Immune System, Allergies, & Infection

What are immunostimulants?

Drugs that stimulate the immune system to fight infection

Describe interferon

Immunostimulant

• Used to suppress growth of cancer cells, antiviral activity

  • Can cause flu-like symptoms, n&v, diarrhea, anorexia

  • Prolonged therapy can cause immunosuppression, hepatotoxicity, neurotoxicity

What are immunosuppressants

Inhibits the immune system— used to treat autoimmune diseases

• Toxic to bone marrow

  • Will lead to decreased WBC, RBC, platelets (infection, anemia, bleeding)

Assessment for those on immunosuppressant drug therapy

• Complete health history

• Assess for presence of cancer (suppressed immunity)

• Skin integrity (skin breakage)

• CBC

• Vital signs (temperature— infection)

Who is required to be on immunosuppressant drugs?

Patients with transplants

Describe methotrexate

Immunosuppressant

• Chemotherapy agent that exerts high cytotoxic effects for dividing cancer cells

• Can be given in lower doses to suppress autoimmune diseases without the cell-killing action

• Can be very hepatotoxic

Describe corticosteroid

Short-term anti-inflammatory therapy

• Can be used as an immunosuppressant

When used long-term has many adverse effects

• Low lymphocytes, monocytes, macrophages

Describe NSAIDs

For mild to moderate inflammation

• Inhibits synthesis of prostaglandins (promotes inflammation, fever, pain)

COX-1

• Reduces gastric secretion

• Promotes renal blood flow

COX-2

Promotes inflammation, sensitizes pain receptors, & causes fever

Nonspecific NSAIDs will affect

Both COX-1 & 2

Classes of NSAIDs

• Salicylates

• Ibuprofen

• COX-2 antagonists

Describe ibuprofen (Advil)

Anti-inflammatory— inhibits both COX-1 & 2

• Used for MSK disorders, rheumatoid arthritis, osteoarthritis, mild to moderate pain, reduction of fever

  • Can increase gastric secretions, increased renal blood flow

If an NSAIDs is nonspecific & will affect both COX-1 & 2, who would not be the best choice for these drugs?

Those with Crohn’s disease or cholitis

• CNA cause GI bleeding, gastric upsets

People with reduced kidney function

• Renal blood flow will increase

What should be carefully monitored for Aspirin as an NSAID?

Potent anti-platelet, so monitor for bleeding

• High doses may cause salicylism

  • Tinnitus

  • Dizziness, headache

  • Sweating

Role of nurses for monitoring NSAIDs

• Baseline

• Kidney/liver function tests

• Bleeding time for long-term administration

• CBC

• Changes in pain, temperature

• GI bleeding, hepatitis, nephrotoxicity, hemolytic anemia

Describe systemic glucocorticoids

Anti-inflammatory drugs that can suppress severe cases of inflammation

• Supresses histamine release

• COX-2 specific

Describe prednisone

Synthetic glucocorticoid (suppresses histamine)

• Used to treat inflammation

  • Can cause high BP, obesity, round red face, buffalo hump, weak bones, fragile skin

    • Increases risk of infection

Pharmacological management for systemic glucocorticoids

• Assess for infection

• Alternate day therapy

• Tapered usage when ending usage

• Can cause ehyperglycemia

• Increase sodium in the blood

Describe antipyretic drugs

Used to treat fever as prolonged fever is dangerousness & life-threatening

Describe acetaminophen

Used for fever, mild to moderate pain (NOT for inflammation)

• Inhibits COX activity in CNS but not in the body

Who should not be taking Tylenol (acetaminophen)?

Those with liver failure, kidney

• Hepatotoxicity

• Renal failure

Describe diphenhydramine (Benadryl)

Antihistamine (Allergic reaction)

• Can be used as antiemetic, antitussive

  • Can cause sedation, ataxia, anticholinergic effects

Describe fluticasone

Intranasal glucocorticoid (anti-inflammatory)

• Can cause headaches, epistaxis, burning

What should be done if patient is in anaphylaxis?

Give epinephrine

• Raise the feet

Describe epinephrine

Used for anaphylaxis, hypotension, dysrhythmias

• Can cause n&v, palpitations, headaches, tenderness