Immunosuppressant Drugs


How the immune system works video - click me!
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The Immune System -

The body has several defense mechanisms in place to protect it from injury or foreign invasion
Barrier defenses include:
  •  Skin
  • Mucous membranes
  • Normal flora
  • Gastric Acid

Cellular defenses include:
  • Lymphocytes
  • T and B cells
  • Myelocytes

Stem cells in the bone marrow produce two types of leukocytes (white blood cells):

Lymphocytes
  • T cells
  • B cells
  • Natural Killer cells (NK cells)

Myelocytes - important to inflammaroty and immune responses
  • Neutrophils
  • Basophils
  • Eosinophils
  • Monocytes
  • Macrophages

Lymphocytes ~ Response to specific invasion resulting in a specific response

T Lymphocytes
  • Migrate from bone marrow to thymus for maturation
  • Cell mediated immunity

B Cells
  • Produce antibodies in response to exposure to specific antigen
  • Programmed to identify specific proteins

Interferons and Interleukins

Interferons
  • Chemicals that have been secreted by cells that have been invaded by a virus
  • Prevent viral replication
  • Suppress malignant cell replication and tumor growth
Interleukins ~ Chemicals secreted by active leukocytes to influence or "communicate" with other leukocytes
  • To initate an immune response
  • To produce more T cells

Tumor Necrosis Factor

Chemicals released by macrophages
  • Inhibits tumor growth
  • Causes tumor regression (shrinkage)
  • Can make inflammatory andimmune response more aggressive

More Terms
  • Neoplasms - occur when mutant cells excape teh normal surveillance of the immune system and begin to grow and multiply.
  • Autoimmune Disease - body responds to specific self-antigens to produce antibodies or cell-mediated immune response against it's own cells.
  • Transplant Rejection - self - transplantation - result: no immune response. All other transplants result in immune response (matching tissue is critical)



Why Stimulate your Immune System?
  • Chronic hepatitis B & C
  • AIDS - related Kaposi sarcoma
  • Malignant melanoma

Stimulant Drugs

Interferon
  • Interferon Alfa-2b (Intron A)
Interleukins
  • Aldesieukin (Proleukin)
  • Oprelvekin (Neumega)
Hematopoietic Agents
  • Epoeitn alfa (Epogen, Procrit)
  • Filgrastim (Neupogen)

Special Teaching
  • Preganacy - contrtaceptives during childbearing years

Risks
  • Flu-like symptoms
  • Bone marrow suppression
  • Depression - Suicidal Ideation
  • Liver impairment

Why Suppress your Immune System?
  • Prophylaxis for organ rejection
  • Chronic rejection
  • Rheumatoid arthritis
  • Severe Psoriasis

Drugs that Inhibit T and B cells
  • Cyclosporine - *grapefruit juice increases bioavailability
  • Copaxone - *treats MS by blocking the autoimmune activity against material in myelin sheath surrounding nerves

Special Teaching
  • Avoid crowds, sick people
  • Report fever, sore throat, chills, joint pain, fatigue
  • Therapy is lifelong

Nursing Implications
  • Assess for contraindications and cautions
  • Physical assessment
  • Supportive care - flu-like symptoms
  • Barrier contraception
  • Monitor for adverse and therapeutic effects

RISKS
  • Secondary infections - *acne, GI upset, diarrhea
  • Increased risk for infection
  • Increased risk of developing neoplasms
  • Hepatotoxicity
  • Renal toxicity
  • Tremor

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No Mommy No!


Monoclonal Antibodies
  • Treat acute rejection in renal, liver, and heart transplant patients

Special Teaching (Again....)
  • Avoid crowds and sick people
  • Report signs of infection
  • Therapy is lifelong - with organ transplantation

Contraindications

~ Allergy - murine products (mice)Mouse_-_Cartoon_07.jpg
~ Pregnancy/lactation
~ Fever



Nursing Implications
  • Take with food
  • Take several days before surgery
  • Antifungal agents can be used to treat oral candidiasis
  • Observe oral cavity for white patches
  • Monitor for therapeutic response (they get to keep the organ)

