Module 10: Drugs Affecting the Immune System
Topic Outline:
● Overview of the Immune System
○ Comparison of Innate and Adaptive Immunity
■ Innate (non-specific) Immunity
● 4 Barriers to Infection
● 1st Line of Defense
● Cells of the Immune System
● Leukocytes involved in Innate Immunity
■ Adaptive Immunity
● 4 Attributes
● Requires 2 Major Groups of Cells
● The Antigen presentation scenario
● Humoral vs Cell-mediated Immune Respons
● Immune Stimulants
○ Immunestimulants
■ Interferons
■ Interleukins
■ Colony Stimulating Factors
○ Vaccines
■ Immunity
● Active Immunity
● Acquired Immunity
● Passive Immunity
■ Types of Vaccines
■ Examples of Vaccine Preventable Diseases
■ Immunization Before Foreign Travel
■ Nursing Process : Vaccines
● Immunosuppressants
○ Selective Inhibitors of Cytokine Production
○ Immunosuppressive Antimetabolites
○ Antibodies
○ Corticosteroids
OVERVIEW OF THE IMMUNE SYSTEM
a large network of organs, white blood cells, proteins
(antibodies) and chemicals. This system works together to
protect you from foreign invaders (bacteria, viruses, parasites,
and fungi) that cause infection, illness and disease.
Interactions between the two systems
Comparison of Innate and Adaptive Immunity
Innate (non-specific) Immunity
4 Barriers to Infection
-
-
Anatomic/ Physical
Skin → epidermis w/ keratin mucus membrane
→inner surfaces
Physiologic/ Chemical
Temperature, pH, soluble substances
Phagocytic/Complement
Blood monocytes, tissue MØ, and neutrophils
Inflammatory
Triggered by wound/foreign particle
Cardinal Signs Of Inflammatory Response:
- Vasodilation
- Capillary permeability
- Influx of phagocytes
The Inflammation Process
● Neutrophils
● Basophils
● Eosinophils
● Macrophage*
● Natural Killer Cells*
● Dendritic*
*can also be found on adaptive Immunity
Adaptive Immunity
1.
1st Line Of Defense
2.
●
includes chemicals, structure of skin/other epithelia,
and mechanisms as well ascells – mainly neutrophils
and macrophage
Most Macrophages are quickly cleared within few days by
innate immunity – before adaptive immunities are activated
Cells of the Immune System
3.
4.
Antibody specificity – distinguishes minute
differences in molecular structure to determine
non-self antigens.
Diversity – the immune system can produce a hugely
diverse set of recognition molecules which allows us
to recognize literally billions of molecular shapes
Memory – once it has responded toan antigen, the
system maintains a memory of that Ag
Self-nonself recognition – the system typically
responds only to foreign molecules
Adaptive Immunity requires 2 major groups of cells:
A. B and T Lymphocytes (B or T cells)
Development of the Immune System
Leukocytes involved in Innate Immunity
➢ B Lymphocytes
- Form and mature in bone marrow
- Exhibit antibody receptors on membrane
- Once naïve B cells bind Ag, they divide rapidly to
produce
a.
Plasma Cells (effector B cells) - are
secretory; live only a few days (produce >
2,000 molecules of Ig/sec)
b. Memory cells - have longer life span than
naïve B cells
➢ T Lymphocytes
● Formed in bone marrow;
migrate to and mature in
Thymus gland
●
Exhibit unique T-cell
Antigen receptors (TCR’s) on
surface
● TCR’s can only recognize Ag
with associated with MHC
glycoproteins
○ MHC I – found on
nearly all nucleated
cells
○ MHC II – found only
on APC’s
-
-
●
The B lymphocytes or B-cells are responsible in :
cross-linking several Ags to form clumps → more
easily phagocytized
Bind complement proteins
Neutralize toxins, viruses, and bacteria from
binding target cells
Cell-Mediated Immune Response
Occurs when effector T cells are activated
Activated TH cells → activate phagocytic cells
activate B cells to produce Ab
- Activated TC cells kill altered self cells (viral
infected and tumor cells)
-
IMMUNE STIMULANTS
Immunostimulants or immune stimulants are drugs that
energize the immune system when it is exhausted from
fighting prolonged invasion or when the immune system needs
help fighting a specific pathogen or cancer cell. It is one of the
classifications of a drug class called immunomodulators.
B. Antigen presenting cells (APC’s)
-
Macrophage (MØ)
Dendritic cells (DC)
B cells
The Antigen Presentation Scenario
A. Interferons
●
●
●
Different patterns of cytokines determines types of IR:
- If TC cell recognizes an Ag/MHC I complex, it
divides and differentiates to become CTL
If TH cell recognizes Ag/MHC II complex, it
divides and stimulates B cells, TC cells, and MØ
Humoral vs Cell-mediated Immune Response
●
-
Humoral Immune Response
Occurs when Antigens (ag) becomes coated with
Antibodies (Ab) which brings about the
elimination of the foreign body
●
●
●
●
Stimulates cytotoxic T-cell activity and enhances
inflammatory response. (Innate and Adaptive IRs)
Production of antiviral proteins to prevent viruses
from entering the cell
commonly used in patients with used to treat various
cancers (e.g., leukemia, melanoma, AIDS-related
Kaposi's sarcoma)
Hepatitis
IM/IV
Common Drugs:
– peginterferon alfa-2b (Peg-Intron)
– Interferon Gamma 1b (Actimmune)
Nursing Alerts
- FLU-LIKE SYNDROME
- lethargy, myalgia, arthralgia, anorexia,
nausea
- Most
interferons
are
NOT
RECOMMENDED for children
- Do not give to pregnant and lactating
women
- Supportive Care
B. Interleukins
●
●
●
●
●
●
●
Interleukin-2 stimulates cellular immunity by
increasing the activity of natural killer cells, platelets,
and cytokines.
