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Today’s video is all about immunosuppressants for Nursing Students and NCLEX Review.
Free Pharmacology NCLEX Prep Download: https://simplenursing.com/pharmacology/utm_source=youtube.com&utm_content=opioids
The immune system is a complex network of cells and processes that helps the body fight off infection, disease, and illness.
Many medicines are available to help your patients manage their immune system, including Hydroxychloroquine, Methotrexate, tumor necrosis factor (TNF) inhibitors, and Cyclosporine. Watch to learn more about these drugs’ mechanisms of action, interactions, and more.
Key Moments:
00:00 Introduction
02:49 Immunosuppressants
05:22 Methotrexate
13:31 Epinephrine
18:48 Patient Education for EpiPens
23:36 Effective EpiPen Teaching
25:24 Labs to Review Before Immunosuppressants
#Immunology #immunesystem #pharmacology #RN #registerednurse #nurse #nclexprep #nclexreview
Hey guys, nurse Mike here and welcome to simple nursing.com. Check out our brand new app and get access to our new pharmarmacology and med surge mastery courses. Join for free. Click the link in our description below. All right, guys, let’s begin. Now for the immune drugs we have 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 WBC’s 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 imunosuppressants where the immune system is suppressed. Now the first drug is hydroxychloricquin given to treat lup 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 6 to 12 months. Make sure to write that down. So the big memory trick we use here is hydroxchloricqueen causes eye damage with that hydroxy. And just think chloricqueen sounds like chlorine. So we got to 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 him every 6 to 12 months for those regular eye appointments. Now lastly, don’t let the enclelex 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 imunosuppressant is methtoresate. Now this one is the drug to know for the enclelex 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 amunosuppressants 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 methotate we just call it methodate. 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 meth noxate. 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° C. And secondly, we avoid crowds and sick people. And then lastly, we avoid fresh fruits as well as flowers. Now, for thrombocytoenia, that’s technically platelets under 100,000. So just remember under 50 is very risky and under 150 is very iffy. So we monitor those platelets under 100,000. Some big key numbers there. So report bleeding in these various ways. So patiki that bleeding under the skin, perpa or purple spots under the skin as well as melanina that black tar stool could indicate a GI bleed and even hematmesis that vomiting of blood and bleeding gums. So we must report these findings to the HCP immediately. Now the hessi question that was asked for methtoresate. 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 zaster. So no live vaccines. So don’t be tricked guys. Now lastly, no pregnancy because methnotexate 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 3 months after treatment is finished. And a third said, “Men, no trying for a baby until 3 months after treatment with methtoresate is complete.” Now, don’t let the anklelex trick you here. There’s no need for frequent eye checkups since it’s not eye toxic. So, remember the differences with the memory trick. Methodate, we say methnotexate since no babies. and hydroxychloricquin is eye damage for that imunosuppressant. Now that’s how you know the differences. Next up we have TNF which is tumor necrosis factor inhibitors. We have the drugs iterep infleximab and adiblimab. Now these are other imunosuppressants given to autoimmune disease patients where the body’s attacking itself. So the memory trick we use is a tannercept intercepts the immune response causing imunosuppression and mab ending is mad immunosuppression. So abdlimab as well as inflammab inflicts mad imunosuppression. Now the key points to write down like all imunosuppressants the big thing is to report to the HCP elevated WBC’s as well as a fever over 100.3 or 38° C. That’s the biggest enclelex 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 quizbanks. 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 imunosuppressants 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 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 inflammab or any other imunosuppressant. Now lastly, let’s talk about labs here so that you don’t get tricked. So listen very closely. For labs, we report elevated WBC’s. Clients with infections will normally have elevated WBC’s. But a client who’s immunosuppressed with an elevated WBC or a fever, guys, these are big key words. 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 ENLEX will try and trick you here, asking for which option shows the effectiveness of imunosuppressants. So CRP again was the most commonly chosen distractors nearly 50% of the time. So very 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 WBC’s and fever which indicates a huge infection for those who are imunosuppressed. Now for the last drugs for imunosuppressants we have cycllosporin as well as aothioprne 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 cycllosporin just think cycllosparin 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 amunosuppressants bone marrow suppression like low WBC’s and low platelets. So we get a big risk for infection as well as bleeding. So before giving these medications, we always check WBC’s and platelets. So we report the key numbers for lucopenia to the HCP. So low WBC’s below 4,000 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 cycllosporin is that gingerville 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 enlex tip. We always avoid grapefruit juice on 99% of the drugs on the enlex 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 hessi says teaching for cycllosporin and as aoprene we avoid crowds no live vaccines like herpes zaster as well as