Pharm Exam 3

Who is RhoGam given to?

An Rh negative mother who has an Rh positive baby

Herd Immunity

The successful immunization of 95% or more of a population confers protection on the entire population

Antibody titer

Measure of the amount of an antibody in the blood needed to react with and neutralize a given volume or amount of a specific antigen

Toxoids

A vaccine made from toxin of the microorganism, no longer poisonous

Antivenin

An antiserum against a venom used to treat humans or other animals that have been envenomed

What are 4 situations when you would give immunoglobin

-Hepatitis A
-Measles
-Before bone marrow transplant
-Pediatric HIV/AIDS pts

Passive immunity

Immunity of an infection occurring by injecting a person with antiserum or concentrated antibodies that directly give the host the means to fight off invading microorganisms

Active immunity

A type of immunization that causes the development of complete and acquried immunity through the exposure of the pathogen

Artificial passive immunity

Immunoglobins or drugs containing antibodies/antitoxins that can kill or inactivate pathogens by binding to the associated antigens

Natural passive immunity

acquired by a child through placenta and breast milk

Artificial active immunity

vaccines

Natural active immunity

production of one's own antibodies or T cells as a result of infection or natural exposure to antigen

Vaccines

Suspension of live, attenuated, or killed microorganisms that can promote an artificially induced active immunity against a particular microorganism

Immunization

The induction of immunity by administration of a vaccine or toxoid or antiserum

Immune response

A cascade of biochemical events that occur in response to entry of an antigen in the body

When does serum sickness occur?

After repeated injections of equine (horse) derived immunizing drugs

S/S of serum sickness

Edema of the face
Rash
Urticaria
Cyanosis
Pain

What is the vaccine location for infants and young children

Vastus lateralis

What degree of fever should be treated after an immunization?

Fever higher than 103

What can a fever be treated with

Acetaminophen and sponge bath

What are three common side effects of immunizations

Low grade fever
Soreness at the injection site
Minor rash
Itching (urticaria)

Contraindications for vaccines (4)

-Allergy to the immunization or egg or yeast
-Febrile illness
-Immunocompromised
-Cancer pts who had chemotherapy

What is given for an anaphylactic reaction?

Epinephrine

When is the flu vaccine given and to who?

In the fall and should be given to everybody

Pneumoccal vaccine

Given to adults who are 65 years or older and those who smoke and are 19-64

Pneumoccal vaccine contrainindications

Allergy to latex

Zostavax vaccine

shingles vaccine
- recommended for people over age 50

Zostavax contraindications

Neomycin
Gelatin
Immunosuppressed patients
Children
Pregnant women

Where should you store zostavax

In the freezer

How often do you get the Tdap booster

Every 10 years

What is the vaccine for HPV (genital warts)

Gardasil

Gardasil age recommendations

All girls and boys 11 to 12 yrs of age and can be given to adult men and women up to 45 yrs of age

Gardasil dose recommendations

3 injections
-1st injection and then 2 more doses 2 months and 6 months later

Gardasil contraindications

yeast allergy
pregnancy
children younger than 9

What are 2 biological weapons

Anthrax
Small pox

What should be done prior to getting a vaccine if needed

Take pain meds before

What can be done if patient experiences discomfort at the injection site

-Apply a warm compress
-Rest arm
-Administer analgesic or anti-inflammatory med as ordered

Hepatitis B virus vaccine dosage

Series of 3 injections (pediatric, adult, dialysis formula)

Hepatitis B virus vaccine contraindications

Yeast allergy

Vaccines that are Pregnancy category B or C

Tdap
Hepatitis B
Influenza
Meningococcal
Pneumococcal

Measles, mumps, rubella contraindication

Egg allergy
Neomycin
Pregnancy

How long should pregnancy be avoided after getting the MMR vaccine

For 3 months

What vaccines should pregnant women not get

MMR
HPV
Gardasil (papillomavirus)
Herpes zoster

Meningococcal vaccine dosage

1 time dose
-patients 9-55 years old
-patients 11-55 years old

Rabies vaccine dosage

5 injections on day 0, 3, 7, 14, 28

Rabies shot contraindications

Allergy to neomycin, gentamicin, amphotericin B

Varicella vaccine recommendations

1st dose 12-15 months of age
Second dose 4-6 years old

Varicella contraindications

Immunodeficient patients
Patients who are taking high doses of systemic steroids

Immnunoglobin dosage type

As either an intramuscular or intravenous form

What does an immunoglobin provide

Passive immunity by increasing antibody titer and antigen-antibody reaction potential. Help prevent certain infectious diseases in susceptible persons or ameliorate the disease in those already infected

