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IMMUNE MODULATOR
They are used to modify the actionsof the immune system.
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Problems that may ariseinvolving the immune system
Neoplasm occur when mutant cells escapethe normal surveillance of the immunesystem and start to grow and multiply.
Viral invasion of cell- viruses are parasiteonly invading the host cell that providenourishment necessary for viral replication
Autoimmune disease when the bodyrespond to specific self antigens to provide
antibodies or cell mediated immuneresponse against it own self cell. Transplant rejection-it is more of the
foreign cell introduced in the body.
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IMMUNESU
PPR ESSAN
TS Are used to block the normal effects
of the immune system.
In cases of organ transplantation (inwhich non-self-cells are transplantedinto the body and destroyed by theimmune reaction)
In autoimmune disorder (in which thebody¶s defenses recognize self-cellsas foreign and work to destroy them)
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Kinds of
Immune Stimulants
Interferon, which are release by humancells in response to viral invasion
Interleukins, synthetic compounds thatcommunicate between lymphocytes, whichstimulates cellular immunity and inhibittumor growth.
T- and B cells modulator calledlevamisole (Ergamisol), which restoresimmune function and also stimulateimmune system activity.
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Therapeutic Actions of Interferons They act to prevent virus particles from
replicating inside other cells.
They also stimulate interferon receptor
sites on non-invaded cells to produceantiviral proteins, which prevent virusfrom entering the cells.
It inhibit tumor growth and replication
Interferon gamma- 1b also acts likean interleukins, stimulatingphagocyte to be more aggressive
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Indications of interferon
Interferon¶s are indicated for treating selectedleukemia¶s (alfa-2a, alfa 2b)
Multiple sclerosis (beta 1a, beta 1b)
Intra-lesional treatment of warts (alfa-n3, alfa-2b)
Chronic hepatitis B or chronic hepatitis C (alfa-2b)
Chronic hepatitis C (alfacon-1,peginteferon)
Acquired immune deficiency syndrome (AIDS)-related Kaposi¶s sarcoma
And severe infection cause by granumalotous disease(gamma-1b)
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Pharmacokinetics of interferon Generally absorbed after SQ and IM
injection
Excreted in the kidneys They are teratogenic in animals
Use of barrier contraceptive is
advised for woman in child bearingage.
It is advise not to be given duringlactation
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Contraindication and caution of interferon
resence of allergy to any interferonor product component
Pregnancy and lactation
Caution in patient with cardiacdisease because hypertension andarrhythmias have been reported with
the use of these drugs. These drugs may further suppress
bone marrow
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INTER LEUKIN
S They are chemicals secreted by active
leukocytes to influence other leukocytes. IL 1 stimulates T and B cells to initiates an
immune response. IL 2 is release from active T cells tostimulate production of more T cells and toincrease the activity of B cells, cytotoxiccells and natural killer cells.
Interleukins also cause fever, myalgia,arthalgia, and slow wave sleep induction allthings that help to conserve energy for usein fighting off invader
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Therapeutic Action of
interleukins Natural IL2 is produced by helper T cells to activate
cellular activity and inhibit tumor growth by increasinglymphocyte numbers and their activity.
When interleukins are administer,there are increases
in the number of natural killer cells and lymphocytes,in cytokine activity and in number of circulatingplatelets.
Aldesleukin is indicated for treatment of specificrenal carcinoma and possibly AIDS
Oprelvekin is indicated for prevention of severethrombocytopenia (an abnormal decrease in platelets)after myelosuppressive chemotheraphy in selectpatient.
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Pharmacokinetics of Interleukins
They are rapidly distributed afterinjection
They where shown to be embryocidaland teratogenic in animal studies
Primarily cleared from the body bythe kidneys
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Contraindication and caution of Interleukins
Contraindicated in the presence of drug allergy to interleukin or E. coli-
produced products and duringpregnancy and lactation
Caution should be used with renal,liver, or cardiovascular impairment
because of the adverse effect of drugs.
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Adverse effects of
Interleukins
y The adverse effect can be attributedto their effect on the body during
inflammation (e.g., lethargy, myalgia,arthralgia, fatigue, fever), respiratorydifficulties, CNS changes and cardiacarrhythmias.
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T and B-cellM
odulator The drug levamisole (Ergamisol) is
an immune stimulant that restore
suppressed immune function incertain situation
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Therapeutic Actions andIndications of levamisole Levamisole stimulates B cells, which
in turn stimulate antibody formation,
enhance T cell activity, and increasethe activity of monocytes andmacrophages.
Levamisole is indicated for
treatment of dukes¶ stage C coloncancer after surgical resection and inconjunction with fluorouracil therapy.
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Pharmacokinetics of Levamisole
It is absorbed at the GI tract reachingthe peak levels of 1.5 to 2 hours
It is metabolize in the liver andexcreted in the urine.
With half life of 16 hours
It is embryotoxic in animal studiesand should not be used inpregnancy.
Drugs should not be used in lactation.
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Adverse
Effects of levamisole
Flu- like effects: lethargy, myalgia,arthralgia, fever.
