Drugs That Affect The Immune System PDF

**I. Drugs That Affect the Immune System** - **A. Vaccines** - **Definition:** A preparation of synthetic, killed, or weakened bacteria or viruses administered to stimulate antibody production by B lymphocytes against a specific disease. - **Mechanism:** Stimulates t...

**I. Drugs That Affect the Immune System** - **A. Vaccines** - **Definition:** A preparation of synthetic, killed, or weakened bacteria or viruses administered to stimulate antibody production by B lymphocytes against a specific disease. - **Mechanism:** Stimulates the immune system to produce antibodies, providing protection against future infections. - **Efficacy:** - Not as stimulating as natural acquisition of active immunity (i.e., contracting the disease). - May require multiple injections to achieve full immunity. - Immunity may wane over time, necessitating booster shots for continued protection. - **Distinction:** - **Vaccine:** The actual medication or injection. - **Immunization:** The result of a successful vaccination. - **B. Vaccine and Booster Schedules** - **Artificially acquired active immunity** often requires multiple injections. This ensures that enough B cells are sensitized to the specific antigen. Some vaccines require smaller, more frequent doses. - **Example:** The DTaP vaccine (diphtheria, tetanus, pertussis) is given at: - 2, 4, and 6 months of age - Booster at 15-18 months - Booster at 4-6 years - Booster at 11 or 12 years - Booster at 19 years then once every ten years thereafter - The CDC provides recommended vaccination schedules for children and adults. - **Types of Vaccines**: - **Inactivated Vaccines:** Composed of organisms that have been killed or inactivated by heat to prevent reproduction, examples include polio, hepatitis A, and rabies. - **Attenuated Vaccines:** Contain live organisms that have been weakened; contraindicated in patients with active infections and those who are pregnant; examples include MMR and varicella. - **Toxoids:** Modified pathogenic microorganisms that are no longer toxic; examples include diphtheria and tetanus. - **Biosynthetic Vaccines:** Made using genetic engineering processes, containing a synthetic or natural extract of the disease-causing virus or bacterium; example is Hepatitis B. - **C. Adult Vaccination Considerations** - Vaccines may be required for children and adults based on history, job exposure, or travel. - Military personnel may need special vaccinations such as yellow fever, anthrax, and cholera. - **D. Antibody Titer** - **Purpose:** A test to detect and measure the amount of a specific antibody in the blood to determine the strength of a person's immunity to a specific organism. - **Interpretation:** - A **zero titer** for a disease such as chicken pox (VZV) indicates no antibodies and a high risk of developing the disease. - An **antibody titer of 32** for a disease indicates good immunity. - **E. Seasonal Flu Vaccine** - **Recommendations:** Yearly vaccination for children and adults, especially those who are immunocompromised. - **Strain Variability:** Flu strains vary, and the vaccine is updated annually to reflect the likely strains circulating in communities. - **F. Side Effects** - **Common minor side effects:** sore arm, minor swelling at injection site, low-grade fever. - **G. Adverse Reactions** - Can range from mild to severe, including: - Fever - Hives - Joint discomfort - Severe fever \> 103°F - Seizures - Neuropathy - Severe reactions can result in anaphylactic shock. - **H. Nursing Implications and Patient Teaching** - **Nursing:** - Obtain a history of immunodeficiency, pregnancy status, and plans for pregnancy. - Obtain a drug history including immunosuppressive drugs, immune globulins, and blood products. - Complete allergy history (medications, vaccines, environmental). - Assess for symptoms of illness (with or without fever) that may require delaying vaccination. - **Patient Teaching:** - Inform about possible localized reactions and discomfort, advise using cool compresses, acetaminophen, or ibuprofen for symptom relief. - Advise patients to notify the healthcare provider for fever \> 101°F. - Keep current immunization schedule. - Teach parents about the risks of contracting the disease versus the risks of vaccination. - Provide CDC handouts for further information. - **I. Immunomodulation** - **Definition:** A process in which an immune response is altered. - **Immunomodulating drugs** can stimulate or suppress the immune system. - **Purpose:** Used to hinder the response to organ transplants and autoimmune diseases. - **Immunostimulants:** Stimulate the immune response when it is deficient; vaccines are an example. **II. Selective Immunosuppressants for Autoimmune Diseases** - **A. Overview** - The immune system can overreact in certain tissues, resulting in an autoimmune disorder. The body can see the tissue as foreign and attack it. Examples include rheumatoid