Regulate cell growth, differentiation, and motility.
They are particularly important in stimulating
immune responses, such as inflammation.
Commonly used in the treatment for cancer,
inflammatory bowel disease, multiple sclerosis, and
severe thrombocytopenia
IV in form
Common Drugs:
– aldesleukin (Proleukin)
– oprelvekin (Neumega)
Nursing Alert:
- FLU-LIKE SYNDROME
- Watch out for RESPIRATORY DISTRESS
- Oprelvekin has been associated with severe
hypersensitivity reactions, and patients
should be instructed to report difficulty
breathing or swallowing, chest tightness, or
swelling.
Acquired immunity
– Exposed to antigen
Passive immunity
– Receives antibodies from another source
TYPES OF VACCINE
● Antigen
● Attenuated virus
● Toxoids
● Conjugate vaccines
● Recombinant subunit vaccines
● Adjuvant
Examples of Vaccine Preventable Diseases
● Anthrax
● Pneumococcal disease
● Diphtheria
● Poliomyelitis
● Haemophilus influenzae type B (Hib)
● Rabies
● Hepatitis B
● Rotavirus
● Hepatitis
● Rubella
● Human papillomavirus
● Smallpox
C. COLONY STIMULATING FACTORS
● Influenza
● Tetanus
●
● Japanese encephalitis
● Tuberculosis
● Measles
● Typhoid
● Meningococcal disease
● Varicella
● Mumps
● Yellow fever
● Pertussis
● Zoster
●
increase production of neutrophils and can activate
mature granulocytes and monocytes.
● SQ/ IV
● Commonly used for
- Reduction of SQ/ IV
- Commonly used for
- Reduction of incidence of infection in
patients with bone marrow suppression
- Decrease in neutropenia associated with
bone marrow transplants and chemotherapy
- Treatment of various blood-related cancers
● Nursing Alert
- Supportive Therapy for side-effects
○ Skeletal pain
○ Diarrhea
○ Alopecia
○ Fever
○ Mucositis
- DO NOT GIVE with Lithium or
Corticosteroids
VACCINES
IMMUNITY
● Active immunity
– Body produces antibodies.
– Natural immunity
IMMUNIZATION BEFORE FOREIGN TRAVEL
● All immunizations indicated based on age and/or
immunization history
● Typhoid
● Yellow fever
● Meningococcal disease
● Rabies
● Japanese encephalitis
NURSING PROCESS: Vaccines
● Assessment
● Nursing Diagnoses
● Planning
● Nursing Interventions
○ Patient Teaching
○ Cultural Consideration
● Evaluation
●
IMMUNOSUPPRESSANTS
Immunosuppressant drugs are a class of drugs that suppress,
or reduce, the strength of the body’s immune system. Some of
these drugs are used to make the body less likely to reject a
transplanted organ, such as a liver, heart, or kidney. These
drugs
are
called
anti
rejection
drugs.
Other
immunosuppressant drugs are often used to treat autoimmune
disorders such as lupus, psoriasis, and rheumatoid arthritis.
●
D. Corticosteroids
●
●
General Nursing Alert
●
No Fresh fruits of veggies or be around other sick people or
any circumstances that they can have an increased risk of
infection
● Bone marrow suppression – CBC
● Hepatotoxicity – liver function tests,
● Nephrotoxicity – kidney function tests
A. Selective Inhibitors of Cytokine Production
●
Interferes with the production or activity of
the IL-2, growth factor that stimulates the
proliferation of an;gen-primed (helper) T
cells, which subsequently produce more
IL-2, IFN-γ, and TNF-α.
● Thus, collectively inhibiting the activation
of natural killer cells, macrophages, and
cytotoxic T lymphocytes.
● Commonly used for Transplants, and
Psoriasis
● Oral forms
● Common Drugs:
- cyclosporine (Neoral)
- Tacrolimus (Prograf)
B. Antimetabolites
●
●
Immunosuppressive antimetabolite agents are
generally used in combina;on with corticosteroids
and the calcineurin inhibitors, cyclosporine and
tacrolimus.
Common Drugs:
– Mycophenolate Mofetil
– Azathioprine
C. Antibodies
They are prepared by immunization of either rabbits
or horses with human lymphoid cells (producing a
mixture of polyclonal antibodies or monoclonal
antibodies) or by hybridoma technology (producing
antigen-specific monoclonal antibodies)
Common Drugs:
– Muromonab
– Basiliximab
The exact mechanism responsible for the
immunosuppressive action of the corticosteroids is
unclear.
The T lymphocytes are affected most. The steroids
are able to rapidly reduce lymphocyte populations by
lysis or redistribu;on.
Common drugs:
– prednisone
– methylprednisolone