NCLEX Quick Sheet – Immunological & Anti-inflammatory
Pharmacology
•NSAIDs (ibuprofen, naproxen, ketorolac) – Inhibit COX → ↓ prostaglandins → ↓ pain, fever, inflammation.
SE: GI bleeding, ulcers, renal injury. NCLEX: Take with food, avoid in ulcers or kidney disease.
•Aspirin – Irreversible COX inhibition. Low-dose for cardioprotection. SE: bleeding, tinnitus, Reye’s in kids.
NCLEX: Stop 7 days pre-surgery; avoid with viral illness in children.
•Acetaminophen – Analgesic/antipyretic; no anti-inflammatory effect. Max 4 g/day. Antidote: N-acetylcysteine.
NCLEX: Monitor liver function; avoid alcohol.
•Glucocorticoids (prednisone, methylprednisolone, dexamethasone) – Anti-inflammatory and
immunosuppressive. SE: hyperglycemia, infection risk, osteoporosis, Cushingoid features. NCLEX: Taper
slowly; take with food; avoid sick contacts.
•Mineralocorticoid (fludrocortisone) – Replaces aldosterone; used in Addison’s. NCLEX: Monitor BP, weight,
edema, and electrolytes.
•Antihistamines – 1st gen (diphenhydramine): sedation, anticholinergic effects. 2nd gen (loratadine, cetirizine):
less sedation. NCLEX: Avoid alcohol and driving.
•Immunosuppressants – Calcineurin inhibitors (cyclosporine, tacrolimus): inhibit IL-2, prevent transplant
rejection. SE: nephrotoxicity, hypertension, tremor. NCLEX: Monitor drug levels, avoid grapefruit juice.
•Azathioprine – Purine synthesis inhibitor for autoimmune disease/transplant. SE: bone marrow suppression,
hepatotoxicity. NCLEX: Monitor CBC, LFTs; avoid infection exposure.
•Mycophenolate mofetil – Inhibits lymphocyte proliferation. SE: teratogenic, GI upset, leukopenia. NCLEX:
Use contraception; report infection signs.
•Methotrexate – Antimetabolite; immunosuppressive for RA/psoriasis. SE: hepatotoxicity, mucositis, marrow
suppression. NCLEX: Avoid pregnancy, alcohol; give folic acid supplement.
•Biologic Agents (adalimumab, infliximab, etanercept) – TNF-α inhibitors for RA, IBD. SE: infection risk, TB
reactivation. NCLEX: Screen for TB before therapy; avoid live vaccines.
•Monoclonal Antibodies (rituximab) – B-cell depletion for autoimmune disease. SE: infusion reaction, infection.
NCLEX: Premedicate with acetaminophen + antihistamine.
•Vaccination with Immunosuppressants – Avoid live vaccines (MMR, varicella, intranasal flu). Inactivated
vaccines recommended before starting therapy.
•Allopurinol – Xanthine oxidase inhibitor for gout. SE: rash, SJS/TEN. NCLEX: Stop immediately if rash;
increase fluids to prevent kidney stones.
•Colchicine – Microtubule inhibitor for acute gout. SE: diarrhea, bone marrow suppression. NCLEX: Stop if
severe GI upset or infection develops.
•Hydroxychloroquine – Used for lupus/RA. SE: retinal toxicity, GI upset. NCLEX: Eye exam q6–12 months;
take with food.
•Levamisole (immunomodulator) – Used in nephrotic syndrome and colon cancer adjunct. SE:
agranulocytosis, rash. NCLEX: Monitor CBC and infection signs.
•Key NCLEX Tip – Immunosuppressive drugs increase infection and cancer risk: avoid crowds, monitor WBC,
report fever, and use PPE with neutropenic precautions.
