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
- Aldesleukin (Proleukin)
- 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
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