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Hey guys nurse mike here and welcome to simplenursing.com before we get today’s lectures started please remember check out our brand new app and get access to our new pharmacology and med surg mastery courses plus 11 other courses like fundamentals pediatrics maternity mental health and more complete with over 300 follow along cheat sheets and a massive quiz
Bank loaded with detailed rationales to test your knowledge join for free click the link in our description below alright guys let’s begin of immunosuppressants given to help the body stop attacking itself like with clients in autoimmune diseases where the body’s own immune system is attacking normal organs and immunosuppressants are also given with patients
With organ transplant so the body doesn’t reject that new organ now let the name help you here immunosuppressants are given to suppress that immune system like putting those wbcs those white blood cells to sleep the good news is the body stops attacking itself but the bad news here is we get bone marrow suppression with immunosuppressants meaning we have a big
Risk for infections and high risk for bleeding now guys please focus on those two things the two biggest test tips i can give you for immunosuppressants where the immune system is suppressed now the first drug is hydroxychloroquine given to treat lupus where the body’s attacking its own skin and joints so this drug helps to decrease inflammation and fatigue so
Commonly we’ll see patients with increased energy when taking this drug now it’s taken for several months to reach that therapeutic level so the benefits are not seen overnight now the key point comes in the major adverse effects big time retinal damage as well as vision problems so we must teach patients for regular eye appointments every key number here six
To 12 months make sure to write that down so the big memory trick we use here is hydroxychloroquine causes eye damage with that hydroxy and just think chloroquine sounds like chlorine so we gotta check the eyes every single year for that retinal damage now the hessie mentioned in their question that teaching is effective when the client states i need to see the
Optometrist at least once a year yes technically this is correct because we have to see them every six to 12 months for those regular eye appointments now lastly don’t let the nclex trick you there’s no need for a medical alert bracelet which is typical for seizure patients and there’s no need for osteoporosis vitamins like calcium and even vitamin d those were
The two most commonly chosen distractors now our next immunosuppressant is methotrexate now this one is the drug to know for the nclex as well as your exit exams mainly given for rheumatoid arthritis as mentioned by kaplan this is where the body is attacking its own joints and psoriasis where the body is attacking its own skin and even certain types of cancer
To slow the growth of that cancer now the mechanism of action is pretty simple it stops folic acid metabolism which stops cellular reproduction in the fastest replicating cells now the bad news like all immunosuppressants the fastest replicating cells in the body are in the blood and immune system as well as pregnant clients with the growing fetus so we end
Up with a very weak immune system leading to infections low platelet count leading to serious bleeding and even fetal death with our pregnant clients so the memory trick for methotrexate we just call it methnotrexate no pregnant clients no crowds or live vaccines to avoid infection and no razors or brushing teeth hard huge bleed risk with those low platelets
These are the big no-nos for methnotrexate so the big key points for your exam come in terms of infection and bleeding risk so infection risk the big three are we report fever over the key number 100.3 fahrenheit or 38 degrees celsius and secondly we avoid crowds and sick people and then lastly we avoid fresh fruits as well as flowers now for thrombocytopenia
That’s technically platelets under a hundred thousand so just remember under 50 is very risky and under 150 is very iffy so we monitor those platelets under a hundred thousand some big key numbers there so report bleeding in these various ways so petechiae that bleeding under the skin purple or purple spots under the skin as well as melano that black tarry stool
Could indicate a gi bleed and even he met emesis that vomiting of blood and bleeding gums so we must report these findings to the hcp immediately now the hesi question that was asked for methotrexate it suppresses b and t lymphocytes basically meaning it suppresses white blood cells in the immune system now the big teaching point here is we get flu and pneumonia
Vaccines that are keyword inactivated so flu vaccines are not contraindicated but what is contraindicated is live vaccines like herpes zoster so no live vaccines so don’t be tricked guys now lastly no pregnancy because methnotrexate is not baby safe we must teach the patient to use birth control so one question bank said no pregnancy until one menstrual cycle
After treatment is resolved another quiz bank said no pregnancy until three months after treatment is finished and a third said men no trine for a baby until three months after treatment with methotrexate is complete now don’t let the anklex trick you here there’s no need for frequent eye checkups since it’s not itoxic so remember the differences with the
