Podcast
Questions and Answers
Which of the following is NOT a component of the first line of defense in the innate immune system?
Which of the following is NOT a component of the first line of defense in the innate immune system?
Which cells are responsible for producing antibodies in the adaptive immune system?
Which cells are responsible for producing antibodies in the adaptive immune system?
What is the role of the second line of defense in the innate immune system?
What is the role of the second line of defense in the innate immune system?
What is the role of T-cells in the adaptive immune system?
What is the role of T-cells in the adaptive immune system?
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Which of the following is NOT a characteristic of the adaptive immune system?
Which of the following is NOT a characteristic of the adaptive immune system?
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Which of the following is a function of the immune system's third line of defense?
Which of the following is a function of the immune system's third line of defense?
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What is the main difference between innate and adaptive immunity?
What is the main difference between innate and adaptive immunity?
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Which of the following is NOT a component of the second line of defense in the innate immune system?
Which of the following is NOT a component of the second line of defense in the innate immune system?
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Which of the following is NOT a potential adverse effect of infliximab (Remicade)?
Which of the following is NOT a potential adverse effect of infliximab (Remicade)?
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Which medication targets CD20 on B lymphocytes and is used for refractory rheumatoid arthritis, certain cancers, and lupus?
Which medication targets CD20 on B lymphocytes and is used for refractory rheumatoid arthritis, certain cancers, and lupus?
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Which of the following medications is considered a cornerstone therapy for rheumatoid arthritis?
Which of the following medications is considered a cornerstone therapy for rheumatoid arthritis?
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What is the primary mechanism of action for TNF-alpha inhibitors like infliximab and adalimumab?
What is the primary mechanism of action for TNF-alpha inhibitors like infliximab and adalimumab?
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Which of the following is NOT listed as a common self-management strategy for Rheumatoid Arthritis?
Which of the following is NOT listed as a common self-management strategy for Rheumatoid Arthritis?
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Which of the following is NOT a mechanism of action for corticosteroids?
Which of the following is NOT a mechanism of action for corticosteroids?
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Which of the following is a potential adverse effect associated with long-term use of corticosteroids?
Which of the following is a potential adverse effect associated with long-term use of corticosteroids?
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Which medication class is primarily used for the prevention of organ transplant rejection?
Which medication class is primarily used for the prevention of organ transplant rejection?
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What is a common adverse effect associated with short-term use of corticosteroids?
What is a common adverse effect associated with short-term use of corticosteroids?
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Which of the following medications is NOT a calcineurin inhibitor?
Which of the following medications is NOT a calcineurin inhibitor?
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Which of the following is a potential drug interaction with calcineurin inhibitors?
Which of the following is a potential drug interaction with calcineurin inhibitors?
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What is the primary mechanism of action for mTOR inhibitors?
What is the primary mechanism of action for mTOR inhibitors?
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Which of the following is a common indication for the use of calcineurin inhibitors?
Which of the following is a common indication for the use of calcineurin inhibitors?
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What is the primary function of pro-inflammatory cytokines?
What is the primary function of pro-inflammatory cytokines?
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Which cytokine is known for its role in suppressing inflammation?
Which cytokine is known for its role in suppressing inflammation?
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What is the role of cytokines in the immune system?
What is the role of cytokines in the immune system?
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Which of the following cytokines stimulate the growth and activation of T cells and B cells?
Which of the following cytokines stimulate the growth and activation of T cells and B cells?
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What is an example of a drug class that targets pro-inflammatory cytokines?
What is an example of a drug class that targets pro-inflammatory cytokines?
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What must patients be screened for before starting medications that suppress the immune system?
What must patients be screened for before starting medications that suppress the immune system?
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Which of the following is an example of a chemokine?
Which of the following is an example of a chemokine?
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Which cytokines are primarily known for enhancing antiviral defenses?
Which cytokines are primarily known for enhancing antiviral defenses?
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Which medication is considered first-line therapy for systemic lupus erythematosus?
Which medication is considered first-line therapy for systemic lupus erythematosus?
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What is a common symptom of systemic lupus erythematosus?
What is a common symptom of systemic lupus erythematosus?
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Which class of medications is specifically used to manage acute flares in systemic lupus erythematosus?
Which class of medications is specifically used to manage acute flares in systemic lupus erythematosus?
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Which symptom should patients with systemic lupus erythematosus be monitored for to detect possible kidney involvement?
Which symptom should patients with systemic lupus erythematosus be monitored for to detect possible kidney involvement?
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What type of agents are known to present risks of nephrotoxicity in transplant patients?
What type of agents are known to present risks of nephrotoxicity in transplant patients?
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What education should be prioritized for patients on hydroxychloroquine?
