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[L.2] Immune- Pharm

Terms in this set (50)

Key of Drugs
1.) Know what you are giving.
2.) Why you are giving.
3.) What can happen.

** There are NO safe drugs!
Immunity
>Antibody (humoral) mediated
-B cell activation
-B cell clones itself and produces antibodies
-Some vaccines work in this manner

>Cell-mediated
-T cells (helper/CD4) activates immune cells
-T cells (cytotoxic/ killer CD8)
-T cells produce cytokines
VACCINES
>ACTIVE IMMUNITY:
pt's immune system stimulated to produce antibodies after exposure to antigen

>PASSIVE IMMUNITY:
direct administration of antibodies - usually short lived

EX:
Diphtheria, tetanus, pertussis
Haemophilus influenza
Hepatitis B
Measles, mumps, rubella
Poliovirus
Varicella zoster

>>SIDE EFFECTS:
>Redness and discomfort at the site of injection
>Fever
>Anaphylaxis

-- Parent may ask about risks: never say "safe" can say the benefits out weight he risks.
--Can check titer for immunity

>>CONTRAINDICATED:
>Those who are:
-immunocompromised
-immunosuppressed
-have diarrhea
-vomiting, or
-fever
-->Give Immune Globulin
IMMUNOSTIMULANTS
INTERFERONS:
>Increase phagocytosis
>Enhance cytotoxic activity of T-cells
>Used to treat AIDS related Kaposi's sarcoma, Hairy Cell Leukemia, and chronic Hepatitis (both B & C)

INTERLEUKINS:
>Stimulates T-cell function
>Stimulates B-cell production
>Promotes inflammation
>Used for treatment of metastatic renal cancer and certain bladder cancers
Immunostimulants:
Nursing Considerations
>Baseline laboratory tests required prior to administering

>Major risk:
-Possibility of CNS changes D/T bone marrow. suppression (Autoimmune)
-Encephalopathy from bone marrow suppression.

>> SIDE EFFECTS:
-Muscle aches
-Fever
-Weight loss
-Anorexia
-N/V
-Arthralgia (joint pain)

>>CONTRAINDICATED:
-Transplant Patients
-Pts. with renal/liver disease(this is not the same as CA)
INFLAMMATION
CHEMICAL MEDIATORS:
>Histamine 1
>Leukotriene's
>Bradykinin
>Complement
>Prostaglandins

RESPONSE FROM A STIMULI:
>Physical injury
>Exposure to toxic chemicals
>Extreme heat
>Invading microorganisms
>Death of cells
HISTAMINE
>Stored in Mast cells
>Found in epithelial membranes:
-Skin
-Bronchial tree
-Digestive tract
-Blood vessels
-CNS
HISTAMINE 1
>Receptors in smooth muscle of vascular system, bronchial tree, digestive tract, heart, and CNS

>Stimulation results in itching, pain, edema, vasodilation, and bronchoconstriction
HISTAMINE 2
>Primarily in the stomach

>Stimulation results in secretion of hydrochloric acid (HCl)

>Can be given to Decrease HCL secretion
ANTIHISTAMINES:
1ST GENERATION
>NON-SELECTIVE
>BLOCKS H1 & H2

>May cause CNS depression

>Has anticholinergic properties-dry mouth, urinary retention, tachycardia

>CAUTION:
-pts. who have urinary retention
>Young children; effects on growth and development not established

>>CONTRAINDICATED:
-Patients with dysrhythmias or heart failure
-Patients with severe liver and kidney impairment
ANTIHISTAMINES:
2ND GENERATION
>SELECTIVE FOR H1 ONLY

>NO CNS EFFECTS
>NO EFECTS ON GASTRIC ACID PRODUCTION (H2 effects stomach)

>Used for the treatment of allergies, motion sickness, and insomnia
>For allergy symptoms need to be taken prophylactically
>Has anticholinergic properties-dry mouth, urinary retention, tachycardia

>CAUTION:
-pts. who have urinary retention
-young children; effects on growth and development not established

>>CONTRAINDICATED:
-Patients with dysrhythmias or heart failure
-Patients with severe liver and kidney impairment
NSAIDs
>Analgesic, antipyretic, anti-inflammatory properties
>Drug of choice for mild to moderate inflammation
NSAIDs:
1ST GENERATION
>Block COX-1 & COX-2
>ASA and Ibuprofen
(COX 1:protects stomach lining)
>Slows synthesis of mediators of inflammation
>Inhibition of COX prolonged in platelets
>Cause total inhibition for total lifespan of platelet (8-11 days)
>Anticoagulant effect

>>SIDE EFFECTS:
>GI bleeding, gastric upset, reduced kidney function

>>ADVERSE EFFECTS:
>GI bleeding
-Esp. with smoking, alcohol abuse, hx of peptic ulcer disease
-Watch for interactions with herbals: Feverfew, Garlic, Ginseng, Gingko

>>CONTRAINDICATION:
>end-stage liver disease (ESLD)

>>CAUTION:
>Pregnant women (fetal abnormalities in 2nd and 3rd trimester)
>Children under 19 - Reye's syndrome
-Reyes: infection - fat accumulation in brain and liver, potentially fatal

**BLOCKING COX1 & H2 EFFECT STOMACH LINING!


>EDUCATION:
-Take with meals
-Report blood in urine and stool
-Report Changes in hearing (tinnitus)
-Report Abdominal pain
-Report Rash
NSAIDs:
2ND GENERATION
>SELECTIVELY BLOCK COX-2
>Reduces inflammation without side effects of COX-1 (does not effect stomach lining)

>FOR THOSE WITH:
Gastrointestinal, kidney, and liver problems

>Possible cardiovascular risk after prolonged use in some patient
GLUCOCORTICOIDS
>Immunosuppresants
>Antimetabolites, Antibodies, Calcineurin

>Potent anti-inflammatory: Blocks both-(COX-1 and Cox-2)-Naturally released by the adrenal cortex.
>Used only for severe cases of inflammation-Short-term treatment

>FOR:
-Allergies
-Seasonal rhinitis
-Post-transplant surgery
-Long term prevention of asthma attacks
-Replacement therapy for individuals with adrenocortical insufficiency
-Treatment of neoplasia

>>NURSING:
>Screen for existing infection - concurrent antibiotic therapy
>Accuchecks - increase glucose
>Sodium and fluid retention--->Daily weight
>s/s Cushing's syndrome (adrenocortical excess)
>s/s gastric ulcers
>Monitor vital signs and blood tests that would provide information about infection
>Take meds at same time each day--> Dont want therapeutic variation!
>Do not stop abruptly, ALWAYS taper off---Can cause (ADRENAL) crisis to stop abruptly
>Report any s/s of infection immediately
>Watch for s/s bleeding, i.e., nose bleeds, bloody stools, etc

>Tell patient to report:
-alopecia
-arthralgia
-respiratory distress
-edema
-n/v
-fever
-blood in urine
-black stools
-feelings of sadness

*Possibility of superimposed infection
*Should avoid sick people
*TAKE CONTRACEPTION!

>>ADVERSE RXN:
-Adrenal insufficiency
-Hyperglycemia
-Mood changes
-Cataracts
-Peptic ulcers
-Osteoporosis
-Can mask the signs and symptoms of infection

>>CONTRAINDICATION:
-Leukemia
-Metastatic cancer
-Active infection
-Renal or liver disease
-Pregnancy
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