Exam 19 - Drugs Affecting the Immune System

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Questions and Answers

What is the primary purpose of an antibody titer test?

To identify the specific type of bacteria causing an infection.

To measure the amount of antibodies produced by the body.

To determine the strength of a person's immunity to a specific organism. (correct)

To diagnose an existing infection.

Which of the following is NOT a common minor side effect of a seasonal flu vaccine?

Minor swelling at the injection site

Headache (correct)

Low-grade fever

Sore arm

What does a 'zero titer' for a disease like chickenpox (VZV) indicate?

A previous infection with the disease.

Complete immunity to the disease.

The need for additional vaccinations.

No antibodies and a high risk of developing the disease. (correct)

What is the recommended frequency for receiving the seasonal flu vaccine?

Every year (D) Signup and view all the answers

Which of the following is NOT a potential adverse reaction to a vaccine?

Kidney failure (A) Signup and view all the answers

Which of these drugs can lead to an increase in blood glucose? (Select All That Apply)

Tacrolimus (A), Cyclosporine (C) Signup and view all the answers

What information should be obtained from a patient BEFORE administering a vaccine?

Past medical history, including allergies and medication use (A) Signup and view all the answers

What is a common side effect experienced by patients taking all selective immunosuppressant drugs?

Gastrointestinal Problems (A) Signup and view all the answers

Which of these drugs can cause an increased risk of liver toxicity or failure?

All of the above (D) Signup and view all the answers

What is the recommended course of action for a patient who develops a fever of over 101°F after receiving a vaccine?

Notify the healthcare provider. (D) Signup and view all the answers

What is the primary purpose of immunomodulation?

To alter the immune response either by stimulating or suppressing it. (A) Signup and view all the answers

What type of vaccine should be avoided in patients taking immunosuppressants?

Live vaccines (B) Signup and view all the answers

What is the significance of understanding strain variability in relation to the seasonal flu vaccine?

Flu vaccine effectiveness is limited by the specific strains circulating in communities. (D) Signup and view all the answers

Which drug has a significant number of drug interactions?

Cyclosporine (C) Signup and view all the answers

What is a common side effect of cyclosporine?

Gingival Hyperplasia (D) Signup and view all the answers

What should be included in the patient teaching for those on immunosuppressants?

Avoid contact with people who are ill and take daily temperature. (D) Signup and view all the answers

What is a potential consequence of taking immunosuppressants for a long period?

All of the above (D) Signup and view all the answers

Why should patients taking immunosupressants avoid live flowers and fresh fruit?

They can introduce potential infections (C) Signup and view all the answers

Which of the following is NOT a type of selective immunosuppressant drug used for organ transplant rejection?

Methotrexate (D) Signup and view all the answers

Which type of immunosuppressant drug works by inhibiting enzymes necessary for lymphocyte reproduction?

Antiproliferative drugs (D) Signup and view all the answers

Which of the following is a common example of a DMARD used to treat both autoimmune diseases and transplant rejection?

Adalimumab (Humira) (D) Signup and view all the answers

What is the primary mechanism of action for calcineurin inhibitors like tacrolimus (Prograf)?

Inhibit the activation of T lymphocytes (C) Signup and view all the answers

Which of the following statements accurately describes the function of azathioprine (Imuran)?

It inhibits purine metabolism, affecting DNA synthesis and cell division (C) Signup and view all the answers

How do corticosteroids, like prednisone, act as immunosuppressants?

By inhibiting the production of inflammatory cytokines (C) Signup and view all the answers

What is the main goal of immunosuppressant therapy for organ transplant patients?

To prevent the body from rejecting the transplanted organ (C) Signup and view all the answers

Which of the following is a common side effect associated with immunosuppressant therapy?

Increased risk of infection (D) Signup and view all the answers

Which type of drug is most commonly used for treating autoimmune diseases like rheumatoid arthritis and psoriasis?

Disease-modifying antirheumatic drugs (DMARDs) (C) Signup and view all the answers

Which of the following vaccine types uses live, weakened organisms?

Attenuated Vaccines (D) Signup and view all the answers

Why is it important to get booster shots for certain vaccines?

Booster shots help to re-introduce the body to the specific antigen, increasing antibody levels. (C) Signup and view all the answers

What is the main mechanism by which vaccines work?

Vaccines stimulate the immune system to produce antibodies against the disease. (C) Signup and view all the answers

Which of the following is an example of a toxoid vaccine?

Tetanus (B) Signup and view all the answers

Which of the following vaccines are given to children at 2, 4, and 6 months of age?

