Chemotherapeutic Agents Nursing Pharmacology

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


  • 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


  • 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
Chemotherapeutic Agents Nursing Pharmacology

Introduction to Cell Physiology

Introduction to Cell Physiology

Chemotherapeutic Agents

  • Alter cellular function or disrupt cellular integrity, causing cell death
  • Prevent cellular reproduction, eventually leading to cell death

Chemotherapeutic Drugs

  • Destroy organisms that invade the body
    • Bacteria, viruses, parasites, protozoa, fungi
  • Destroy abnormal cells within the body
    • Neoplasms and cancers

Parts of a Human Cell

  • Nucleus
  • Cell membrane
  • Cytoplasm

Structure of a Cell

Stucture of a Cell
Stucture of a Cell

Cell Nucleus

  • Contains genetic material
    • Necessary for cell reproduction
    • Regulates cellular production of proteins
  • Each cell is “programmed” by the genes for the production of specific proteins
    • Allows the cell to carry out its function
    • Maintains cell homeostasis or stability
    • Promotes cell division

Cell Membrane

  • Surrounds the cell
  • Separates the intracellular fluid from the extracellular fluid
  • Essential for cellular integrity

Structure of a Lipid Cell Membrane

Structure of a Lipid Cell Membrane
Structure of a Lipid Cell Membrane

Organelles of the Cytoplasm

  • Mitochondria
  • Endoplasmic reticulum
  • Free ribosomes
  • Golgi apparatus
  • Lysosomes

Components of Cell Membrane

  • Cell membrane is made up of lipids and proteins
  • Several lipids make up the cell membrane
    • Phospholipids
    • Glycolipids
    • Cholesterol
  • Lipid layer provides a barrier for the cell and maintains homeostasis of the cell

Receptor Sites

  • Found on the cell membrane
  • Specific receptor sites allow interaction with various chemicals

Identifying Markers

  • Surface antigens
  • Important in the role of cellular immunity
  • Histocompatibility proteins allow for self-identification
  • The body’s immune system recognizes these proteins and acts to protect self-cells and to destroy non–self-cells


  • Channels or pores allow for the passage of substances into and out of the cell
  • Some drugs are designed to affect certain channels within the cell

Cell Properties

  • Endocytosis
    • Involves incorporation of material into the cell
    • Pinocytosis and phagocytosis occur
  • Exocytosis
    • Allows a cell to move a substance to the cell membrane and secrete the substance outside the cell
    • Hormones, neurotransmitters, and enzymes are excreted into the body by this process

Homeostasis of the Cell

  • Passive transport
    • Happens without the expenditure of energy and can occur across any semipermeable membrane
    • Occurs by diffusion, osmosis, and facilitated diffusion
  • Active transport
    • Energy-requiring process
    • Movement of particular substances against a concentration gradient
    • Important in maintaining cell homeostasis

Passive Transport

  • Diffusion
    • Does not require energy
    • The movement of solutes from a region of high concentration to a region of lower concentration across a concentration gradient
  • Osmosis
    • Does not require energy
    • Movement of water from an area low in solutes to an area high in solutes

Phases of the Cell Cycle

  • G0 phase
    • Resting phase
  • G1 phase
    • Gathering phase
  • S phase
    • Synthesizing phase
  • G2 phase
    • Last substances needed for division are collected and produced
  • M phase
    • Actual cell division occurs, producing two identical daughter cells

Cell Cycle

Cell Cycle
Cell Cycle

Cell Physiology

  • May alter the cell membrane, causing the cell to rupture and die
  • May deprive the cell of certain nutrients, altering the proteins that the cell produces and interfering with normal cell functioning and cell division
  • May affect the normal cells of patients to some extent