Introduction to Clinical Pharmacology Chapter 50- Immunologic Agents

1. Introduction to Clinical PharmacologyChapter 50-Immunologic Agents

2. Cell-mediated Immunity • Results from: Activity of leukocyte actions, reactions, interactions that range from simple to complex • Depend on actions of T lymphocytes- responsible for delayed type of immune response • CMI reduced in acquired immunodeficiency syndrome (AIDS): Body is unable to protect against viral, bacterial, fungal infections

3. Humoral Immunity • In Humoral immunity: • B lymphocytes: Produce circulating antibodies to act against foreign substance • Based on antigen-antibody response • Antigen: Protein that stimulates the body to produce antibodies • Antibody: Globulin produced by B lymphocytes as defense against an antigen

4. Active and Passive Immunity • Involve use of agents that stimulate antibody formation-ACTIVE • Ex. Vaccines and toxoids • Injection of ready-made antibodies found in serum of immune individuals or animals -PASSIVE

5. Active and Passive Immunity: Active Immunity • Two types of active immunity: • Naturally acquired active immunity • Artificially acquired active immunity • Naturally acquired active immunity: • Occurs when person is exposed to disease, experiences disease, body manufactures antibodies to provide future immunity to the disease

6. Active and Passive Immunity: Active Immunity (cont’d) • Artificially acquired active immunity: • Occurs: Individual is given killed or weakened antigen (vaccine)- stimulates formation of antibodies against the antigen • Require periodic booster injections to keep adequate antibody level circulating in blood • Booster injection: Additional dose of vaccine to boost production of antibodies to level - maintain desired immunity

7. Active and Passive Immunity: Passive Immunity • Obtained from administration of immune globulins or antivenins • Provide individual with ready-made antibodies from another human or an animal • Provides immediate immunity to invading antigen • Lasts for only a short time

8. Immunologic Agents • Capitalize on body’s natural defenses: Stimulate immune response and create within body protection to specific disease • Supply ready-made antibodies to provide passive immunity

9. Immunologic Agents: Actions and Uses • Vaccines and Toxoids: • Vaccines: Contain either attenuated (weakened) or killed antigen, developed to create immunity to certain diseases • Toxin: Poisonous substance produced by some bacteria that cause tetanus • A toxin attenuated but still capable of stimulating body to produce antitoxins is called a toxoid

10. Immunologic Agents: Actions and Uses (cont’d) • Vaccines and toxoids are used for: • Routine immunization of infants and children • Immunization of adults against tetanus • Adults at high risk for certain diseases • Children or adults at risk for exposure to a particular disease • Immunization of prepubertal girls or nonpregnant women of childbearing age against rubella

11. Immunologic Agents: Actions and Uses (cont’d) • Immune globulins- (Proteins present in blood serum or plasma and contain antibodies) and antivenins: • Immune globulins: Solutions obtained from human or animal blood containing antibodies formed by body to specific antigens, those receiving immune globulins receive antibodies only to the diseases to which the donor blood is immune, onset of protection is only 1-3 months • Antivenins: Used for passive, transient protection from toxic effects of bites by spiders-black widows and snakes –rattlesnakes, copperheads, cottonmouth and coral

12. Immunologic Agents: Adverse Reactions • Vaccines and toxoids: • Chills; Fever • Muscular aches and pains; Rash; Lethargy • Pain and tenderness at the injection site • Hypersensitivity reaction

13. Immunologic Agents: Adverse Reactions (cont’d) • Immune globulins and antivenins: • Immune globulins: • Urticaria; Angioedema; Erythema, malaise; Nausea; Diarrhea • Antivenins: • Hypersensitivity; Apprehension; Flushing; Itching • Urticaria; Edema of the face, tongue, and throat; Dyspnea; Cyanosis

14. Immunologic Agents: Contraindications and Precautions • Vaccines and toxoids: • Contraindicated in patients: • Moderate or severe illness, with or without fever, knowns allergy to vaccine or vaccine constituents, virus vaccines (varicella, MMR) should not be given to pregnant women

15. Immunologic Agents: Contraindications and Precautions (cont’d) • Immune globulins contraindicated in patients: • History of allergic reactions after administration of human immunoglobulin preparations • Isolated immunoglobulin A deficiency • Antivenins contraindicated in patients: • With hypersensitivity to horse serum or any other component of serum

16. Immunologic Agents: Interactions • Vaccines and Toxoids: • Corticosteroids; Antineoplastic drugs; Radiation therapy: Depress immune system • Salicylates administered with varicella vaccination: Risk for Reye’s syndrome develops

17. Immunologic Agents: Interactions (cont’d) • Immune Globulins and Antivenins: • Antibodies in immune globulin preparations: • Interfere with immune response to live virus vaccines, particularly measles, others, such as mumps and rubella

18. Nursing Process:Assessment • Preadministration assessment: • Obtain allergy history, before administration of any vaccine • Tell primary health care provider before vaccine is given if individual is known to have allergies of any kind • Determine whether patient has any conditions that contraindicate administration of agent

19. Nursing Process:Assessment (cont’d) • Ongoing assessment: • Ask patient to stay in clinic or office for observation after injection to observe for signs of hypersensitivity • Keep emergency resuscitation equipment available to use in event of severe hypersensitivity reaction

20. Nursing Process: Planning • Expected outcome • Optimal response to immunologic agent: • Support of patient needs related to the management of common adverse drug effects • Understanding of and compliance with prescribed immunization schedule

21. Nursing Process: Implementation • Read directions enclosed with vaccine • In general, all vaccines may be administered to those with a minor illness, such as a cold, and to those with a low grade fever • Document following information in patient’s chart or form: • Date of vaccination; Route and site, vaccine type, manufacturer • Lot number and expiration date • Name, address, title of individual administering vaccine • Serious viral infection of the CNS and fatalities have been associated with use of vaccines, the number of incidents is small, but the risk remains

22. Nursing Process: Implementation • Monitoring and managing patient needs: • Pain: Acute • Increase fluids in diet, allow for adequate rest • Keep atmosphere quiet and nonstimulating • Treat local irritation at injection site with warm or cool compresses, depending on patient’s preference

23. Nursing Process: Implementation • Educating the patient and family: • Discuss risks of contracting vaccine-preventable diseases, benefits of immunization • Instruct parents to bring immunization records to all visits • Provide date for return for next vaccination • Discuss adverse reactions, methods to combat these reactions

24. Nursing Process: Evaluation • Therapeutic effect is achieved • Disease does not present itself • Adverse drug reactions: Managed successfully • Patient or parents/guardians comply with the immunization schedule • Patient and family express understanding of need for immunizations