Passive immunizing drugs may precipitate what

Serum sickness

When giving active immunizing drugs the nurse should tell the patient about what

Contrainindications
Cautions
Drug interactions

Immune Modulators

Groups of drugs given to modify the actions of the immune system

Immune-mediated diseases

A large group of diseases that results when the cells of the immune system react to a variety of situations such as transplanted organ tissue or drug-altered cells

Autoimmune disease

caused by a disorder in the immune system in which the system attacks itself producing a disease

Immunosuppressants

Block the normal effects of the immune system to prevent organ transplant rejection or prevent tissue damage from autoimmune disorders

Immune stimulant

Boost the immune system to energize or help fight pathogen or cancer cells

What does the immune system participate in

Hypersensitivity
Anaphylactic reactions
Rejection of kidney, liver and heart transplants

How long do transplant patients have to take immunosuppressants

For life

Side effects of immune suppressants

-Increased risk for opportunistic infections
-GI upset
-Anemia (decrease in RBCs)
-Throgmbocytopenia (decreased platelets)
-Cancer

Cyclosporin (Sandimmune) use

Inhibits activation of T-cells by blocking the production and release of the cytokine mediator IL-2. Prevention of organ rejection

Cyclosporin forms

Oral or IV piggyback form

What should cyclosporine be taken with

Chocolate milk

Cyclosporin side effect

Headaches
Tremors

Orthoclone use

Prevents and reverses organ transplant

Orthoclone is taken from what

Mice

Orthoclone dose routes

Subcutaneous and parenteral injection

Orthoclone has more what

Allergies because its animal based

Immune suppressants

Pregnancy
Lactation
Renal/Hepatic disease
History of neoplasms (cancer)

Immune suppressants nursing diagnosis

Risk for infection r/t immune supression

Lab tests for immune supressants

CBC
Liver and renal function tests

How to protect patients from infection, injury, invasive procedures

Aseptic/sterile technique
Hand hygiene
Limit visitors
No fresh flowers
Only fruit you can peel
No pets, masks in public
Avoid travel/busy places

Following immune therapy what should nurses tell females

Use barrier contraceptives for up to 12 weeks following therapy

What should not be taken with immune suppressants

Grapefruit juice

Effect of grapefruit juice on cyclosporin

Will increase blood concentrations

Photophobia teaching with immune suppressants

Sunscreens/protective clothing

Why are anti-fungals given to pts taking immune suppressants

Prevent oral candidiasis

What is CSF

colony stimulating factor

What do immune stimulants do

Promote production of blood components by increasing growth, differention (maturity) and the function of bone marrow

What are immune stimulants used for

Help the pt stay on cancer regimen but does not treat cancer

Patients are at a risk of what due to chemotherapy

Increased incidence of anemia, neutropenia, and thrombocytopenia

Epoetin (procrit)

Synthetic derivative of the hormone erythropoietin

What route is procrit given

Given by injection

Low hemoglobin levels

Male: Less than 13
Female: Less than 12

Normal WBC

5,000-10,000

What does epoetin do

Stimulates RBCs and treats anemia associated with cancer treatment and bone marrow supression

Filgrastin (Neupogen)

Increased production of neutrophils and the type of WBCs known as granulocytes

What route is fligrastin (neupogen) given

IV/Subcut

Who does fligrastin treat

Neutropenia

When should fligrastin not be given

Do not give within 24 hours of chemo

Interferon

Naturally released from cells in response to viral invasion

Interferons prevent

Viral replication and prevents them from entering the cell

Interferons inhibit

Tumor growth

Interferons enhance

The activity of the macrophages and natural killer cells

Interferons treat

Hematology cancers and warts

Interferon route

Injection (Subcut, IM, or IV)

Interferons that are given subcut should be

Rotating sites

Interferon side effects

flu like symptoms, fatigue, fever, chills, malaise

Interferon interactions

May increase theophylline levels
Additive myelosuppression with antineoplastics
Zidovudine increase hematologic toxicity

Interleukins

An anti-tumor that causes t-cells to multiply resulting in lymphokine activated killer cells