What education should be prioritized for patients on hydroxychloroquine?
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Which of the following is a common side effect associated with mTOR inhibitors?
Which of the following is a common side effect associated with mTOR inhibitors?
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When should a patient receive a complete ophthalmologic exam while on hydroxychloroquine?
When should a patient receive a complete ophthalmologic exam while on hydroxychloroquine?
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What are the primary indications for Infliximab and Adalimumab?
What are the primary indications for Infliximab and Adalimumab?
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What is the mechanism of action for Rituximab?
What is the mechanism of action for Rituximab?
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Which of the following is a common adverse effect of monoclonal antibodies such as Infliximab and Adalimumab?
Which of the following is a common adverse effect of monoclonal antibodies such as Infliximab and Adalimumab?
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Which drug is contraindicated with live vaccines during therapy?
Which drug is contraindicated with live vaccines during therapy?
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What is a major concern when using polyclonal antibodies like Anti-Thymocyte Globulin?
What is a major concern when using polyclonal antibodies like Anti-Thymocyte Globulin?
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The primary use of Interferon beta in treatment is for which condition?
The primary use of Interferon beta in treatment is for which condition?
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What is a notable adverse effect associated with polyclonal antibodies?
What is a notable adverse effect associated with polyclonal antibodies?
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Which mechanism of action defines the role of Infliximab and Adalimumab?
Which mechanism of action defines the role of Infliximab and Adalimumab?
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Study Notes
Immunity 2025 Course Objectives
- Identify safe, effective nursing management of pharmacological interventions for individuals across the lifespan and their families dealing with chronic immune disorders.
- Select and prioritize nursing outcomes and interventions to develop a plan of care for individuals with chronic immune disorders.
Drug Classification
- Students must understand the following details for each drug class:
- Generic name/trade names
- Classification
- Indications
- Mechanism of action (pharmacokinetics, including absorption, distribution, metabolism, excretion, half-life, onset/peak/duration)
- Contraindications/precautions
- Adverse reactions/side effects (including toxicity and overdose management)
- Drug-drug and food-drug interactions
- Route/dosage
- Nursing considerations (lab values/assessment and monitoring priorities, nursing interventions, and patient/family teaching)
- Additional self-study: Human Immunodeficiency Virus (HIV)
Immune System Defense
- Innate Immunity: Skin, mucous membranes, enzymes, natural microbial flora; Phagocytes (granulocytes, macrophages)
- Adaptive Immunity: Lymphocytes (T-cells, B-cells)
Immune System Key Players
- T cells: Central to immune activation and cytokine production
- B cells: Produce antibodies and contribute to autoimmune responses
- Antibodies: Bind to pathogens or self-antigens to neutralize or flag for destruction
- Macrophages: Process antigens, secrete cytokines, and initiate inflammation
Cytokines: Immune Regulation
- Cytokines are small proteins acting as messengers between immune cells
- Key role in coordinating and regulating immune responses (inflammation, immune activation, suppression)
- Types and functions of cytokines include pro-inflammatory, anti-inflammatory, growth/differentiation, interferons, and chemokines
- Examples and examples of drug classes for each cytokine type are provided in the notes.
Screening Prior to Immunosuppressant Medication
- Prior to administering medications that suppress the immune system, patients should be screened for:
- Tuberculosis
- Hepatitis C and B
- Any acute or chronic infections (pneumonia, osteomyelitis)
- Vaccination status
- Pregnancy status and potential future reproduction considerations
Immune Modifying Therapy Nursing Implications
- Agency protocols should be reviewed for who is permitted to administer immunosuppressants and the requirements for a double-check.
- Units may have additional safeguards (e.g., Foothills Medical Centre Unit 37 does not allow student nurses to work with transplant patients).
- Safe handling and safe disposal of cytotoxic medications are essential.
Immune Modifying Therapies
- Immunosuppressants: Drugs that reduce immune system activity (e.g., corticosteroids, calcineurin inhibitors)
- Immunomodulators: Drugs that regulate or enhance immune responses without broadly suppressing them (e.g., interferons, IVIG)
Specific Drug Classes
- Various categories of immune-modifying therapies (e.g., broad immunosuppressants, targeted immunosuppressants, cytotoxic/antiproliferative agents, antibody-based therapy, immune modulators) are presented with their corresponding drug classes (e.g., corticosteroids, calcineurin inhibitors, mycophenolate, JAK inhibitors, monoclonal antibodies, interferons, interleukin inhibitors, IVIG).