arthritis and psoriasis. - **Immunosuppressant drugs** prevent or suppress this response. - **B. Types of Immunosuppressant Drugs** - **Nonselective drugs:** - Corticosteroids (e.g., prednisone) - Cancer chemotherapy drugs (e.g., methotrexate) - **Selective Immunosuppressants** - Disease-modifying antirheumatic drugs (DMARDs) are most commonly used - Examples include adalimumab (Humira) and etanercept (Enbrel). **III. Selective Immunosuppressants for Transplant Rejection** - **A. Overview** - Antirejection drugs suppress the immune system cells and factors responsible for rejecting transplanted tissues and organs. - Dosages are adjusted based on the immune response, as these drugs cause general immunosuppression. - DMARDs and corticosteroids can be used for this purpose. - **B. Types of Selective Immunosuppressant Drugs** - **Antiproliferative Drugs**: slow the growth of lymphocytes that cause autoimmune disease and transplant rejection. - **Azathioprine (Imuran):** Least selective, inhibits purine metabolism (important for DNA synthesis and cell division) and suppresses T lymphocytes. - **Mycophenolate (CellCept):** More selective in suppressing T and B lymphocytes, inhibits enzymes needed for lymphocyte reproduction, and prevents T cell activation. - **Sirolimus (Rapamune):** Inhibits T cell activation and reproduction, blocks rapamycin pathways promoting cell division for T cells. - **Everolimus (Zortess):** Acts like sirolimus but is more specific than the general antiproliferative drugs. - **Calcineurin Inhibitors:** form a complex with calcineurin in T cell lymphocytes, preventing the activation of those cells and reducing their ability to attack transplanted tissues and organs. - Examples include cyclosporine (Gengraf, Sandimmune, Neoral) and tacrolimus (Prograf, Astagraf XL, Hecoria). **IV. Side Effects, Adverse Effects, Drug Interactions, Nursing Implications, and Patient Teaching for Immunosuppressants** \* \*\*A. Side Effects of Selective Immunosuppressant Drugs and Calcineurin Inhibitors\*\*\ \* \*\*Selective immunosuppressant drugs:\*\*\ \* Vary depending on the mechanism of action\ \* All cause GI problems and rashes.\ \* Tacrolimus can cause diabetes mellitus.\ \* Sirolimus and everolimus can increase blood cholesterol.\ \* \*\*Calcineurin inhibitors:\*\*\ \* Increase blood cholesterol, causing salt-sensitive hypertension\ \* Increase blood glucose, making diabetes harder to control.\ \* Cyclosporine can cause gingival hyperplasia. \* \*\*B. Adverse Effects\*\*\ \* Selective immunosuppressants increase the risk of cancer, especially skin cancer, due to reduced immunity.\ \* Antiproliferative and calcineurin inhibitors increase the risk for skin cancer and liver toxicity/failure (increased with acetaminophen and alcohol).\ \* All of these drugs can cause electrolyte imbalances.\ \* Avoid live vaccines due to reduced immunity, increasing the risk of contracting the disease. \* \*\*C. Drug Interactions\*\*\ \* All selective immunosuppressants interact with numerous drugs; it is important to take a good drug history and check with a pharmacist or drug reference book for interactions.\ \* Example: Cyclosporine has 57 serious reactions and 37 moderate interactions. - **D. Nursing Implications** - **Assessment:** - Complete detailed history and physical exam. - Include a complete drug history. - Screen visitors for infection and reinforce hand hygiene, and advise that patients not receive gifts that might introduce infection (e.g. live flowers and fresh fruit). - Use PPE as antiproliferative drugs can be absorbed through skin and mucous membranes. - Obtain baseline labs (CBC, chemistry, platelets, kidney and liver function, bilirubin, and EKGs). - Assess IV/port sites for irritation, phlebitis, or thrombosis. - Assess for hypersensitivity. - Monitor vital signs and report abnormal findings. - Monitor patient-reported fevers, chills, fatigue, cough, difficulty breathing, and gum problems. - **E. Patient Teaching** - Take temperature daily and watch for signs/symptoms of infection. - Report any findings immediately to the healthcare provider. - Check with provider before getting any vaccines. - Keep all appointments for monitoring blood counts and other labs. - Take drugs exactly as prescribed to maintain effectiveness and prevent rejection. - Notify provider of any skin discoloration, especially yellow skin, urine, or stool. - If using liquid medications, mix exactly as directed, with the correct solution, and rinse the container thoroughly. - Separate sirolimus and cyclosporine by at least 4 hours to ensure best effect. - Sirolimus and tacrolimus cannot be mixed with grapefruit. - Always check with healthcare provider before taking any new drugs or supplements, since antiproliferative and calcineurin inhibitors interact with multiple drugs. This study guide should provide a solid foundation for understanding the material. Let me know if you have any other questions.