Immunosupressant+Drugs

= = = Immunosuppressant Drugs =

[|How the immune system works] video - click me! 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 Interleukins ~ Chemicals secreted by active leukocytes to influence or "communicate" with other leukocytes
 * Chemicals that have been secreted by cells that have been invaded by a virus
 * Prevent viral replication
 * Suppress malignant cell replication and tumor growth
 * 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 Interleukins Hematopoietic Agents
 * Interferon Alfa-2b (Intron A)
 * Aldesieukin (Proleukin)
 * Oprelvekin (Neumega)
 * 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

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) ~ 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)

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

-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. || Interleukins || -Metastatic renal cell carcinoma in adults -Metastatic melanomas
 * Mechanism of Action**
 * Immune Stimulants:

-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 || -Epoetin alfa (Epogen, Procrit) -Filgrastim (Neupogen) || -Enhances RBC and platelet counts -Allow for higher doses of chemotherapy -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 ||  || -Cyclosporine -Glatiramer Acetate (Copaxone) || -Prophylaxis for organ rejection -Kidney, liver, and heart transplants -Treatment of Rheumatoid Arthritis -Treatment of severe psoriasis
 * Mechanism of Action**
 * Immune Stimulants Hematopoietic Agents:
 * Mechanism of Action**
 * Immune Suppressants T and B Cell Suppressants:

-Inhibist T and B cells - reversable
 * Mechanism of Action**

-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 -Pregnancy and lactation, known cancers
 * Grapefruit juice increases bioavailability || Contraindications:

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 || Muromonab-CD3 (Orthoclone OKT3) || -Treatment of **acute rejection** in renal, liver, and heart transplant patients
 * Immune Suppressants Monoclonal Antibodies:

-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
 * Mechanism of Action**

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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