Immune Modifying Therapy General Nursing Considerations
- Head-to-toe assessment considerations (allergies, infection, hypertension, bleeding, side effects associated with inhibiting cell division, including toxicity to liver, kidney, or lungs)
- Lab test considerations (CBC and differential, CRP, liver function, kidney function, CXR, serum drug levels)
- Confirming the last medication dose and preventing pharmacokinetic disruption
Corticosteroids: Review
- Examples: Prednisone, Dexamethasone, Methylprednisolone
- Indications: Short-term management of acute immune flares (e.g., lupus, RA), adjunct in preventing transplant rejection, used in combination with others for long term disease control
- Mechanism of action: Reduce inflammation by inhibiting phospholipase A2, decreasing prostaglandin and leukotriene synthesis; suppress immune response by reducing cytokine production and lymphocyte proliferation
- Adverse effects: Long-term use: Osteoporosis, hyperglycemia, hypertension, adrenal suppression, Cushing's syndrome; short-term use: Mood changes, fluid retention; glucocorticoids cannot be abruptly stopped
Calcineurin Inhibitors
- Examples: Cyclosporine, Tacrolimus
- Indications: Prevention of organ transplant rejection, treatment of autoimmune diseases (e.g., rheumatoid arthritis, psoriasis)
- Mechanism of Action: Block calcineurin, a protein needed for activating T cells and producing interleukin-2, essential for cellular proliferation, thereby suppressing the immune system.
- Adverse effects: Nephrotoxicity, hypertension, hyperkalemia, neurological effects (e.g., tremors, headaches), increased risk of infections
- Drug interactions: Grapefruit juice, NSAIDs (increased risk of kidney damage), phenytoin, rifampin (reduce drug efficacy by increasing metabolism)
mTOR Inhibitors
- Examples: Sirolimus (Rapamune), Everolimus (Zortress)
- Indications: Organ transplant rejection prevention, treatment of specific cancers (e.g., renal cell carcinoma)
- Mechanism of Action: Block mTOR, a protein that controls T-cell growth and division after being activated by interleukin-2, suppressing the immune system.
- Adverse effects: Hyperlipidemia, thrombocytopenia, delayed wound healing
- Drug interactions: CYP3A4 inhibitors (e.g., ketoconazole), increase drug levels, CYP3A4 inducers (e.g., rifampin) decrease efficacy.
Cytotoxic (Antiproliferative) Agents
- Examples: Methotrexate, Azathioprine, Mycophenolate mofetil
- Indications: Lupus nephritis, autoimmune hepatitis, rheumatoid arthritis, organ transplant maintenance therapy
- Mechanism of Action: Block DNA or RNA synthesis, preventing rapid division of immune cells (T and B lymphocytes), suppressing the immune system.
- Adverse effects: Bone marrow suppression (anemia, leukopenia, thrombocytopenia), GI disturbances (nausea, vomiting, diarrhea), hepatotoxicity, increased infection risk
- Drug interactions: allopurinol, antacids and cholestyramine (reduce absorption of mycophenolate)
Cytotoxic (Antiproliferative) Agents: Janus Kinase (JAK) Inhibitors
- Examples: Tofacitinib, Baricitinib
- Indications: Rheumatoid arthritis, psoriatic arthritis, ulcerative colitis
- Mechanism of Action: Block Janus kinase (JAK) pathways, which are crucial for cytokine signaling and immune activation, thereby reducing inflammation and immune overactivity.
- Adverse effects: Increased risk of infections, elevated liver enzymes, thrombosis
- Drug interactions: CYP3A4 inhibitors/inducers alter drug metabolism.
Monoclonal Antibodies
- Examples: Infliximab (Remicade), Rituximab (Rituxan), Adalimumab (Humira)
- Indications: Rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriatic arthritis, multiple sclerosis
- Mechanism of Action: Infliximab/Adalimumab: TNF-alpha inhibitors; Rituximab: targets CD20, a protein on B lymphocytes, marking them for destruction, reducing B cell-driven immune responses.
- Adverse effects: Infusion reactions, increased risk of infections
- Drug interactions: Live vaccines, concurrent immunosuppressive drugs.
Polyclonal Antibodies
- Example: Anti-thymocyte globulin (ATG)
- Indications: Prevention and treatment of acute organ transplant rejection, aplastic anemia unresponsive to other therapies.
- Mechanism of Action: Antibodies made from animals (rabbits or horses) immunized with human т-cells that target multiple T-cell antigens, binding to, and destroying T cells. Suppresses immune response.
- Adverse effects: Infusion reactions (fever, chills, hypotension), risk of infection, serum sickness.