G I upset, nausea, taste perversions,and diarrhea; headache, anddepression; bone marrow depression;dermatitis and hair loss
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Clinically important Drug-Drug
Interactions of Levamisole This drug should be avoid to be
combine with alcohol (Disulfiram-type
reaction) Do not combine with phenytoin. (it
will increase the phenytoin level andtoxicity level)
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Nursing Consideration forpatient receiving Immune
stimulants Assessment: History and Examination
Any allergies to any of these drugs ortheir components
Pregnancy or lactation
Hepatic and renal function
Cardiac disease
Bone marrow depression CNS disorder, including seizure
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Nursing diagnoses
Acute pain related to CNS, G I upset,and flu-like effect
Imbalance in nutrition: less thanBody Requirements related to flu-likeeffect.
Anxiety related to diagnosis and drugtherapy
Deficient Knowledge regarding drugtherapy
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Implementation foradministration of immune
stimulants Arrange for laboratory test before and periodically during therapy
including CBC and differential count, to monitor for drug effectsand adverse effect.
Administer drug as indicated; Instruct the patient and a significantother if injection is required to ensure that the drug will be giveneven if the patient is not able to administer it
Monitor severe reaction and arrange to discontinue drugimmediately if they occur.
Arrange for supportive care and comport measures For flu-like symptoms (e. g., rest, environmental control,
acetaminophen) to help the patient to cope with the drug effect.
Instruct female patient to use barrier contraceptives to avoidpregnancy during drug therapy because of the potential for
adverse effect on the fetus. Provide drug education Offer support and encouragement to deal with the diagnosis and
drug regimen
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Evaluation For immune
stimulant administration Monitor patient response to the drug
Monitor for adverse effects
Evaluate for the effectiveness of theteaching plan
Monitor for effectiveness of comportmeasures and compliance with theregimen.
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IMMUNESU
PPR ESSAN
TS Are used in conjunction with
corticosteroids, which block the
inflammatory reaction and decreaseinitial damage to the cells.
They are especially beneficial in casesof organ transplantation and in the
treatment of autoimmune diseases
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Focus on Patient Safety inadministration of immune
suppressants Patient receiving is immune suppressant are high risk
for infection and cancer.
They should be warned in situation that may exposethemselelf to infection.
They should avoid activity that may cause injurywhich lead to infection
They should be educated for protective strategies.
This includes wearing masks and heavy gloves.
Delaying vaccinations
Knowing S/S of infection Obtaining regular physical examination and
screenings for diseases of developing neoplasm
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T- and B- cells Suppressors T-cells- they destroy foreign cells and stimulate
immune and inflammatory reactions.
T suppressor cells they dampen the immune andinflammatory response to conserve energy and
prevent cellular damage. Lymphokine- are activated killer cells or Natural killer
cells- they are anti-neoplastic and stimulate rapidcellular death
B-cells- they recognize specific proteins and produce
antibodies (immunoglobulin) Cyclosporine (Sandimmune, Neoral)- used to
suppress rejection in a variety of transplantationscenarios.
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Action of T-and B-Cells
Suppressor Reversely inhibits immuno competent
lymphocytes; inhibits T- Helper cells
and T suppressor cells, Lymphokineproduction, and release of interleukin-2 and T-cell growth factor.
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Adverse effects of T- and B Cells
suppressors Tremors, hypertension, gum
hyperplasia, renal dysfunction,
diarrhea, hirtuism, acne, bonemarrow depression.
Cyclosporine is embryotoxic inanimals and crosses breast millk.
Should not be used during pregnancyand lactation.
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T-and B Cells available in themarket
Neoral- is also used to treat rheumatoid arthritis and psoriasis.Alefacept- is used to treat adult patient with severe, chronicpsoriasis who are candidates for systemic therapy.
Azathioprine (imuran)- is used specifically to prevent rejectionin renal homotransplant and to treat rheumatoid arthritis(autoimmune disorder) in selected patients.
Glatitramier acetate (Cepaxone) is used specially to reducerelapses multiple sclerosis. which is thought to be related toautoimmune reaction.
Mycophenolate (CellCept) ±is an oral drug that is used withcyclosporine and corticosteroid to prevent organ rejection afterrenal, hepatic, or heart transplantation.
Tacrolimus (Prograf)- is used to prevent liver and renal
transplant rejection and being studied for multiple other transplantscenarios. Sirolimus ( Rapamune)- is used to prevent organ rejection in
patient receiving renal transplants and should be used withcyclosporine and corticsteriod .
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INTER LEUKIN R ECEPTOR AN
TAGONI
ST INTER LEUKIN 1- they simulate T- and B
cells to stimulate immune response.
Anakira (Kineret)- specially antagonizes
interleukin 1 receptors, blocking the activityof interleukin 1 levels are elevated inresponse to inflammation and immunereactions and are thought to be responsible
for the degradation of cartilage that occurin rheumatoid arthritis.
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Therapeutic Actions andI
ndications They are used to reduce the S/S of
moderately to severely active
rheumatoid arthritis in patients whohave not responded to the traditionalanti- rheumatic drug.
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Pharmacokinetics Dosage: 100mg/ day
Peak level 3 to 7 hours
Half life 4 to 6 hours They cross the placenta and may
enter breast milk
It is excreted in the urine
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Adverse effects
Headache, sinusitis,nausea,diarrhea, upper respiratory and
infection Injection site reaction
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Drug-Drug Interactions
Should not be given in patientreceiving etaranecept (enbrel)
because of severe infection
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Always Remember thisStudents, Fellow Nurses:
The use of immune suppressants mayincrease the susceptibility to infection
and increase risk to neoplasmassociated with the use of this drugs.Patient need to be protected toinfection, injury, and invasive
procedure
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SALAMAT PO
GO IN PEACE