Drugs for Infections III

Protect against infectious disease

purpose of immunizations

Vaccine

Whole or fractionated microorganisms

Toxoid

Bacterial toxin that has changed to a nontoxic form

Vaccination

Any vaccine or toxoid

response to infection or to administration of a vaccine or toxoid

Active immunization

Conferred by giving a patient preformed antibodies (immune globulins), Protects immediately but persists only as long as the antibodies remain in the body.

Passive immunization

Specific immune globulins

Preparations contain a high concentration of antibodies directed against a specific antigen (for example, hepatitis B virus)

Donated blood

preparations of specific immune globulins are made from what?

• Determine whether an outbreak is occurring

• Evaluate prevention and control strategies

• Evaluate the impact of national immunization policies and practices

Why is it important to report vaccine -preventable diseases? [3]

uTo ensure appropriate vaccination

uTo avoid overvaccination

why are immunization records kept? [2]

uDate of vaccination

uRoute and site of vaccination

uVaccine type, manufacturer, lot number, expiration date

uName, address, title of person administering the vaccine

immunization record contains what? [4]

uCovid-19

uMeasles

uMumps

uRubella

uDiphtheria

uTetanus (lockjaw)

uPertussis (whooping cough)

uPoliomyelitis (polio, or infantile paralysis)

target diseases for immunization [8]

Severe thrombocytopenia

Adverse effect of MMR vaccine

dose under 2 years old, second between 4-6, then another in high school

MMR dose schedule

you have a fever

important not to give DTaP vaccine if…

influenza

safest vaccine

inactivated poliovirus (IPV, Salk vaccine)

Polio vaccine is made from what?

live, attenuated

what kind of vaccine is varicella virus

•Hepatitis B surface antigen (HBsAg), the primary antigenic protein in the viral envelope.

Viral component, not live virus (cannot cause disease)

Hepatitis B vaccine

•Promotes synthesis of specific antibodies directed against hepatitis B virus

Hep B vaccine MOA

Gardasil and Cervarix  

HPV vaccines [2]

1. increased ris of infection

2. increased risk of neoplasms

immunosuppressant toxicity can cause:

1. prevents organ rejection

2. treating autoimmune disease

immunosuppressant uses [2]

prevent organ rejection

principle use of Calcineurin inhibitors

Cyclosporine, tacrolimus, pimecrolimus

most effective immunosuppressants [3]

Inhibition of calcineurin suppresses production of interleukin (IL-2)

IL-2 needed for T-cell proliferation

Calcineurin inhibitor MOA:

Suppresses the production of IL-2, interferon gamma, and other cytokines

Cyclosporine (Sandimmune) MOA

cyclosporine

drug of choice for organ rejection (kidney, liver, and heart) of an allogenic transplant

Highly protein bound (toxicity)

Why is it important to monitor cyclosporine levels?

uAdverse effects

uNephrotoxicity

uInfection

uHepatotoxicity

uLymphoma

uHypertension (50% of patients)dr

uLeukopenia, gingival hyperplasia, gynecomastia, sinusitis, hyperkalemia

uAnaphylactic reaction

Cyclosporine adverse effects

dilantin

Drug that decreases cyclosporine levels

erythromycin

drug that increases cyclosporine levels

Repaglinide (can get hypoglycemia)

cyclosporine increases the plasma levels of:

Inhibits metabolism of cyclosporine. Cannot have any grapefruit juice at all.

