Pharm(T3-Ch49)

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____ – The ability of the body to fight of disease/infection/foreign substances

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Immunity

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____

foreign proteins from an invading organism

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Antigens

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_____

Immunoglobulin molecules that have antigen-specific amino acid sequences

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Antibodies

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_____

Glycoprotein molecules created in the humoral immune system for the purpose of destroying all substance that the body recognizes as foreign

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Immunoglobulins

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Two (2) ways to obtain immunity

Can be 2

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Active immunization

Passive immunization

Each can be artificial or natural

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____ – the body is clinically exposed to relatively harmless for of an antigen that does not cause an infection.

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Artificial Active

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_____ – involves administration of serum or concentrated immunoglobulins – which provide the ability of the body to fight off invading microorganisms

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Artificial Passive

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_____ – the body acquires immunity by surviving the disease itself and produces ATBs.

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Natural Active

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____ – when ATBs are transferred from mother to baby via breast milk, or bloodstream via placenta.

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Natural Passive

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___immunity is activated automatically in ones system through exposure

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Active

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Immunization is through

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Biological Antimicrobial Drugs

Also called biologicals

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Biological Antimicrobial Drugs

2

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Toxoids and vaccines (immunizing biologicals)

Antitoxins, Antisera (Antiserum) & ImG

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Rely on the body’s immune system

Active immunizing drugs

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Toxoids and vaccines (immunizing biologicals)

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Passive immunizing drugs

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Antitoxins, Antisera (Antiserum) & ImG

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These drugs are used to prevent, treat, or cure infectious diseases

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Active Immunization

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____ - Venoms, snake bites, etc  injected into sheep to produce imG. Then given to imG are extracted to give to humans

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Antitoxins

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A substance that contain antigens, most often in the form of bacterial exotoxins.

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Toxoids

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____ – Toxin secreted by bacteria

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Exotoxin

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_________ – foreign proteins from an invading

organism

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Antigen

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Detoxified with chemicals or heat

Cannot revert back to a toxic form

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Weakened or “attenuated”

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____ are usually given after exposure. (ie Tetanus exposure with HIV patient) – Giving antibodies

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imG

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____ are usually given before exposure. (MMR) – body will build up antibodies on own

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Vaccines

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Stimulate one’s immune system to produce a specific antibody

This is done by administering ___

These antibodies protect against future exposures

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active immune response

Toxoids

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Artificial active immune response

Effective against diseases such as

2

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Diphtheria – serious respiratory infection

Tetanus – serious nervous system infection/effects nerves and muscles

(Booster Every 10 years – possible)

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Mom to baby –

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natural passive

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Hep B vaccine takes ____ to work

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6 months

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Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms

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Vaccines

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These slight alterations in the bacteria and viruses prevent the person injected from contracting the disease

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Vaccines

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_____ with killed bacteria or virus provide partial immunity, and booster shots are needed periodically

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Vaccinations

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Active Immunizing Drugs: Examples

15

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BCG vaccine (tuberculosis)

Used in Africa

Diphtheria, tetanus, and pertussis toxoids, several forms

Haemophilus influenzae type B conjugate vaccine

Hepatitis A and B virus vaccines

Measles, mumps, and rubella virus vaccine, live—several forms

Pneumococcal bacterial vaccines

Human papilloma virus vaccine (Gardasil)

Poliovirus vaccine; several forms

Rabies virus vaccine

Smallpox virus vaccine

Tetanus toxoid (vaccine)

Varicella virus vaccine (chickenpox)

Live attenuated

Not to pregnant woman or immunocomprimised

Yellow (jaundice) fever virus vaccine

Flu like symptoms

Shock & organ (liver) failure

Africa, east area

Many others

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____ is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month (because those individuals have weakened immune systems)

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Varicella vaccine

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It is also recommended that ____ be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye’s syndrome.

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salicylates

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allergy to eggs implication.

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flu vaccine

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Serum or concentrated immunoglobulins from humans or animals are injected into a person

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Passive Immunization

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Glycoprotein molecules created in the humoral immune system for the purpose of destroying all substance that the body recognizes as foreign

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immunoglobulins

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The substances needed to fight off invading microorganisms are given directly to a person

The immune system is bypassed

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Passive Immunization

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Short-lived compared with active immunization, but works faster

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Passive Immunization

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Administration of serum or concentrated immunoglobulins

Provides the inoculated person the substance needed to fight off the invading microorganism

Bypasses the host’s immune system

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Artificial Passive Immunization

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Antibodies are transferred

From mother to fetus through the placenta

From mother to infant through breast milk

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Natural Passive Immunization

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Passive Immunizing Drugs

3

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Antitoxins

Immunoglobulins

Snake and spider antivenins (antivenom)

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Passive Immunizing Drugs: Examples

6

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Antivenins

Hepatitis B immune globulin

Immunoglobulin, various forms

Rabies immunoglobulin (human)

Tetanus immunoglobulin

Varicella-zoster immunoglobulin

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Used to prevent/minimize poisoning

Pit viper, coral snake

Black widow spider

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(Antisera)

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This is prenancy (rh- mom, rh+ child)

The fetus blood crosses the placenta, and the mother sends antibodies to attack baby

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Rho(D) immune globulin (RhoGAM)

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Chicken pox IgG

Not to anyone immunocompromised

Herpes zoster if for shingles

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Varicella-zoster immunoglobulin

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____- body is doing something for it (own body doing it for you)

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Active

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____- something else is doing it for you (their body is doing it)

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Passive

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____ – defense developed by self, by being exposed (chicken pox)

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Natural active

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____ is a vaccine for bacteria infections

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Toxoid

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__2__rely on a person’s immune system in order to work

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Vaccines and toxoids

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Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount ____

In these situations, passive immunizing drugs such as immunoglobulins are warranted.

