Immune Anti Hist NSAIDS 2024.docx

Immunizations, Immunosuppressants, Anti-histamine, NSAIDS (2024) IMMUNIZATIONS (protect against infections) pg. 209 Key Terms: Immunization—bolsters immune system to provide protection from a specific disease vaccination—refers broadly to any vaccine or toxoid vaccines—induce antibody formation by u...

Immunizations, Immunosuppressants, Anti-histamine, NSAIDS (2024) IMMUNIZATIONS (protect against infections) pg. 209 Key Terms: Immunization—bolsters immune system to provide protection from a specific disease vaccination—refers broadly to any vaccine or toxoid vaccines—induce antibody formation by using killed (inactive) vaccines or live (weakened) components toxoid—use an altered bacterial toxin to stimulate the body to form an Ab to protect from the toxin Individual Immunization Agents and Target Diseases: Measles, mumps, rubella (MMR) Diphtheria, tetanus, pertussis (DTaP, the Tdap, then Td every 10 yrs.) Chickenpox—varicella virus (Varivax) Poliomyelitis—poliovirus vaccine (IPV) Hepatitis A (Hep A) and Hepatitis B (Hep B) Many, many others: pneumococcal vaccine, meningococcal vaccine, influenza, rotavirus, human papillomavirus, respiratory syncytial virus Often given in combination: For example, PEDIARIX—diphtheria, tetanus, pertussis, hepatitis B, and poliovirus **Immunization Schedules—key to remember is that it changes DRUGS TO DECREASE IMMUNITY (Immunosuppressants) pg. 226 Immunosuppressants inhibit immune response. Used to prevent organ rejection and treat autoimmune diseases. All are toxic and increase risk for infection and risk for neoplasm. Conventional Antirejection Agents—cyclosporin (often in combo with methotrexate). Binds with calcineurin so suppresses production of Interleukin-2, which is needed for T- and B-cell proliferation. Adverse effects—nephrotoxicity, hirsutism, gingival hypertrophy, hypertension, tremors, and serious infections. Other drugs are cytotoxic (e.g. methotrexate and mycophenolate) Glucocorticoids (see previous content) ANTI-HISTAMINES 619 HISTAMINE—the first chemical released in the immune response which results in allergic response. Mostly synthesized and stored in Mast cells, which are found in lung, skin, and blood (called basophils here) Gastrointestinal tract where it stimulates stomach acid Brain—likely functions as a neurotransmitter Histamine 1 stimulation causes (vascular) vasodilation and increased permeability Dilates arterioles so capillaries become more permeable causing local edema (bump after a mosquito bite) Could cause anaphylactic shock if severe (lungs) bronchoconstriction, causing difficulty breathing; wheezing (skin) itching, pruritis; hives ANTI-HISTAMINES—Histamine 1 Antagonists These do NOT block release of histamine, they block at the receptor site First Generation H1 Receptor Antagonists Prototype: diphenhydramine Inhibit dilation so it decreases edema. At therapeutic doses, depresses CNS, so causes sedation But, with an overdose, the CNS is stimulated. Found in many OTC cough and cold remedies Uses include allergic rhinitis, conjunctivitis, dermatitis, motion sickness, insomnia, and parkinsonism Adverse Effects: CNS depression symptoms Anti-cholinergic effects—dry mouth, urinary retention, constipation, blurred vision Second generation H1 Receptor Antagonists Prototype: cetirizine mostly peripheral, so less CNS effects Third generation H1 Receptor Antagonists Prototype: fexofenadine even less, so even less drowsiness and sedation ANTI-HISTAMINE--Histamine -2 Antagonist H2 stimulates gastric acid secretion Will be discussed in the Gastrointestinal meds Nonsteroidal Anti-inflammatory Drugs and Acetaminophen (NSAIDs) These drugs (aspirin and acetaminophen and NSAIDS) inhibit the synthesis of prostaglandins which respond to the inflammatory response. Cyclooxygenase (COX) enzymes (which produce prostaglandins) occurs in a variety of areas: At tissue injury, promotes inflammation and sensitizes to painful stimuli At stomach, protects gastric mucosa At platelets, stimulates aggregation At blood vessels, causes vasodilation In kidney, maintain renal blood flow In brain, mediate fever and pain perception So, COX inhibitors prevent the effects above from happening, so the drugs help with inflammation, pain, protects from MI & stroke, but causes GI bleeding and renal impairment, alleviates pain and fever. First Generation NSAIDs (inhibit both COX1 and COX2): Salicylates: Prototype: aspirin --relieve pain, also antipyretic, and suppress platelet aggregation Propionic Acid Derivatives: Prototype: ibuprofen --NSAIDS that inhibit prostaglandin synthesis --Numerous adverse effects: dry mouth, gingival hyperplasia, dyspepsia, heartburn, nausea, epigastric pain, constipation, GI ulceration, nephrotoxicity, elevated BUN and creatinine, dyspnea, bronchospasm, hemoptysis. Others include naproxen ketorolac--an injectable drug often used for pain. Non NSAID—Prototype: acetaminophen Non narcotic analgesic --relives pain and fever --large number of prescription and OTC meds --Adverse effects: hepatotoxicity and renal failure, myocardial damage if high doses. Second Generation NSAIDs (inhibit only COX-2) prototype: celecoxib --Referred to as coxibs. Expensive. --Seems to be less bleeding especially initially, but maybe not for long term --Contraindicated if allergic to sulfonamides, NSAIDs or aspirin Quick Comparison of aspirin, acetaminophen and ibuprofen Aspirin (acetyl salicylic acid) Acetaminophen Ibuprofen General information NSAID Salicylate Oral and rectal Very widely use Has no anti-inflammatory effects Oral and rectal Relieves the pain of inflammation but not the inflammation itself NSAID Propionic Acid Derivative Oral mostly More similar to aspirin than acetaminophen Mechanism of action Inhibits cyclooxygenase (inhibits prostaglandins) Decreases prostaglandins in CNS so work on fever and pain Inhibit prostaglandins in central and peripheral nervous system Therapeutic Uses Pain—excellent relief of mild to moderate pain. Fever in adults Inflammatory diseases like rheumatoid arthritis and osteoarthritis. Decrease platelet aggregation so protects against MI and stroke (low dose). Reduces minor pain Reduces fever in children Better for those with sensitive stomachs Relieves mild to moderate pain Rheumatoid arthritis and osteoarthritis Adverse effects and toxicity and Overdose Rare if short term use. Bleeding ulcers Reye’s syndrome (especially if viral infection) Nephrotoxicity May be fatal in children Rare at therapeutic levels No nausea, vomiting, or GI bleed Hepatotoxicity—overdose is leading cause of acute liver failure. **acetylcysteine is 100% effective in preventing liver damage if given within 8 – 10 hours of overdose. Also renal impairment Many GI adverse effects Nephrotoxicity Respiratory effects Interactions Alcohol ACE inhibitors Other NSAIDS Warfarin and all other anticoagulants Don’t use if have ulcers or bleeding disorder. Category D Alcohol Warfarin Category B Anticoagulants Other analgesics Corticosteroids