a type of white blood cell.

So in terms of nursing care, we're going to want to monitor the patient's CBC levels during therapy, and we also want to advise the patient to take this medication with food in order to help reduce the GI upset that is common when taking hydroxychloroquine.

All right. Time for quiz. I have three questions for you. First question, what is the key side effect that we need to know for all immunosuppressive agents? The answer is infection. So we want to do all the nursing care and patient teaching we can do to help prevent infection in patients taking immunosuppressive agents. Question number two, what immunosuppressive agent is used to dissolve an ectopic pregnancy? The answer is methotrexate. Question number three, what medication is used to prevent organ rejection in transplant patients? The answer is cyclosporine.

Okay. I hope you did well with that quiz. If you got some of those wrong, then definitely go back and read the flashcards, do some repetition with those cards because, really, repetition is where it's at when it comes to pharmacology. Take care and good luck with studying.