Natural Immunity
- Present at birth
- Protection provided by physical barriers:
- Skin, mucus membranes
- Phagocytic cells
- NK cells
Specific Acquired Immunity
Production of antibodies against antigens
Active:
- Having the infection or a vaccine / toxoid
- Takes weeks to months to take effect
Passive:
- Administration of preformed antibodies (immunoglobulins)
Major Cells of the Immune System
- B cells — Produce antibodies
- Macrophages & Dendritic Cells
- –Phagocytosis
- Helper T cells (CD4)
- –Activate B cells
- –Responsible for delayed hypersensitivity reaction
- Cytotoxic T cells (CD8)
- –Directly destroy target cells
Important: You can find the latest list of childhood vaccines (ages, side effects etc. from the cdc). Here is the link.
http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
MMR Vaccine
Therapeutic Uses:
- Measles, Mumps, Rubella
Adverse Effects:
- Local reactions (rash, fever, swollen glands)
- Anaphylaxis
Contraindications/Precautions:
- Allergies to eggs, gelatin, and neomycin
- Hx of thrombocytopenia
- Immunocompromised individuals
- Recently received blood products or immunoglobulins
DTaP Vaccine
Therapeutic Uses:
- Diphtheria, Tetanus, Pertussis
Adverse Effects:
- Encephalopathy (fever, persistent crying)
- Seizures
- Local reaction at injection site
Contraindications/Precautions:
- Severe febrile illness
- Hx of anaphylaxis
- Hx of encephalopathy 7 days after DTaP vaccination
- Occurrence of seizures with 3 days of vaccination
- Inconsolable crying (>3 hrs) within 48 hrs of vaccination
Hepatitis Vaccine
Therapeutic Uses:
- Hepatitis A & B viruses
Adverse Effects:
- Local reaction
- Anaphylaxis
Contraindications/Precautions:
- Hx of anaphylaxis
- Allergy to Baker’s yeast
Varicella Virus Vaccine
Therapeutic Uses:
- Varicella zoster virus (chickenpox)
Adverse Effects:
- Varicella-like rash
Contraindications/Precautions:
- Pregnancy
- Cancer
- Hx of allergy to neomycin or gelatin
- Immunocompromised patients
Education:
- Slight risk of virus being transmitted. If child develops rash after vaccination they should be presumed to be infected and appropriate precautions taken.
Inactivated Polio Vaccine
Therapeutic Uses:
- Immune response to poliovirus
Adverse Effects:
- Vaccine-related paralytic poliomyelitis
- Local reaction
Contraindications/Precautions:
- None
Influenza Vaccine
Therapeutic Uses:
- Immunity to influenza strains in the vaccine
Adverse Effects:
- Guillain-Barré syndrome (ascending paralysis, weakness of BLE, dyspnea)
- Local reaction
- Fever
Contraindications/Precautions:
- Acute febrile illness
- Hypersensitivity to eggs
Immune Globulin
Expected Action: Proto: Gamma globulin (IgG)
- Passive immunity
Therapeutic Uses:
- Immunodeficiency syndrome
- Bone marrow transplantation
- Measles, rubella, varicella exposure • Chronic lymphocytic leukemia
- Hep A, Hep B exposure
Adverse Effects:
- Local reaction / hypersensitivity
Contraindications/Precautions:
Interactions:
- Live viruses can lead to disease – avoid live viruses for 3 months following IgG
Education:
- Administer in deep muscle / Date of exposure must be known (6 days measles, 7 days Hep B, 14 days Hep B)
Immunostimulants
Expected Action: Proto: Interferon Alfa, Aldesleukin, Interleukin 2
- Enhance immune response / reduce proliferation of cancer cells
Therapeutic Uses:
- Leukemia / melanoma / Kaposi’s sarcoma
Adverse Effects:
- Flu-like symptoms / Marrow suppression, alopecia, cardiotoxicity, neurotoxicity
- Hypotension
Contraindications/Precautions:
- Hypersensitivity / pregnancy and lactation (C)
Interactions:
- Theophylline (toxicity)
- Zidovudine or retrovir ( neutropenia)
- Antihypertensives ( hypotensive effect)
Education:
- Refrigerate / Do not shake vial
Immunosuppressants
(General)
- Act on helper T lymphocytes to suppress proliferation of B cells and cytotoxic T cells
- For treatment of autoimmune disorders and to prevent organ rejection
