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

Prototype Immune Stimulants

Prototype Interleukins

Prototype T and B Cell Suppressors

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