shingles and we use a soft bristle 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 cycllosporin with grapefruit juice. No we never do that. And then secondly cycllosporin 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. Now our last drug in the immune section is epinephrine aka epi auto injector as well as epi pen. Now as you guys know epi is a life-saving drug called a vasopressor which helps press the vessels to press up the vitals. So it prevents deadly low BP with shock. Now it does this by stimulating the alpha and beta receptors causing vasoc constriction which increases blood pressure and also causes bronco dilation which helps open the lungs to facilitate breathing. Now not typically tested on question banks but it’s nice to know that epi affects the heart as a positive chronotropic and positive ionotropic. So simply think Kronos means time so we get more beats per minute with positive chronotropic and ionotropic means more force so we get a more forceful heart contraction. So remember by saying I know the answer there’s a lot of force when you know something so just think I know tropic is a positive forceful contraction. So that’s how you know the key terms. Now for the two most common reasons to give epi we give for both cardiac arrest as well as anaphylaxis reaction that severe allergic reaction. So for cardiac arrest epi is given IV push and we cover this in detail in the cardiac lectures but for this lecture we’re talking about anaphilaxis that severe allergic reaction. We give an EpiPen or aka auto injector to inject straight into the outer thigh for an IM injection. Typically after severe allergic reactions, for example, a beast sting or food allergies. Say we’re eating shellfish with an allergy, the client goes into an anaphylactic shock resulting in deadly hypotension and bronco constriction, which inevitably leads to death via cardiac and respiratory arrest. So the key points to know Hessie mentions EPI is the first drug used for anaphilaxis and ATI backs this up by saying first signs of anaphilaxis reaction those hives dysnia and hypotension we use an epi pen. So the key term here to know is it’s the first drug for the first sign of anaphylactic reaction. We always use epi first. Now, two big Enclelex tips. We repeat every 5 to 15 minutes if the signs and symptoms continue. And we repeat epi until the signs and symptoms resolve. So, we keep on repeating EPI until those signs and symptoms go away. Then we give the other medications. And in the Anklex world, we just keep on giving this drug forever until those symptoms resolve. Now, how do you know if it’s a superersized anaphylactic reaction and not just a mild allergic reaction? Well, any allergy that affects the ABCs, the airway, breathing, and circulation, or even induces hives. This is deadly anaphylaxis, the superersized allergy reaction. So, again, don’t delay epi injection. We inject immediately upon these signs and symptoms. And no skin prep is necessary. Just stab that outer thigh straight through the pants and hold it there for about 10 seconds. So the correct medication sequence is epi first, then dyen hydramine or basically benadryil and lastly albuterol and steroids. But out of all these, most question banks only stress about epi being that first drug during anaphilaxis and the rest only after the acute signs and symptoms have resolved. Remember we repeat epi as a priority until those signs and symptoms resolve. Now Kaplan mentions a patient scenario administration of ampeillin and the client reports itchiness and difficulty breathing. The priority actions is number one stop the infusion that’s causing the problem. Number two, you assess by oscultating the lungs or listening to the lungs. And number three, you prepare to administer epinephrine first. So again, not steroids, not eluterol. It’s always epi first. And secondly, the captain mentions effective management of shock. You have a BP that’s a little bit high, apical pulse that is 99, and a cap refill that’s less than 2 seconds. Guys, this indicates good perfusion, meaning epi is doing its job to press on the veins as a phasopressor. So, it’s pressing those vital signs up. And speaking of normal expected side effects to know after giving this medication, tacocardia, that heart rate over 100, palpitations and dizziness. Again, these side effects means that EpiP is doing its job to prevent that shock or basically that death from low blood pressure. Now, for patient education, how to use the EpiPen, the three big key points here. Number one, we inject into the outer thigh at a 90° angle on the onset of symptoms. So, Hessie mentions we stab the pen into the outer thigh and we hold it in place for about 10 seconds. So not 5 seconds, not 3 seconds, but a full 10 seconds here. Now number two is we seek immediate medical attention after use. So go to the hospital. Don’t wait. Since EPI wears off in about 10 to 20 minutes and signs and symptoms may return. Lastly, number three, this is a big one here. Store EpiPens in a dark place at room temperature. So not too cold, not too hot. So, not in a refrigerator and not in a car. Since this medication can be deactivated by heat and light. Now, for the top missed questions from the immune section. Question number one, a patient is prescribed methtoresate for the treatment of an autoimmune disorder. Which patient report requires immediate assessment and intervention by the nurse? Okay, so let’s break this down. The questions asking for methtoresate which report needs immediate intervention as well as immediate assessment. So before looking at the options we’re just thinking of two or three things we know about the drug. So methotate we call meth noxate no babies and a big bleed risk as well as infections. And always think what kills the patient first. So the enclelex is all about safety. So we’re thinking loss of life, loss of limb and ABCs first. So first option is I will consult with my provider before discontinuing birth control. So this is incorrect since it’s not a priority here. So guys, yes, we always consult with the HCP