Karina, a client with myasthenia gravis, is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it:
A. Promotes the removal of antibodies that impair the transmission of impulses
B. Stimulates the production of acetylcholine at the neuromuscular junction.
C. Decreases the production of autoantibodies that attack the acetylcholine receptors.
D. Inhibits the breakdown of acetylcholine at the neuromuscular junction.
Correct Answer: C. Decreases the production of autoantibodies that attack the acetylcholine receptors.
Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction. Immunotherapy is used to upregulate or downregulate the immune system to achieve a therapeutic effect in immunological mediated disorders including immunodeficiencies, hypersensitivity reactions, autoimmune diseases, tissue and organ transplantations, malignancies, inflammatory disorders, infectious diseases, and any other disease, where immunotherapy can improve the quality and life expectancy.
Option A: Immunosuppressive therapies do not remove the antibodies, they reduce the production of these antibodies that attack the acetylcholine receptors at the neuromuscular junction. Steroids inhibit cytokine synthesis, affect cell migration, and inhibit the production of leukocytes. Cyclophosphamide acts by covalent alkylation, together with chlorambucil, exert an immunomodulatory effect. They inhibit strand separation of DNA during replication.
Option B: The production of acetylcholine is unaffected during immunosuppressive therapy. Methotrexate is an analog of folic acid and blocks pathways essential for DNA synthesis. Azathioprine is a drug that can convert to 6-mercaptopurine, and its effect is incorporation into DNA as a fraudulent base.
Option D: Pyridostigmine is an anticholinesterase inhibitor that works at the neuromuscular junction and prevents the breakdown of acetylcholine. The use of cytokines to successfully treat certain malignancies is a reality, for example, the use of IL-2 in combination with interferon-gamma for renal carcinoma; use of interferon-alpha and beta for hairy leukemia; and TNF-alpha used in various tumors caused a notable reduction of the mass. These cytokines upregulated the immune system through stimulation of T cell and NK cell activation and increased MHC class I expression.