- –Rheumatoid arthritis
- –Early type 1 diabetes
- –Lupus
- –Myasthenia gravis
Adverse Effects
- Teratogenesis
- increased risk of infection
Medications:
- Cyclosporine (Gengraf, Neoral)
- Tacrolimus
- Glucocorticoids (prednisone)
- Methotrexate
- Cytotoxics (azathioprine)
Cyclosporine
Adverse Effects: Hepatotoxicity Nephrotoxicity (BUN, Creatinine, I&O)
Contraindications/Precautions: Pregnancy / Recent live virus vaccination / Recent contact ĉ chickenpox or herpes
Interactions:
- Phenytoin, phenobarbital, rifampin, carbamazepine, TMP-SMZ ([cycl] ò)
- Ketoconazole, erythromycin, amphotericin ([cycl] ñ ð toxicity)
- Amphotericin, aminoglycosides, NSAIDs (all nephrotoxic ð ñ renal damage)
Grapefruit juice (ñ [cycl] by 50%)
Nursing
- Mix oral dose ĉ milk or OJ to ñ palatability
- Admin initial dose over 2-6 hours
Monitor for hypersensitivity, stay ĉ pt. for 30 mins
Glucocorticoids
Adverse Effects:
- Osteoporosis (use Ca2+& vitamin D supplements
- Renal insufficiency (stop drugs immediately)
Fluid retention
Contraindications/Precautions:
Systemic fungal infections
Recurring live virus vaccines
Interactions:
- K+-depleting diuretics (ñ hypokalemia)
- NSAIDs (ñ GI ulceration)
Glucocorticoids (Promote hyperglycemia)
Proto: Prednisone, prednisolone
Azathioprine
Adverse Effects:
- Bone marrow depression à neutropenia & thrombocytopenia
Contraindications/Precautions:
- None listed in ATI
Interactions:
- Allopurinol (delays inactivation of azathioprine)
Antihistamines
(General)
- Action is on H1 receptors which blocks histamine release
Medications
- 1st Generation:
- Diphenhydramine (Benadryl)
- Promethazine (Phenergan)
- Dimenhydrinate (Dramamine)
2nd Generation:
- Loratadine (Claritin)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Desloratadine (Clarinex)
Therapeutic Uses:
- Mild allergic reactions
- Anaphylaxis
- Motion sickness
- Insomnia
Antihistamines
(1st Generation)
Expected Action: Proto: Diphenhydramine, promethazine, dimenhydrinate
- Block H1 receptors – prevent histamine release into small blood vessels & nerves
Therapeutic Uses:
- Mild allergic reactions
- Motion sickness
- Anaphylaxis
- Insomnia
Adverse Effects:
- Sedation
- GI discomfort
- Anticholinergic effects (dry mouth, constipation)
- Acute toxicity (flushed face, fever, tachycardia), children can have hallucinations, incoordination and seizures –> to treat –> Induce vomiting and give activated charcoal.
Contraindications/Precautions:
- 3rd trimester, lactation, newborns / use cautiously in kids and elderly
- Caution ĉ asthma, urinary retention, open angle glaucoma, & hypertension.
Interactions:
CNS depressants
- EtOH
- Benzodiazepines
- Opioids
- Barbiturates
Chemotherapy Agents
(Medications)
- Nitrogen mustards —> cyclophosphamide
- Platinum compounds —> cisplatin
- Folic acid analog —> methotrexate
- Pyrimidine analog —> cytarabine
- Purine analogs —> mercaptopurine
- Antitumor antibiotics —> doxorubicin
- Mitotic inhibitors —> vincristine, paclitaxel
- Topoisomerase inhibitors —> topotecan, irinotecan
- Breast cancer —> tamoxifen (antiestrogen)
- Prostate cancer —> leuprolide
- Progestins —> megestrol acetate
Cytotoxic medications
- Asparaginase
- Hydroxyurea
- Procarbazine
Chemotherapy Agents
(Side Effects)
- Bone marrow suppression –tx — Avoid crowds, check for bleeding gums
- GI discomfort –tx — Give antiemetic (ondansetron) with dexamethasone, metoclopramide or granisetron at outset
- Alopecia –tx — Occur 7-10 days after, persist max of 2 months’ after
- Mucositis –tx — Frequent oral care, soft toothbrush, EtOH mouthwash
- Reproductive toxicity –tx — Sperm banking, Avoid gravid on meds.
- Hyperuricemia or inc uric acid –tx — inc fluids, I&O, Give allopurinol if inc uric acid
- Extravasation of vesicants such as carmustine, dactinomycin, daunorubicin, and vincristine
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