before stopping birth control. So methotate, we have no pregnancy. Now the second option is correct. I notice that I have developed tiny reddish purple lesions all over my arms. So yes, this is correct since it’s a big priority indicating a bleed. Tiny red purple lesions are petiki basically bleeding under the skin. Now the last two options are incorrect. I have not had a normal bowel movement in about 2 days. So 2 days is fine for a no bowel movement, not life-threatening. But anything over 5 days is a little bit concerning. Now the last one here, I seem to be losing excessive amounts of hair since starting this medication. Again, that’s not priority since it’s not life-threatening. Now, the next question here, what should the nurse include for teaching for a patient newly prescribed hydroxylchloricquin for treatment of systemic lup? Select all that apply. Okay, let’s break this down. This question is asking what teaching to include for the keyword hydroxyocchloricquin. So what the heck is that drug right? So the memory trick hydroxy just think hydroxy. So eye damage and chloricquin just think chlorine in the eyes. We need to see the eye doctor at least every 6 to 12 months. And always think what kills the patient first. So the anklelex again is all about safety. So specifically, we’re thinking loss of life and loss of limb in the eyes here. So option number one, ensure to see the optometrist at least every 2 years. Big no, it’s incorrect. We teach every 6 to 12 months, not every 2 years. Now option number two, report any new visual changes to your provider. Yes, visual changes with hydroxy we think hydroxy that eye damage. So report changes in vision. Number three, this medication is likely to increase feelings of fatigue associated with lupus. No, this is incorrect. This drug actually helps increase energy to improve symptoms of lupas where we typically have fatigue. Now, the last two options are also incorrect. Notify your provider if no improvements in the symptoms is noticed within about a week of beginning the medication. So no, this option is incorrect. Like most amunosuppressants, this medication takes time to kick in. Typically over a few weeks, not over one week. And lastly, supplementation with calcium and vitamin D is recommended. No, this is incorrect. It’s not needed because it doesn’t cause bone problems. So remember, focus on the eye in the hydroxychloricquin. Now, the next question. The nurse is instructing a patient with a severe allergy to a wasp sting on the proper use of an epinephrine auto- injector. Which patient statement best demonstrates that teaching has been effective? Okay, so let’s break this down. The question is asking the proper use of an epi auto injector. The key word here is best demonstrates effective teaching. So before looking at the options, think of the top two or three things you know about the drug for epipens. So number one, we inject into the outer thigh at a 90° angle. Number two, it’s used immediately at the first sign of an allergic reaction and we seek immediate medical attention after the use. Now number three, store EpiPens in a dark place at room temperature. Again, not too hot or not too cold. So option number one is incorrect. I’ll keep my EpiPen stored in the refrigerator. No, this is too cold. Remember, room temperature here. Now, option two. This one’s correct. I will inject the medication into the outer thigh at the first sign of the allergic reaction. So, yes, outer thigh at the first sign. And again, first signs mean ABCs, airway, breathing, and circulation. And also hives, too. Now, the last two options are incorrect. I will seek follow-up treatment within about 24 hours of injecting the medication. No, we seek immediate attention immediately after use. 24 hours is way too long. And the last option, I will hold the EpiPen firmly in place for at least 5 seconds. No, we hold it in place for 10 seconds minimum. Now the last question here, which lab result should the nurse review prior to the administration of a tannercept to a patient with seriatic arthritis? Select all that apply. Okay, so let’s break this down. The question is asking for which lab result to review before a tannercept. So before looking at the options, what do we know about a tannercept? So in tannercept we say intercepts the immune response to cause a lower immune system and with low immune system this means big risk for infection as well as bone marrow suppression. So option one is correct here. Tuberculin skin test or that TB skin test. Yes, the big risk for infection. This drug can actually reactivate the TB since the immune system is so low. Meaning that the defense shield of the body is low. Now option number two, a PTT or partial thrombolast in time. Guys, no. This one’s a little bit tricky, but it’s incorrect. So bone marrow suppression can lead to low platelets and bleed risk, but there’s no need to check the PTT directly. Now on the ENLEX, we typically only check the PTT for Hepin and not for imunosuppressants. Now option three, white blood cell count. Yes, this is huge with a low immune system. WBC’s are always priority. We must check these before giving any amunosuppressant. And the last two options here, total cholesterol panel. No, this is incorrect here. So cholesterol is not affected with this medication. Typically, it’s statins like lovatin. And lastly, option five, a red blood cell count. Yes, this one is correct. So anemia is to be expected from bone marrow suppression. So we got to check those RBC’s. That’s in the CBC, the complete blood count there. All right, guys. That wraps it up for this segment. Don’t forget to take your quiz and download the study guides. All right, guys, that wraps it up for this segment. Don’t forget to take your quiz and download the study guides. Thanks for watching. For our full video and new quiz bank, click right up here to access your free trial. And please consider subscribing to our YouTube channel. Last but not least, a big thanks to our team of experts helping us make these great videos. All right, guys. See you next time.
