immune system drugs

cisplatin

drug therapy to prevent disease

Vaccines, immunity

“If immune is low, leave them alone!”

• ❗ NO live vaccines in immunocompromised

• ❗ Risk of allergic reaction (anaphylaxis)

• ❗ Mild fever = normal, but high fever = concern

• produces antibodies

Vaccines/Immunity

👶Birth-6 years old vaccines

Hep A & B, Rotavirus, DTaP, Hib, PCV, MMR, Polio (IPV), Varicella, Influenza (start at 6 months)

🧒7-18 years old vaccines

T dap booster (11-12 yrs old), HPV (11-12 years old), meningococcal (11-18 years old), influenza (every year), catch up vaccines if missed

🧑🧓adults/older adults vaccines

Influenza (annually), Tetanus/Diphtheria (Td) (every 10 yrs), pneumococcal (65 or older, or high risk), shingles (herpes zoster) (50 yrs or older), other PRN (Hep A/B, MMR, Varicella)

Cancer drugs

Methotrexate, Cyrarabine, Mercaptopurine, Cyclophosphamide, Carmustine, Cisplatin, Doxorubicin, Vincristine, Paclitaxel, Topotecan, Leuprolide, Flutamide, Tamoxifen, Anastrozole, Trastuzumab, Inferferon alfa-2A/2B, Imatinib

“Watch your bones, liver, and lungs!”

• ❗ Bone marrow suppression (MAJOR)

• ❗ Hepatotoxicity

• ❗ Pulmonary toxicity

• ❗ Antidote = Leucovorin rescue

Methotrexate (Folic Acid Analog)

“I wipeout your cells”

• ❗ Bone marrow suppression

• ❗ Neuro toxicity (arachnoiditis)

• ❗ Avoid live vaccines

Cytarabine (Pyrimidine Analog)

“me and allo make a toxic combo”

• ❗ Bone marrow suppression

• ❗ Hepatotoxicity

• ❗ ⚠ TOXIC with allopurinol

Mercaptopurine (Purine Analog)

“I put blood in your urine! 🩸”

• ❗ Bone marrow suppression

• ❗ Hemorrhagic cystitis (BIG one!)

• ❗ Electrolyte imbalance

Cyclophosphamide (Nitrogen Mustard)

“toxicity hits later”

• ❗ Delayed bone marrow suppression (weeks later!)

• ❗ Pulmonary toxicity

• ❗ Severe extravasation damage

• administer central line

Carmustine (Nitrosourea)

“I can’t hear you and I can’t pee 🧏🚫🚽”

• ❗ Nephrotoxicity (kidney killer)

• ❗ Ototoxicity (hearing loss)

• ❗ Peripheral neuropathy

• To minimize adverse effects, hydrate client with 1-2 liters of IV fluid!

Cisplatin (Platinum)

“Watch your heart! (they call me demon👿) 🫀”

• ❗ Cardiotoxicity (BLACK BOX) ❤

• ❗ Bone marrow suppression

• ❗ Red urine (harmless but scary)

Doxorubicin (Anthracycline)

“Very numb, no poop”

• ❗ Peripheral neuropathy (MAJOR)

• ❗ Paralytic ileus (severe constipation)

Vincristine

“allergic attack!!”

• ❗ Bone marrow suppression

• ❗ Severe hypersensitivity reactions

• ❗ Bradycardia

Paclitaxel (Taxane)

“I topple your platelets”

• ❗ Severe bone marrow suppression

• ❗ Bleeding risk

Topotecan (Topoisomerase Inhibitor)

“I level up before going down”

• ❗ Initial tumor flare (worsening symptoms first!)

• ❗ Hormonal effects (hot flashes)

Leuprolide (GnRH Agonist)

“Feminizing + give you liver failure”

• ❗ Hepatotoxicity

• ❗ Gynecomastia

Flutamide (Androgen Blocker)

“I give you clots + cancer in the uterus”

• ❗ Thromboembolism (BIG)

• ❗ Uterine cancer risk

• ❗ Teratogenic

Tamoxifen (Estrogen Blocker)

“I age the bones”

• ❗ Osteoporosis

• ❗ Bone fractures

Anastrozole (Aromatase Inhibitor)

“I trash the heart (sorry!)”

• ❗ Cardiotoxicity (heart failure)

• ❗ Infusion reactions

Trastuzumab (Monoclonal Antibody)

“i have the flu 🤒”

• ❗ Flu-like symptoms (VERY COMMON)

• ❗ Bone marrow suppression

• ❗ Depression/CNS effects

Interferon alfa-2A/2B

“Imma accumulate fluid 💧”

• ❗ Bone marrow suppression

• ❗ Fluid retention (edema)

• ❗ Drug interactions (CYP3A4)

Imatinib (Target Therapy)

HIV Drugs

Enfuvirtide, maraviroc, zidovudine, delavirdine, raltegravir, ritonavir

“If fuse fails = skin freaks out!”

• ❗ Injection site reactions (VERY common)

• ❗ Hypersensitivity

Enfuvirtide (Entry/Fusion Inhibitor)

“I murder the liver 🔪🔪”

• ❗ Hepatotoxicity

• ❗ CNS effects

• ❗ Drug interactions (CYP3A4)

Maraviroc (CCR5 Antagonist)

“Zero blood cells”

• ❗ SEVERE bone marrow suppression

• ❗ Anemia + neutropenia

Zidovudine (NRTI)

“Deadly skin alert! 🚨🚨”

• ❗ Severe rash (SJS)

• ❗ Hepatotoxicity

Delavirdine (NNRTI)

“Remove and log virus levels”

• ❗ CNS effects

• ❗ Monitor viral load (decreases) + CD4 (cell count is high)

Raltegravir (Integrase Inhibitor)

“Redistribution + interactions overload!”

• ❗ Hyperglycemia

• ❗ Fat redistribution (lipodystrophy)

• ❗ HIGH drug interactions

• ❗ Liver toxicity

Ritonavir (Protease Inhibitor)