DTaP (D) Signup and view all the answers

Which of the following vaccines is an example of an inactivated vaccine?

Polio (B) Signup and view all the answers

Why are attenuated vaccines contraindicated for pregnant women?

Attenuated vaccines contain live organisms that could potentially harm the developing fetus. (A) Signup and view all the answers

What is the purpose of artificially acquired active immunity?

It is used to stimulate the immune system to produce antibodies against specific antigens. (D) Signup and view all the answers

Study Notes

Drugs Affecting the Immune System

Vaccines: Preparations of killed, weakened, or synthetic bacteria/viruses to stimulate antibody production against specific diseases.
- Mechanism: Stimulates the immune system to create antibodies for future infection protection.
- Efficacy: Less effective than naturally contracting the disease; may require multiple doses and booster shots for sustained immunity.
- Types:
  - Inactivated: Killed organisms (e.g., polio, hepatitis A, rabies)
  - Attenuated: Weakened live organisms (e.g., MMR, varicella); contraindicated in those with active infections and pregnancy.
  - Toxoids: Modified non-toxic toxins (e.g., diphtheria, tetanus)
  - Biosynthetic: Made using genetic material (e.g., Hepatitis B)
- Schedules: Multiple injections to ensure sufficient B cell sensitization. DTaP (diphtheria, tetanus, pertussis) vaccine is given at specific ages, with boosters at later intervals (2, 4, 6 months, 15-18 months, 4-6 years, 11 years, then every 10 years).
- Distinction: Vaccine is the injection; immunization is the successful outcome.

Antibody Titer

Purpose: Measures the amount of antibodies in the blood to determine the strength of immunity to a specific organism.
- Interpretation: A zero titer indicates no antibodies; a titer of 32 signifies good immunity.

Seasonal Flu Vaccine

Recommendations: Annual vaccination for all ages, especially immunocompromised individuals.
Strain Variability: The vaccine is updated yearly to correspond with the prevalent strain.

Side Effects

Minor: Sore arm, minor swelling, low-grade fever.
Severe: Can range from hives to seizures to anaphylactic shock.

Nursing Implications and Patient Teaching

Assessment: Obtain complete medical history, including immunodeficiency, pregnancy status, and allergy information.
- Assess for symptoms of illnesses which may necessitate vaccine delay.
Teaching: Provide information about possible side effects (localized reactions, pain), comfort measures (e.g., cool compresses), and when to notify the healthcare provider (e.g., fever).

Immunomodulation

Definition: Altering the immune response, either stimulating (enhancing) or suppressing it.
- Purpose: In cases of organ transplants and autoimmune diseases.
- Immunostimulants: Stimulate a weak immune system; vaccines are an example.

Selective Immunosuppressants for Autoimmune Diseases & Transplant Rejection

Overview: Suppress the immune response in autoimmune disorders (e.g. rheumatoid arthritis, psoriasis) or transplant rejection situations.
Types of Immunosuppressant Drugs:
- Nonselective: Corticosteroids (e.g., prednisone), cancer chemotherapeutic drugs (e.g., methotrexate)
- Selective: Disease-modifying antirheumatic drugs (DMARDs), e.g. adalimumab, etanercept.
Immunosuppressant drugs:
- Antiproliferative Drugs: Slow lymphocyte growth (e.g. azathioprine)
  - Reduce lymphocytes by inhibiting purine metabolism crucial for DNA synthesis and cell division

Adverse Effects of Immunosuppressants

General: Gastrointestinal (GI) problems, rashes, possible cancer (especially skin cancer), liver toxicity, electrolyte imbalances.
Specific to Calcineurin Inhibitors: Increased blood cholesterol and blood glucose; gingival hyperplasia (gum overgrowth).
Specific to Selective Immunosuppressants: Increased risk of skin cancer; increased risk of liver toxicity with acetaminophen/alcohol.

Drug Interactions

Important: Check with a pharmacist or drug reference for interactions. Cyclosporine has numerous interactions (57 serious and 37 moderate).

Nursing Implications

Assessment: Complete history, physical exam, including a complete drug history and infection screening, lab values, including baseline CBC, chemistry, platelets, etc.
Teaching: Emphasize self-monitoring, symptom reporting, vaccine precautions, medication administration, and safety measures (e.g., avoiding grapefruit, timing the use of medications).

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Description

This quiz explores various drugs that impact the immune system, focusing on vaccines and their mechanisms, efficacy, and types. It covers inactivated, attenuated, toxoid, and biosynthetic vaccines, as well as vaccination schedules. Test your knowledge on how these vaccines work to protect against diseases.