Classification/Drug Name
Indication
Mechanism of Action
Side Effects/
Adverse Effects
Special Considerations/
Patient Teaching
Immune Stimulants:
Interferon Alfa-2b
(Intron-A)
-Chronic hepatitis B and C
-Aids-related kaposi sarcoma
-Malignant melanooma
-Hairy cell leukemia

Mechanism of Action
-Prevent virus particles from replicating inside the cell.
-Stimulates non-invaded cells to produce antiviral proteins
-Inhibits tumor growth
-Enhances inflammatory response.
Related to stimulation of immune response:
-Flu-like syndrome (Lethargy, myalgia, arthralgia, anorexia, nausea)
-Bone marrow suppression
-Depression and suicidal ideation
-Liver impairment
Contraindicated in pregnancy and lactation - Barrier contraceptives for women in childbearing years.
Immune Stimulants:
Interleukins
-Metastatic renal cell carcinoma in adults
-Metastatic melanomas

Mechanism of Action
-Communicate between lymphocytes
-To stimulate immune response
-Inhibit tumor growth.
Attributed to their effect on the body during inflammation
-Flu-like effects: lethargy, myalgia, arthralgia, fatigue, fever
-Mental status changes
-Tachycardia, bone marrow suppression
-Hypersensitivity - difficulty breathing, chest tightness
Contraindications:
-Embryocidal and teratogenic in animals
-Contraindicated in Pregnancy
-Barrier contraceptives for women in childbearing years
-Unclear if interleukins cross into breast milk
Immune Stimulants Hematopoietic Agents:
-Epoetin alfa (Epogen, Procrit)
-Filgrastim (Neupogen)
-Enhances RBC and platelet counts
-Allow for higher doses of chemotherapy
Mechanism of Action
-Promote the synthesis of various types of major blood components by:
Promting the growth, or differentiation, and function of their precursor cells in the bone marrow
-Usually mild
--Fever
--Muscle aches
--Bone pain
--Flushing

Immune Suppressants T and B Cell Suppressants:
-Cyclosporine
-Glatiramer Acetate (Copaxone)
-Prophylaxis for organ rejection
-Kidney, liver, and heart transplants
-Treatment of Rheumatoid Arthritis
-Treatment of severe psoriasis

Mechanism of Action
-Inhibist T and B cells - reversable

-used for the treatment of multiple sclerosis (MS)
-Blocks autoimmune activity against material in myelin sheath surrounding nerves
-Increased risk for infections
-Secondary infections: acne, GI upset, diarrhea
-Increased risk of development of neoplasms
-Hepato toxicity
-Renal toxicity
-Tremor
-Cyclosporine
  • Grapefruit juice increases bioavailability
Contraindications:
-Pregnancy and lactation, known cancers

Patient teaching:
-Patients should be told to reduce infection: Aviod crowds, sick people, working in dirt
-Report any fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection immediately
-Lifelong therapy with immunosupressants is indicated with organ transplantation
Immune Suppressants Monoclonal Antibodies:
Muromonab-CD3 (Orthoclone OKT3)
-Treatment of acute rejection in renal, liver, and heart transplant patients

Mechanism of Action
-Reacts as an antibody to human T cells, disabling the T cells
-Severe fluid retention
-Pulmonary ecema
-Flu-like symptoms: fever, chills, malaise
-Increased risk of secondary infection
-Tremors
-Nausea, vomiting, diarrhea
Contraindications:
-Allergy - murine products (mice)
-Pregnancy and lactaion
-Fever

Patient Teaching:

-Patients should be told to reduce risk of infection: Avoid sick people, crowds, working in dirt
-Report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection immediately
-lifelong therapy with immunosupressants is indicated with organ transplantation



References:
Peteges, N. (2011) Pharmacology. Aurora University. Aurora, IL.

Karch, A. (2008). Focus on Nursing Pharmacology
(5th ed.). Philadelphia: Lippincott Williams &
Wilkens.

Lilleu, L., Harrington, S., Snyder J. (2007).
Pharmacology and the Nursing Process (5th ed.).
St. Louis MO: Mosby Elseiver.

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Video from Youtube