Introductory Clinical
Pharmacology
Chapter 54
Immunologic Agents
Copyright © 2008 Lippincott Williams & Wilkins.
Immunity
• The ability of the body to identify and resist potentially
harmful microorganisms
• Cell mediated
– T lymphocytes
– Delayed immune response
– Viral, fungal, some bacterial
• Humeral immunity
– B lymphocytes
– Antigen-antibody response
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Cell-mediated Immunity
• Results from activity of leukocyte actions,
reactions, interactions that range from simple
to complex
• Depend on actions of T lymphocytes, which
are responsible for delayed type of immune
response
• CMI reduced in acquired immunodeficiency
syndrome (AIDS): Body is unable to protect
against viral, bacterial, fungal infections
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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
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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
or experiences disease; body
manufactures antibodies to provide future
immunity to the disease
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Active and Passive Immunity: Active
Immunity (cont’d)
• Artificially acquired active immunity
– Occurs: Individual is given killed or weakened
antigen to stimulate formation of antibodies
against the antigen
– Requires periodic booster injections to keep
adequate antibody level circulating in blood
– Booster injection: Additional dose of vaccine to
boost production of antibodies to level that
maintains desired immunity
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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
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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
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Immunologic Agents: Actions and Uses
• Vaccines and toxins:
– Vaccines: Contain either attenuated
(weakened) or killed antigen, developed
to create immunity to certain diseases
– Toxins: Poisonous substance produced by
some bacteria that cause tetanus
•Capable of stimulating body to produce
antitoxins
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Immunization Preventable Diseases
• Anthrax
• Rotavirus
• Chickenpox
• Hib
• Diphtheria
• HPV
• Hepatitis A
• Influenza
• Hepatitis B
• Measles
• Pertussis
• Pneumococcal
• Polio
• Rabies
• Rubella
• Meningococcus
• Mumps
• Tetanus
• Smallpox
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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
Copyright © 2008 Lippincott Williams & Wilkins.
Immunologic Agents: Actions and Uses
(cont’d)
• Immune globulins and antivenins
– Immune globulins: Solutions obtained
from human or animal blood containing
antibodies formed by body to specific
antigens
– Antivenins: Used for passive, transient
protection from toxic effects of bites by
spiders and snakes
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Immunologic Agents: Adverse Reactions
• Vaccines and toxoids
– Chills; fever
– Muscular aches and pains; rash; lethargy
– Pain and tenderness at the injection site
– Hypersensitivity reaction
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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
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Immunologic Agents: Contraindications
and Precautions
• Vaccines and toxoids
– Contraindicated in patients
•With acute febrile illnesses, leukemia,
lymphoma, immunosuppressive illness
or drug therapy, nonlocalized cancer
– Immunologic agents
•Used with extreme caution in
individuals with a history of allergies
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Immunologic Agents: Contraindications
and Precautions (cont’d)
• Immune globulins contraindicated in patients
with:
–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
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Immunologic Agents: Interactions
• Vaccines and toxoids
– Corticosteroids; antineoplastic drugs;
radiation therapy; depress immune
system
– Salicylates administered with varicella
vaccination: Risk for Reye’s syndrome
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Immunologic Agents: Interactions
(cont’d)
• Immune globulins and antivenins
– Antibodies in immune globulin
preparations
•Interfere with immune response to live
virus vaccines, particularly measles as
well as others (mumps and rubella)
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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
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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
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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
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Nursing Process: Implementation
• Promoting an optimal response to therapy
– Read directions enclosed with vaccine
– 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
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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
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Nursing Process: Implementation
• Monitoring and managing patient needs
(cont’d):
– Individual effective therapeutic regimen
management
•Encourage parents to have their infants
and young children receive
immunizations
•Provide parent with copy of the record
of immunizations
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Nursing Process: Implementation
• Educating the patient and family
– Discuss risks of contracting vaccinepreventable 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
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Nursing Process: Evaluation
• Therapeutic effect is achieved
• Disease does not present itself
• Adverse drug reactions managed successfully
• Patient or parent/guardian comply with the
immunization schedule
• Patient and family express understanding of
need for immunizations
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