Immune Modulators

8/8/2019 Immune Modulators

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IMMUNE MODULATOR

They are used to modify the actionsof the immune system.



Problems that may ariseinvolving the immune system

Neoplasm occur when mutant cells escapethe normal surveillance of the immunesystem and start to grow and multiply.

Viral invasion of cell- viruses are parasiteonly invading the host cell that providenourishment necessary for viral replication

Autoimmune disease when the bodyrespond to specific self antigens to provide

antibodies or cell mediated immuneresponse against it own self cell. Transplant rejection-it is more of the

foreign cell introduced in the body.





IMMUNESU

PPR ESSAN

TS Are used to block the normal effects

of the immune system.

In cases of organ transplantation (inwhich non-self-cells are transplantedinto the body and destroyed by theimmune reaction)

In autoimmune disorder (in which thebody¶s defenses recognize self-cellsas foreign and work to destroy them)



Kinds of

Immune Stimulants

Interferon, which are release by humancells in response to viral invasion

Interleukins, synthetic compounds thatcommunicate between lymphocytes, whichstimulates cellular immunity and inhibittumor growth.

T- and B cells modulator calledlevamisole (Ergamisol), which restoresimmune function and also stimulateimmune system activity.



Therapeutic Actions of Interferons They act to prevent virus particles from

replicating inside other cells.

They also stimulate interferon receptor

sites on non-invaded cells to produceantiviral proteins, which prevent virusfrom entering the cells.

It inhibit tumor growth and replication

Interferon gamma- 1b also acts likean interleukins, stimulatingphagocyte to be more aggressive



Indications of interferon

Interferon¶s are indicated for treating selectedleukemia¶s (alfa-2a, alfa 2b)

Multiple sclerosis (beta 1a, beta 1b)

Intra-lesional treatment of warts (alfa-n3, alfa-2b)

Chronic hepatitis B or chronic hepatitis C (alfa-2b)

Chronic hepatitis C (alfacon-1,peginteferon)

Acquired immune deficiency syndrome (AIDS)-related Kaposi¶s sarcoma

And severe infection cause by granumalotous disease(gamma-1b)



Pharmacokinetics of interferon Generally absorbed after SQ and IM

injection

Excreted in the kidneys They are teratogenic in animals

Use of barrier contraceptive is

advised for woman in child bearingage.

It is advise not to be given duringlactation



Contraindication and caution of interferon

resence of allergy to any interferonor product component

Pregnancy and lactation

Caution in patient with cardiacdisease because hypertension andarrhythmias have been reported with

the use of these drugs. These drugs may further suppress

bone marrow



INTER LEUKIN

S They are chemicals secreted by active

leukocytes to influence other leukocytes. IL 1 stimulates T and B cells to initiates an

immune response. IL 2 is release from active T cells tostimulate production of more T cells and toincrease the activity of B cells, cytotoxiccells and natural killer cells.

Interleukins also cause fever, myalgia,arthalgia, and slow wave sleep induction allthings that help to conserve energy for usein fighting off invader



Therapeutic Action of

interleukins Natural IL2 is produced by helper T cells to activate

cellular activity and inhibit tumor growth by increasinglymphocyte numbers and their activity.

When interleukins are administer,there are increases

in the number of natural killer cells and lymphocytes,in cytokine activity and in number of circulatingplatelets.

Aldesleukin is indicated for treatment of specificrenal carcinoma and possibly AIDS

Oprelvekin is indicated for prevention of severethrombocytopenia (an abnormal decrease in platelets)after myelosuppressive chemotheraphy in selectpatient.



Pharmacokinetics of Interleukins

They are rapidly distributed afterinjection

They where shown to be embryocidaland teratogenic in animal studies

Primarily cleared from the body bythe kidneys



Contraindication and caution of Interleukins

Contraindicated in the presence of drug allergy to interleukin or E. coli-

produced products and duringpregnancy and lactation

Caution should be used with renal,liver, or cardiovascular impairment

because of the adverse effect of drugs.



Adverse effects of

Interleukins

y The adverse effect can be attributedto their effect on the body during

inflammation (e.g., lethargy, myalgia,arthralgia, fatigue, fever), respiratorydifficulties, CNS changes and cardiacarrhythmias.



T and B-cellM

odulator The drug levamisole (Ergamisol) is

an immune stimulant that restore

suppressed immune function incertain situation



Therapeutic Actions andIndications of levamisole Levamisole stimulates B cells, which

in turn stimulate antibody formation,

enhance T cell activity, and increasethe activity of monocytes andmacrophages.

Levamisole is indicated for

treatment of dukes¶ stage C coloncancer after surgical resection and inconjunction with fluorouracil therapy.



Pharmacokinetics of Levamisole

It is absorbed at the GI tract reachingthe peak levels of 1.5 to 2 hours

It is metabolize in the liver andexcreted in the urine.

With half life of 16 hours

It is embryotoxic in animal studiesand should not be used inpregnancy.

Drugs should not be used in lactation.



Adverse

Effects of levamisole

Flu- like effects: lethargy, myalgia,arthralgia, fever.