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an immune response

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Prevents infection caused by bacterial toxins or viruses

Contraindicated in pts with Fever, weakened immune system,

Provides long-lasting or permanent immunity

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Active immunization

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95% of population is immunized which will protect the population

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“Herd immunity”

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Antitoxins, antivenins, immunoglobulins

Minimizes effects of poisoning by the venoms of spiders and certain snakes

Provides quick immunity before a person’s own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses)

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Passive immunization

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____is a vaccine for the prevention of herpes zoster. The vaccine is recommended for patients 60 years or older to prevent reactivation of the zoster virus that causes shingles.

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Zoster vaccine (Zostavax)

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Adverse reactions to vaccines/ immunoglobulins

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Range from mild and transient to very serious or life threatening

Minor effects

Fever, minor rash, soreness at injection site, itching, adenopathy

Severe effects

Fever higher than 103° F, encephalitis, convulsions, anaphylactic reaction (many of these are made in animals that people can be allergic to), dyspnea, others

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Minor reactions (frustration with Chickenpox)

Treated with 2+1

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acetaminophen and rest

Never Asprin because of Rye sydrome

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Repeated injection of horse-derived immunizing drugs

Edema of face, tongue, throat, rash, urticaria, arthritis, dyspnea, cardiovascular collapse, etc.

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Serum sickness

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Report serious or unusual reactions to the ____

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Vaccine Adverse Event Reporting System (VAERS)

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Assess patient’s health history, medication history, allergies, pregnancy status

Assess previous reactions and responses to immunizations

Assess for contraindications, including immunosuppression

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Nursing Implications

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Before giving any drug, recheck the specific protocols for administration and schedules for administration

Follow manufacturer’s guidelines for drug storage, administration, routes, and site of administration

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Nursing Implications

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Vaccines

____

Noninfectious, bacteria-derived

Given by injections to those who are high risk

Pneumonia, cellulitis, sickle cell, pericarditis, Hodgkins DZ

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H. influenzae

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Vaccines

_____

Noninfectious viral vaccine

Given by injection to high risk individuals

Healthcare workers and recommended that children receive this vaccine.

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HBV

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Vaccines

____

Two vaccines

Active immunization to prevent meningitis

Powder form must be diluted

41% state pain at injection site

30% state headache

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Meningococcal

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Meningococcal

Two vaccines

2

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Menactra – 9mo – 55yrs

Menveo – 11yrs-55yrs

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_____

New vaccine - recommended for pt. 50yrs or older

One time vaccine

Used to prevent reactivation of the herpes zoster virus

Can be given to pt. who have had the shingles

Not be used to prevent chickenpox

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Herpes Zoster (shingles)

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Drug must be stored in freezer

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Herpes Zoster (shingles)

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_____

Causes genital wars & cervical CA

Sexually transmitted

Recommended for males and females ages 11 - 26

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Human papillomavirus (HPV)

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Human papillomavirus (HPV) vaccines 2

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Gardasil, Cervarix (first and only vaccine to prevent CA)

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__2__vaccine

SQ 0.5ml

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Pneumoccocal

MMR

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__3__

IM Series of three (6wks – 7yrs, give 2nd & 3rd doses at

4-8wk intervals 0.5ml

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Diphtheria, tetanus, pertussis

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___– IM, initial dose, 1mo., 6mo. 0.5ml

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HBV

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Postexposure prophylaxis

IM 1ml on days 3, 7, 14

Preexposure prophylaxis

IM 1ml on days 0, 7, and between 21 and 28 then q 2-5yrs

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Rabies

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____

Provides passive immunity in postexposure

Pregnancy is not a contraindication due to the harmful consequences of HBV

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HBV immunoglobulin (BayHep B, Nabi –HB)

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Encourage parents of young children to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any

If discomfort occurs at the injection site, apply warm compresses and give acetaminophen – do not give ASA to infantsDo not give aspirin to childrenMonitor for therapeutic responses and adverse reactions

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Nursing Implications

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Anthrax (from ____)

Route: Skin, Inhalation which can lead to fatal ____, & GI

It was original in the soil. 19th century farmers were infected.

TX Vaccine ABT: __2__

Fatal in 50% even with treatment

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spores of bacteria

bacteremia

cipro, dicloxacillin

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___

Flu-like symptoms followed by total body disfiguring rash

TX vaccine may be effective up to 3 days after exposure____

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Smallpox (Virus)

Cidofovir

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Muscle weakness, downward paralysis including

paralysis of diaphragm

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Botulism (bacteria)

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Bleeding from body orifices and in internal organs

in severe cases; renal failure and coma

Comes from rodents/no vaccine

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Viral hemorrhagic fever (virus) (Ebola)

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Causes lungs, skin, blood problems / Respiratory failure and shock

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Plague (Bacteria)

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Sarin (nerve gas)

S/S – Runny nose, seizures

TX - ____

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Pediatric Atropine dosages

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_____

S/S – Skin burns, pulmonary edema, ocular damage

TX - Remove clothing, rinse with water, apply special lotion

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Mustard (blistering agent)

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Cyanide (blood agent)

S/S – Seizures, GI hemorhage, respiratory arrest

TX –__2__

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Amyl nitrate or sodium nitrate

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____(choking agent)

S/S – Respiratoty irritation, Pulmonary edema

TX – Remove from area, provide respiratory support

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Chlorine

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Radioactive elements from bombs and nuclear reactors

S/S – DNA mutation, tissu fibrosis, vascular insufficiency, bone marrow toxicity, organ failure

TX – __2__

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Pentetate Calcium and pentetate zinc

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____

S/S – Respiratory failure, seizures, fever, cough, diarrhea

TX – Remove from area, mechanical vent.

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Ricin –