Memory trick methotrexate we say methnotrexate since no babies and hydroxychloroquine is eye damage for that immunosuppressant now that’s how you know the differences next up we have tnf which is tumor necrosis factor inhibitors we have the drugs etanercept infliximab and idiblimab now these are other immunosuppressants given to autoimmune disease patients where
The body’s attacking itself so the memory trick we use is a tanner sept intercepts the immune response causing immunosuppression and mab ending is mad immunosuppression so ebdiblymab as well as infliximab inflicts mad immunosuppression now the key points to write down like all immunosuppressants the big thing is to report to the hcp elevated wbcs as well as a fever
Over 100.3 or 38 degrees celsius that’s the biggest nclex tip there fever is always priority above anything else since a suppressed immune system that has a fever means typically a big infection now for patient education two big key points here tuberculosis or tb can be reactivated so this can occur with a low immune system and that was mentioned multiple times
On many different quiz banks that’s why a negative tb test is needed before starting therapy so before starting as well as yearly follow-ups to ensure that negative tb now if this tb test does come back positive then a patient has to be treated with anti-tb drugs before starting these immunosuppressants since it can make the tb even worse now the next point
Is for vaccines the yearly flu vaccine is recommended but no live vaccines so no herpes zoster or shingles and we teach clients to avoid infection risk like avoid crowds and sick people now speaking of a contraindication you cannot take the med if you have infections so a chronic reoccurring or even recent infection for example a client who’s on an antibiotic
For a current infection cannot take infliximab or any other immunosuppressant now lastly let’s talk about labs here so that you don’t get tricked so listen very closely for labs we report elevated wbcs clients with infections will normally have elevated wbcs but a client who’s immunosuppressed with an elevated wbc or a fever guys these are big keywords this
Usually indicates a severe infection since the immune system is so suppressed next is elevated crp most students get this wrong all the time so listen close elevated crp is not the most important lab so exams in the nclex will try and trick you here asking for which option shows the effectiveness of immunosuppressants so crp again was the most commonly chosen
Distractors nearly 50 percent of the time so fairly simply just think about the patho here clients with autoimmune diseases already have a ton of inflammation in the body since the body’s attacking itself and if crp is elevated it just represents all inflammation on the body not specific to the disease so we expect patients with autoimmune diseases to already
Have an elevated crp so the priority here is elevated wbcs and fever which indicates a huge infection for those who are immunosuppressed now for the last drugs for immunosuppressants we have cyclosporine as well as azothioprine given to prevent organ transplant rejection so these are lifelong drugs now they lower the immune response to prevent the body from
Attacking the new organ so the memory trick we use for cyclosporine just think cyclosparin since they spare the organ from rejection now it can also be given for autoimmune diseases like ra and ibd but it’s most commonly given for organ transplant patients so the key point here is the adverse effects like all immunosuppressants bone marrow suppression like low
Wbcs and low platelets so we get a big risk for infection as well as bleeding so before giving these medications we always check wbcs and platelets so we report the key numbers for leukopenia to the hcp so low wbcs below 4000 and we monitor bleeding as well as not giving to pregnant patients so we teach to use contraception these are the three typical for all
Immunosuppressants now a common side effect for cyclosporine is that gingival hyperplasia basically meaning that overgrowth of gum tissue around the teeth now no you do not need to report this since this is an expected effect now for patient teaching no grapefruit juice like always the big nclex tip we always avoid grapefruit juice on 99 of the drugs on the
Nclex and we avoid crowds to avoid infection and again we use birth control because it’s not baby safe now the ati mentioned we have to notify the provider for any signs of infection from that low immune system and the hesse says teaching for cyclosporine and as a thioprin we avoid crowds no live vaccines like herpes zoster as well as shingles and we use a
Soft bristled toothbrush since gum bleeding is a common side effect and then lastly we always use contraception because it’s not baby safe now the last point is kaplan mentioned patient statement that requires further teaching so when the patient says i will mix cyclosporine with grapefruit juice no we never do that and then secondly cyclosporine teaching for
Organ transplant we take the medication for life since it’s a lifelong drug and the hcp will evaluate blood work regularly and then lastly you take the medication at the same time every single day these three were the biggest key findings on all the various quiz banks thanks for watching for our full video and new quiz bank click right up here to access your
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Transcribed from video
Pharmacology – Hydroxychloroquine, Immunosuppressants, Methotrexate nursing RN PN NCLEX By Simple NursingliveBroadcastDetails{isLiveNowfalsestartTimestamp2020-11-09T000010+0000endTimestamp2020-11-09T001614+0000}
