Drugs for Immune System Modulation

1
Drugs for Immune System Modulation

• Chapter 32

2
Immune System

• a biochemical complex that protects the body
  against pathogenic organisms and other foreign
  bodies. The system incorporates the humoral
  immune response, which produces antibodies to
  react with specific antigens, and the cell
  mediated response, which uses T-cells to mobilize
  tissue macrophages in the presence of a foreign
  body.
• Mosbys Pocket
  Dictionary, p. 530

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Lymphoid System

• Identify structures of the system.
• Describe the overall purpose of the system.

4
Lines of Protection/Defense

• Compare and contrast the bodys protection
  against pathogens.
• First line (non-specific)
• Second line (specific)

5
Immune Response

• Describe the immune response
• Compare and contrast the divisions of the immune
  response.
• Humoral
• Cell mediated

6
Vaccines

• Describe the MOA of vaccines.
• Discuss the difference between active and passive
  immunity.
• Identify situations in which administration of
  agents producing passive immunity are indicated.

7
Vaccines Nursing Considerations

• Assess for risk based precautions
• Provide education re importance
• Answer questions re risks and benefits
• Instruct re immunization schedule
• Maintain record and keep follow-up visits
• Assess for common side effects
• Monitor for anaphylaxis
• Reliable contraception post vaccine

8
Vaccines

• Prototype Hepatitis B Vaccine, p. 460
• Describe the most common vaccine related adverse
  effects.
• Discuss contraindications to vaccinations.

9
Cell-Mediated Immunity

• Describe the T-cell lymphocyte response.
• Differentiate between the following
• Helper T-cell
• Cytotoxic T-cell
• Activated T-cell

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Cytokines

• Hormone-like substance that
• Regulate the intensity and duration of response
• Mediate cell-to-cell communication
• Discuss the clinical application of cytokines.

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Immunostimulant Therapy

• Prototype Interferon alfa-2A, p. 463
• Cytokines produced through recombinant DNA
  technology.
• Describe the purpose of this therapy.
• Identify two biological response modifier classes
  involved in immunostimulation.

12
Interferons and Interleukins

• Differentiate between interferons and
  interluekins.
• Describe the clinical application for these
  biological reponse modifiers.
• Identify a serious side effect of therapy.

13
Capillary Leak Syndrome

• Pathophysiology
• Increased capillary membrane permeability
• Plasma proteins and other substances leave the
  blood and enter interstitial spaces
• Consequences
• Hypovolemia
• Hypoalbuminemia
• Edema and ascites

14
Immunostimulant Therapy NCs

• Thorough pre-therapy health assessment
• Baseline CBC, lytes, RFTs, LFTs, VS, body wt
• Maintain hydration
• Monitor for ? in mental status
• Assess for depression/suicidal ideation
• May promote development of leukemia
• Interferon alfa 2b
• caution in hepatitis, leukopenia, pulmonary
  disease
• Interferon alfa 2a
• caution in cardiac disease, herpes zoster, recent
  varicalla exposure

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Immunostimulant Therapy Client Teaching

• Reliable contraception
• Avoid steroids
• Liver, endocrine, or neuro effects may be
  permanent
• Keep all follow-up labs
• Non-alcohol mouthwashes
• report any signs of
• Bleeding, infection, biliary obstructiion,
  depression

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Immunosuppresants

• Prototype Cyclosporine, p. 466
• Describe the purpose of immunosuppressants.
• Differentiate between
• Non-selective immunosuppressants
• Selective immunosuppressants
• Describe clinical applications for
  immunosuppressant therapy.

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Immunosuppressant Therapy NCs

• Thorough pre-therapy health assessment
• Caution
• Pancreatic or bowel dysfunction, hyperkalemia,
  hypertension, infection
• Monitor VS, CBC, lytes, liver profile
• Monitor for superimposed infection
• Monitor degree of bone marrow suppression

18
Immunosuppressant Therapy Client Teaching

• Avoid exposure to infection
• Take antibiotics as prescribed
• Immediately report s/s of infection
• Keep scheduled appts. and follow-up labs
• Reliable contraception
• Immediately report adverse effects