Immune Modulators

Immune Modulators

 

Sites of Actions of Immune Modulators

  • Immune modulators
    • Modify the actions of the immune system
  • Immune stimulants
    • Energize the immune system when it needs help fighting a specific pathogen
  • Immune suppressants
    • Block the normal effects of the immune system in organ transplantation and autoimmune disorders

Immune Stimulants

  • Interferons
    • Naturally released from human cells in response to viral invasion
  • Interleukins
    • Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
  • T and B cell modulator (levamisole)
    • Restores immune function and activity

Interferon

  • Actions
    • Prevents virus particles from replicating inside other cells
    • Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
    • Inhibits tumor growth and replication
  • Pharmacokinetics
    • Absorbed well after subcutaneous or intramuscular injection
    • Broken down in the tissues
    • Excreted in the kidneys
    • May be teratogenic
  • Contraindications
    • Known allergy
    • Pregnancy and lactation
    • Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, and bone marrow depression
  • Drug-to-drug interactions

Interleukins

  • Definition
    • Chemicals produced by T cells to communicate between leukocytes
  • Types of preparations
    • Aldesleukin (Proleukin)
      • Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria
    • Oprelvekin (Neumega)
      • A newer agent produced by DNA technology
  • Actions
    • Increase the number of natural killer cells and lymphocytes
    • Activate cellular immunity and inhibit tumor growth
  • Indications
    • Aldesleukin: specific renal carcinomas and possible treatment of AIDS and AIDS-related disorders
    • Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy
  • Pharmacokinetics
    • Rapidly distributed after injection
    • Cleared by the kidneys
    • Teratogenic
  • Contraindications
    • Known allergy, pregnancy, and lactation
    • Caution with renal, liver, or cardiovascular impairment
  • Adverse reactions
    • Lethargy, myalgia, arthralgia, fatigue, fever, and respiratory difficulties

T and B Cell Modulators

  • Action/Indication
    • Levamisole stimulates B cells which in turn stimulate antibody formation, enhancing T cell activity
    • Used in the treatment of Duke’s stage C colon cancer
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in 1.5 to 2 hours
    • Metabolized in the liver and excreted in the urine
    • T½ of 16 hours
  • Contraindications
    • Known allergy, pregnancy, and lactation
  • Adverse reactions
    • Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
  • Drug-to-drug interactions
    • Disulfiram-type reaction
    • Increased phenytoin levels

Types of Immune Suppressants

  • T and B cell suppressors
  • An interleukin receptor antagonist
  • Monoclonal antibodies
    • Produced by a single clone of B cells that react with specific antigens

T and B Cell Suppressors

  • Azathioprine (Imuran): prevents rejection in renal hemotransplants; treats rheumatoid arthritis
  • Cyclosporine (Sandimmune): suppresses rejection in a variety of transplants; treats rheumatoid arthritis and psoriasis
  • Glatiramer acetate (Copaxone): reduces number of relapses in multiple sclerosis in adults
  • Mycophenolate mofetil (CellCept): prevents rejection after renal or heart transplant in adults
  • Sirolimus (Rapamune): prevents rejection after renal transplantation
  • Tacrolimus (Prograf): prevents rejection after liver transplantation
  • Action
    • Inhibit DNA synthesis
  • Contraindications
    • Known allergy, pregnancy, CNS disease, and hepatic disease
  • Drug-to-drug interactions

T and B Cell Suppressor Adverse Effects

  • Increased risk for infection and development of neoplasms
  • Hepatotoxicity
  • Renal toxicity and renal dysfunction
  • Pulmonary edema
  • Possible headache, tremors, and secondary infections such as acne, GI upset, diarrhea, and hypertension

Interleukin Receptor Antagonists

  • Actions
    • Used to treat rheumatoid arthritis
    • Block activity of interleukin-1
  • Pharmacokinetics
    • Given subcutaneously
    • Reach peak in 3 to 7 hours
    • Metabolized in the tissues
    • T½ of 4 to 6 hours
  • Contraindications
    • Known allergy, pregnancy, lactation, and renal impairment
  • Adverse reactions
    • Headache, sinusitis, nausea, and diarrhea
  • Drug-to-drug interaction
    • Etanercept may cause severe and even life- threatening infections

Monoclonal Antibodies

  • Action
    • Antibodies attach to specific receptors
  • Pharmacokinetics
    • Must be injected
  • Contraindications
    • Known allergy and fluid overload
  • Adverse reactions
    • Pulmonary edema, fluid retention, flu-like symptoms
  • Drug-to-drug interaction
    • Severe immune suppression can occur

Use of Immune Modulators Across the Lifespan

Use of Immune Modulators Across the Lifespan

Use of Immune Modulators Across the Lifespan

Prototype Immune Stimulants

Prototype Immune Stimulants

Prototype Immune Stimulants

Prototype Interleukins

Prototype Interleukins

Prototype Interleukins

Prototype T and B Cell Suppressors

Prototype T and B Cell Suppressors

Prototype T and B Cell Suppressors

Prototype Monoclonal

Prototype Monoclonal

Prototype Monoclonal

Nursing Considerations for Immune Stimulators

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Immune Suppressants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
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