G I upset, nausea, taste perversions,and diarrhea; headache, anddepression; bone marrow depression;dermatitis and hair loss



Clinically important Drug-Drug

Interactions of Levamisole This drug should be avoid to be

combine with alcohol (Disulfiram-type

reaction) Do not combine with phenytoin. (it

will increase the phenytoin level andtoxicity level)



Nursing Consideration forpatient receiving Immune

stimulants Assessment: History and Examination

Any allergies to any of these drugs ortheir components

Pregnancy or lactation

Hepatic and renal function

Cardiac disease

Bone marrow depression CNS disorder, including seizure



Nursing diagnoses

Acute pain related to CNS, G I upset,and flu-like effect

Imbalance in nutrition: less thanBody Requirements related to flu-likeeffect.

Anxiety related to diagnosis and drugtherapy

Deficient Knowledge regarding drugtherapy



Implementation foradministration of immune

stimulants Arrange for laboratory test before and periodically during therapy

including CBC and differential count, to monitor for drug effectsand adverse effect.

Administer drug as indicated; Instruct the patient and a significantother if injection is required to ensure that the drug will be giveneven if the patient is not able to administer it

Monitor severe reaction and arrange to discontinue drugimmediately if they occur.

Arrange for supportive care and comport measures For flu-like symptoms (e. g., rest, environmental control,

acetaminophen) to help the patient to cope with the drug effect.

Instruct female patient to use barrier contraceptives to avoidpregnancy during drug therapy because of the potential for

adverse effect on the fetus. Provide drug education Offer support and encouragement to deal with the diagnosis and

drug regimen



Evaluation For immune

stimulant administration Monitor patient response to the drug

Monitor for adverse effects

Evaluate for the effectiveness of theteaching plan

Monitor for effectiveness of comportmeasures and compliance with theregimen.



IMMUNESU

PPR ESSAN

TS Are used in conjunction with

corticosteroids, which block the

inflammatory reaction and decreaseinitial damage to the cells.

They are especially beneficial in casesof organ transplantation and in the

treatment of autoimmune diseases





Focus on Patient Safety inadministration of immune

suppressants Patient receiving is immune suppressant are high risk

for infection and cancer.

They should be warned in situation that may exposethemselelf to infection.

They should avoid activity that may cause injurywhich lead to infection

They should be educated for protective strategies.

This includes wearing masks and heavy gloves.

Delaying vaccinations

Knowing S/S of infection Obtaining regular physical examination and

screenings for diseases of developing neoplasm



T- and B- cells Suppressors T-cells- they destroy foreign cells and stimulate

immune and inflammatory reactions.

T suppressor cells they dampen the immune andinflammatory response to conserve energy and

prevent cellular damage. Lymphokine- are activated killer cells or Natural killer

cells- they are anti-neoplastic and stimulate rapidcellular death

B-cells- they recognize specific proteins and produce

antibodies (immunoglobulin) Cyclosporine (Sandimmune, Neoral)- used to

suppress rejection in a variety of transplantationscenarios.



Action of T-and B-Cells

Suppressor Reversely inhibits immuno competent

lymphocytes; inhibits T- Helper cells

and T suppressor cells, Lymphokineproduction, and release of interleukin-2 and T-cell growth factor.



Adverse effects of T- and B Cells

suppressors Tremors, hypertension, gum

hyperplasia, renal dysfunction,

diarrhea, hirtuism, acne, bonemarrow depression.

Cyclosporine is embryotoxic inanimals and crosses breast millk.

Should not be used during pregnancyand lactation.



T-and B Cells available in themarket

Neoral- is also used to treat rheumatoid arthritis and psoriasis.Alefacept- is used to treat adult patient with severe, chronicpsoriasis who are candidates for systemic therapy.

Azathioprine (imuran)- is used specifically to prevent rejectionin renal homotransplant and to treat rheumatoid arthritis(autoimmune disorder) in selected patients.

Glatitramier acetate (Cepaxone) is used specially to reducerelapses multiple sclerosis. which is thought to be related toautoimmune reaction.

Mycophenolate (CellCept) ±is an oral drug that is used withcyclosporine and corticosteroid to prevent organ rejection afterrenal, hepatic, or heart transplantation.

Tacrolimus (Prograf)- is used to prevent liver and renal

transplant rejection and being studied for multiple other transplantscenarios. Sirolimus ( Rapamune)- is used to prevent organ rejection in

patient receiving renal transplants and should be used withcyclosporine and corticsteriod .



INTER LEUKIN R ECEPTOR AN

TAGONI

ST INTER LEUKIN 1- they simulate T- and B

cells to stimulate immune response.

Anakira (Kineret)- specially antagonizes

interleukin 1 receptors, blocking the activityof interleukin 1 levels are elevated inresponse to inflammation and immunereactions and are thought to be responsible

for the degradation of cartilage that occurin rheumatoid arthritis.



Therapeutic Actions andI

ndications They are used to reduce the S/S of

moderately to severely active

rheumatoid arthritis in patients whohave not responded to the traditionalanti- rheumatic drug.



Pharmacokinetics Dosage: 100mg/ day

Peak level 3 to 7 hours

Half life 4 to 6 hours They cross the placenta and may

enter breast milk

It is excreted in the urine



Adverse effects

Headache, sinusitis,nausea,diarrhea, upper respiratory and

infection Injection site reaction



Drug-Drug Interactions

Should not be given in patientreceiving etaranecept (enbrel)

because of severe infection



Always Remember thisStudents, Fellow Nurses:

The use of immune suppressants mayincrease the susceptibility to infection

and increase risk to neoplasmassociated with the use of this drugs.Patient need to be protected toinfection, injury, and invasive

procedure



SALAMAT PO

GO IN PEACE

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Immune Modulators