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Pharmacology · chapter 6 · Introduction to the Immune System and the Inflammatory Response

Immunosuppressants, Biologics, Monoclonal Antibodies, and Biosimilar Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Infection risk on immunosuppressants

    Clients taking immunosuppressants may be at higher risk for infections, including opportunistic infections that can be life-threatening.

  2. Glucocorticoids need careful tapering

    Glucocorticoids are typically reserved for short-term or last-resort use due to potential toxic effects. Careful tapering is necessary to address potential rebound symptoms resulting from prolonged use (see Table 6.2 for dosing information and Hypothalamus, Pituitary, and Adrenal Disorder Drugs for additional information on glucocorticoids).

  3. Azathioprine and cancer risk

    Long-term use has been associated with an increased risk of certain types of cancer.

  4. How mycophenolate works

    It works by inhibiting the proliferation of T and B immune cells, thus suppressing the immune system’s response against the transplanted organs.

  5. Common glucocorticoid adverse effects

    Common adverse effects for glucocorticoids include weight gain, increased appetite, mood swings, insomnia, fluid retention, and elevated blood sugar levels. Long-term use can lead to more severe adverse effects, such as osteoporosis, high blood pressure, cataracts, and adrenal insufficiency.

  6. Glucocorticoid contraindications

    Contraindications include systemic fungal infections and live virus vaccines.

  7. Serious azathioprine adverse effects

    More severe adverse effects include bone marrow suppression, pancreatitis, and liver toxicity.

  8. Mycophenolate is contraindicated in pregnancy

    It may also be associated with bone marrow suppression and increased risk of birth defects, making it contraindicated during pregnancy.

  9. Adalimumab blocks TNF-alpha

    Adalimumab Adalimumab is a monoclonal antibody that targets and inhibits the action of tumor necrosis factor-alpha (TNF-alpha), a cytokine involved in inflammation.

  10. Biologic contraindications

    Contraindications include hypersensitivity to the drug or any of its components, active infection, sepsis, pregnancy, and breastfeeding.

  11. Pegfilgrastim raises neutrophils

    Pegfilgrastim stimulates the bone marrow to increase white blood cell production, particularly neutrophils, which are essential for fighting infections.

  12. Monitor blood counts and organ function

    Monitor complete blood counts for leukopenia, thrombocytopenia, and anemia; liver function tests for hepatotoxicity; renal functions tests for nephrotoxicity; and lipids for elevated lipid levels.

  13. Check TB status before biologics

    Evaluate the client’s tuberculosis (TB) status prior to administering biologic drugs, as they can increase the risk of reactivating latent tuberculosis.

  14. Report fever, chills, sore throat, rash

    Report symptoms of fever, chills, sore throat, and skin rash to the health care provider because these may indicate an adverse reaction to the drug.

Terms to know

Immunosuppressant
Immunosuppressant Drugs Immunosuppressant is a class of medicines that inhibit or decrease the intensity of the immune response in the body.
Biologic drugs
Biologic Drugs and Monoclonal Antibodies Biologic drugs, also known as biologics, are a class of medications derived from living sources such as cells, proteins, or tissues.
Biosimilar drugs
Biosimilar Drugs Biosimilar drugs are a type of biologic medication that is highly similar to an already approved reference biologic, also known as the original biologic or reference product.
Rituximab
Rituximab Rituximab is a monoclonal antibody that targets a specific protein known as CD20 found on the surface of B cells.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client is scheduled to start etanercept for rheumatoid arthritis. Which assessment should the nurse make sure is done before the first dose?

    1. Visual acuity test
    2. Bone density scan
    3. Hearing test
    4. Tuberculosis status

    Answer: Tuberculosis status

    Biologic drugs can reactivate latent tuberculosis, so the client's TB status is evaluated before they are given. The other tests are not required before starting a biologic in this section.

  2. A kidney transplant recipient taking mycophenolate tells the nurse she is planning a pregnancy. What is the nurse's best response?

    1. Mycophenolate is contraindicated in pregnancy because of the risk of birth defects; discuss this with the provider.
    2. Double the dose to protect the transplant during pregnancy.
    3. Stop mycophenolate today without telling the provider.
    4. Mycophenolate is safe in pregnancy.

    Answer: Mycophenolate is contraindicated in pregnancy because of the risk of birth defects; discuss this with the provider.

    Mycophenolate is associated with birth defects and is contraindicated during pregnancy, so the client needs to discuss this with the provider. Stopping on her own is against teaching, and doubling the dose is never suggested.

  3. A nurse is teaching a client who is going home on a biologic drug given by subcutaneous injection. Which instructions are correct? Select all that apply.

    1. Report fever, chills, sore throat or skin rash.
    2. Avoid contact with sick individuals.
    3. Get the MMR vaccine to boost your immunity.
    4. Reuse needles if they look clean.
    5. Dispose of needles in an FDA-approved sharps container.

    Answer: Report fever, chills, sore throat or skin rash., Avoid contact with sick individuals., Dispose of needles in an FDA-approved sharps container.

    Clients should report fever, chills, sore throat and rash, avoid sick contacts and use a sharps container. They should not receive live vaccines such as MMR or reuse needles.

  4. A client has been taking prednisone for several months. The client says he wants to stop it today because he feels better. What should the nurse explain?

    1. Prednisone must be tapered carefully because of rebound symptoms after prolonged use.
    2. Prednisone can be stopped at any time without risk.
    3. Prednisone only needs to be stopped if blood sugar is low.
    4. Prednisone should be replaced with a live vaccine.

    Answer: Prednisone must be tapered carefully because of rebound symptoms after prolonged use.

    After prolonged glucocorticoid use, careful tapering is needed to address rebound symptoms. Stopping abruptly is not safe, and the other options are not supported by the section.

  5. A client is on long-term azathioprine. Which laboratory tests does the nurse expect to be monitored? Select all that apply.

    1. Thyroid-stimulating hormone
    2. Serum creatinine
    3. Hemoglobin A1c
    4. Complete blood cell count
    5. Liver function tests

    Answer: Serum creatinine, Complete blood cell count, Liver function tests

    Azathioprine can cause bone marrow suppression and liver toxicity, so a complete blood count, liver function tests and serum creatinine for kidney function may be needed. TSH and A1c are not listed for this drug.

  6. A client receiving chemotherapy is ordered pegfilgrastim. The client asks what it is for. Which answer is accurate?

    1. It stimulates the bone marrow to make more white blood cells, which lowers the risk of infection.
    2. It kills cancer cells directly.
    3. It prevents organ rejection.
    4. It blocks new blood vessels that tumors need.

    Answer: It stimulates the bone marrow to make more white blood cells, which lowers the risk of infection.

    Pegfilgrastim stimulates the bone marrow to increase white blood cells, particularly neutrophils, to reduce infection risk during cancer treatment. Blocking tumor blood vessels describes bevacizumab, and preventing rejection describes immunosuppressants.

Where every quote comes from

Section 6.3 Immunosuppressants, Biologics, Monoclonal Antibodies, and Biosimilar Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.