Cyclosporine and grapfruit juice

Tacrolimus [Prograf]

An alternative to cyclosporine. Somewhat more effective but also more toxic. has a Narrow therapeutic index,. Concurrent use with glucocorticoids

prophylaxis of organ rejection (liver, kidney, or heart)

therapetic use of tacrolimus (Prograf)

hyperkalemia

common electrolyte imbalance with organ rejection drugs

uNephrotoxicity is the primary concern

uNeurotoxicity

uGastrointestinal (GI) effects

uHypertension

uHyperkalemia

gum hyperplasia

anaphylaxis

Adverse effects of tacrolimus (Prograf)

NSAIDs or grapefruit juice

tacrolimus (Prograf) should not be taken with

inhibits enzyme that helps regulate cell growth, proliferation, and survival.

mTOR inhibitor MOA

Sirolimus (Rapamune)

Drug used only for renal transplant, used in conjection with cyclosporine and glucocorticoids

•Increased risk of infection

•Raises levels of cholesterol and triglycerides

•Risk of renal injury

•Rash, acne, anemia, thrombocytopenia, joint pain, diarrhea, hypokalemia

Adverse effects of sirolimus (Rapamune) [4]

increases absorption

high fat foods and rapamune

inhibits metabolism

Rapamune and grapefruit juice

Large doses can be used for suppression of allograft rejection, treatment of asthma, rheumatoid arthritis, systemic lupus erythematosus (SLE), and multiple sclerosis

glucorticoids to prevent rejection

of infection

, thinning of skin,

bone dissolution with fracture

, impaired growth in children,

and suppression of hypothalamic-pituitary-adrenal axis

large doses of glucocorticoids increase the risk of [5]

Suppress immune response by killing B and T lymphocytes undergoing proliferation

Nonspecific: Toxic to all proliferating cells

how do cytotoxic drugs suppress immune system?

uBone marrow suppression

uNeutropenia

uThrombocytopenia

uGI disturbances

uReduced fertility

uAlopecia

adverse effects of cytotoxic drugs [6]d

Azathioprine [Imuran]

drugs that suppress cell-mediated and humoral immune responses

1. adjuvant treatment with transplants

2. autoimmune disease

Azathioprine [Imuran] therapeutic uses [2]

uBlood dyscrasias

uNausea and vomiting

uTeratogenic

uNeoplasms

uPancreatitis

adverse effects of azathhioprine (Imuran) [5]

Methotrexate (Rheumatrex, Trexall)

cytotoxic drug that suppresses B and T lymphocytes by interfering with folate metabolism

1. rheumatoid arthritis

2. psoriasis

therapeutic uses for methotrexate [2]

Basiliximab

Monoclonal antibodies that block activation of T-cells by interleukin-1

prophylaxis of acute organ rejection after renal transplantation

therapeutic use of Basiliximab

Generally well tolerated, does not increase the risk of opportunistic infections, and no cancers have been observed 1 year after treatment.

adverse effects of Basiliximab

1. cortisone

2. hydrocortisone

Short acting glucocorticoids [2]

prednisone

intermediate acting glucocorticoid

dexamethasone

long acting glucocorticoid

1. rheumatoid arthritis

2. systemic lupus erthematosus

3. IBD

4. allergic conditions

5. asthma

6. dermatologic disorders

7. suppression of allograft rejection

8. prevention of respiratory distress syndrome in preterm infants

therapeutic uses for glucocorticoids

1. adrenal insufficiency with prolonged adminsitration

2. osteoporosis with prolonged systemic therapy

3. infection (PCP)

4. glucose intolerance

5. myopathy (proximal musciles of the arms and legs affected most)

6. growth suppression

7. fluid and electrolyte imbalances

8. cataracts and glaucoma

9. PUD

10. redistribution of fat

Adverse effects of glucocorticoids [10]

1. sodium retention

2. water retention

3. potassium loss

Fluid and electrolyte imbalances with glucocorticoids [3]

`.1. insomnia

agitation

dizziness

being hyper

Psychologic disturbances with glucocorticoids [4]

1. increases blood glucose, need higher dose to bring sugars down

insulin and hypoglycemics interaction with glucocorticoids

People with lifethreatening condition or potential to cause permanent disability

who uses high dose prolonged glucocorticoid treatment?

alternate day therapy or gradual weening

How to ween off glucocorticoid drugs:

Mimics natural steroids in body early in the day.

Why take glucocortitoids before 9am?