- Drug interactions: Immunosuppressants (e.g., calcineurin inhibitors)
Interferons
- Examples: Interferon beta-1a (Avonex, Rebif), Interferon beta-1b (Betaseron)
- Indications: Multiple sclerosis (reduces relapse rates in relapsing-remitting MS)
- Mechanism of Action: Reduce inflammation by altering cytokine production, decreasing pro-inflammatory and increasing anti-inflammatory cytokines. This shifts the overactive immune system to balance
- Adverse effects: Flu-like symptoms, injection site reactions, depression, increased risk of infections
- Drug interactions: Immunosuppressants, hepatotoxic drugs.
Interleukin Inhibitors
- Examples: Tocilizumab (Actemra), Secukinumab (Cosentyx), Ustekinumab (Stelara)
- Indications: Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn's disease, psoriasis
- Mechanism of Action: Blocks specific interleukin pathways to reduce inflammation and immune activation
- Adverse effects: Increased infection risk, injection site reactions
- Drug interactions: Avoid live vaccines during therapy, immunosuppressants
Intravenous Immunoglobulin (IVIG) Review
- Examples: Gammagard, Privigen
- Indications: Immune thrombocytopenia (ITP), Kawasaki disease, primary immunodeficiencies
- Mechanism of Action: Provides passive immunity by neutralizing autoantibodies and inflammatory cytokines
- Adverse effects: Infusion reactions, headache, thromboembolism
- Drug Interactions: Avoid live vaccines within 6 months of IVIG therapy
Disease-Modifying Antirheumatic Drugs (DMARDs)
- Medications that slow the progression of autoimmune diseases, particularly rheumatic disorders, to reduce inflammation, prevent joint damage, and improve long-term outcomes
- Classifications
- Non-biologic DMARDs: Synthetic compounds broadly suppressing the immune system (e.g., methotrexate, sulfasalazine, leflunomide, hydroxychloroquine)
- Biologic DMARDs: Targeted therapies interfering with specific immune pathways (e.g., infliximab, adalimumab)
Specific Non-Biologic DMARDs
- Methotrexate: Inhibits dihydrofolate reductase, reducing DNA synthesis and T-cell activation
- Adverse effects: Bone marrow suppression, hepatotoxicity, stomatitis
- Drug interactions: NSAIDs, TMP-SMX, PPIs, Aspirin/Salicylates, Folic Acid/Folinic Acid, Penicillins, Alcohol, Leflunomide, Live Vaccines
- Sulfasalazine: Reduces inflammation by modulating immune pathways
- Adverse effects: GI disturbances, hypersensitivity reactions
- Drug interactions: Folic Acid, Methotrexate, Antibiotics, Warfarin
- Hydroxychloroquine: Interferes with how macrophages process antigens, reducing their ability to activate T-cells
- Adverse effects: Retinopathy
- Drug interactions: Tamoxifen, Digoxin, Antacids
- Leflunomide (Arava): Blocks pyrimidine synthesis
- Adverse effects: Hepatotoxicity, hypertension, gastrointestinal disturbances
- Drug Interactions: Warfarin, other hepatotoxic drugs
Specific Biologic DMARDs
- Infliximab (Remicade): TNF-alpha inhibitor
- Indications: Rheumatoid arthritis, Crohn's disease, psoriasis
- Adverse effects: Infusion reactions, infections
- Adalimumab (Humira): Indications: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
- Adverse effects: Infections, injection-site reactions, increased risk of malignancies
- Rituximab (Rituxan): Targets CD20 on B lymphocytes
- Indications: Rheumatoid arthritis (refractory), lupus, certain cancers
- Adverse effects: Infusion reactions, hepatitis B reactivation, hypogammaglobulinemia
- Etanercept (Enbrel): Indications: Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
Chronic Immune Disorders
- General information is included about different types of chronic immune disorders (including rheumatoid arthritis, juvenile idiopathic arthritis, systemic lupus erythematosus, and immune deficiency)
Transplant
- Lifelong immunosuppressive therapy needed to prevent graft rejection
- Includes calcineurin inhibitors, mTOR Inhibitors, corticosteroids, and Polyclonal antibodies.
- Detailed notes are provided on managing side effects from medications such as nephrotoxicity, hyperlipidemia, infection risk, and therapeutic monitoring considerations for transplant patients.
- Additional information includes the importance of infection prevention education, and collaborative care with the multidisciplinary team for transplant patients.
Immune Deficiency
- SCID details and treatment are described, including HSCT and IVIG
- Nursing care considerations and the importance of preventing infections for patients with SCID are underscored.
References
- Resources for various conditions are available in the notes
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Description
Test your knowledge on the components and functions of the innate and adaptive immune systems. This quiz covers key concepts such as the first, second, and third lines of defense, as well as the roles of specific cells and treatments like infliximab. Challenge yourself with questions about immune responses and therapies related to rheumatoid arthritis.
