Unit 11: Medications Affecting the Immune System

How does active immunity differ from passive immunity in terms of duration?

Active immunity is long-lasting, whereas passive immunity is temporary because the body does not independently develop antibodies.

Which type of immunity is acquired when antibodies are passed from a parent to a newborn via colostrum and breast milk?

Passive-natural immunity.

What type of immunity is provided when an individual receives immune globulins following exposure to rabies or a poisonous snake bite?

Passive-artificial immunity.

At what age should the first dose of the Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP) be administered to an infant?

2 months.

What is the recommended timing for the Tetanus and diphtheria (Td) booster after the initial Tdap dose?

One dose every 10 years.

Under what condition can the 6-month dose of the Haemophilus influenzae type B (Hib) vaccine be omitted?

If PedvaxHIB or Comvax was used for the first two doses.

What is the maximum age for initiating the first dose of the Rotavirus (RV) oral vaccine series?

14 weeks, 6 days.

What is the maximum age for the final dose of the Rotavirus (RV) vaccine series?

8 months, 0 days.

At what age should a child receive their first dose of the Measles, mumps, and rubella (MMR) vaccine?

12 to 15 months.

What is the minimum interval required between the two doses of the Varicella vaccine if administered after age 13 years?

4 weeks.

Why is the Pneumovax 23 vaccine not administered to children under the age of 2 years?

It is ineffective for children in that age group.

Within what time frame after birth should the first dose of the Hepatitis B vaccine be administered?

Within 12 to 24 hours.

What is the minimum age for a child to receive the live-attenuated influenza vaccine (LAIV) nasal spray?

2 years.

At what age should a child receive the first dose of the Meningococcal conjugate vaccine (MenACWY)?

11 to 12 years.

What is the recommended age range for the initial dose of the 9-valent human papillomavirus (9vHPV) vaccine?

11 to 12 years (can be given as early as 9 years).

If a patient starts the HPV vaccine series at age 16, how many total doses are required?

Three doses (0, 1-2 months, and 6 months).

A client born before _____ is generally considered immune to measles and mumps and may not require the MMR vaccine.

1957

Which two vaccines are explicitly contraindicated for administration during pregnancy due to being live virus vaccines?

MMR and Varicella.

An anaphylactic-like reaction to gelatin or neomycin is a contraindication for which vaccine?

MMR (or Varicella).

For an adult age 65 or older with an unknown vaccination history, which pneumococcal vaccine should be administered first?

PCV15 or PCV20.

Which form of the seasonal influenza vaccine is approved for pregnant clients?

Inactivated influenza vaccine (IIV).

The Zoster vaccine is recommended as a two-dose series for all adults starting at what age?

50 years.

What temperature finding is considered a 'moderate' adverse effect of the DTaP vaccine?

$40.6^\circ\text{C}$ ($105^\circ\text{F}$) or greater.

A history of _____ is a specific contraindication for receiving the Rotavirus (RV) vaccine.

Intussusception

A nurse should instruct guardians to avoid giving _____ to children to treat fever following a live virus vaccine to prevent Reye syndrome.

Aspirin

What is the appropriate injection site for intramuscular (IM) immunizations in infants and young children?

Vastus lateralis or ventrogluteal muscle.

Which allergy serves as a specific contraindication for the Hepatitis B vaccine?

Anaphylactic allergy to yeast.

A nurse is preparing to give a 5-year-old the IPV vaccine; what route should be used?

Subcutaneous.

Which allergy is a contraindication for the HPV vaccine?

Severe allergy to yeast.

What is the primary rationale for using combination chemotherapy instead of monotherapy?

To reduce medication resistance, increase effectiveness, and reduce toxic effects to healthy cells by attacking different cell cycle phases.

Which specific tissues are most commonly affected by the toxicity of cytotoxic chemotherapy agents?

Fast-growing cells including skin, hair, intestinal mucosa, and hematopoietic cells.

What is the first nursing action required if extravasation of a vesicant chemotherapy agent is suspected?

Stop the infusion immediately.

Methotrexate kills cancer cells by interrupting which specific phase of cell reproduction?

S-phase (it is a folic acid analog).

Which medication is administered as a 'rescue' agent to reduce toxicity to healthy cells in clients receiving high-dose methotrexate?

Leucovorin.

A client on methotrexate reports mouth sores; what specific nursing intervention should be implemented?

Provide frequent oral hygiene using soft toothbrushes and avoid alcohol-based mouthwashes.

What is the recommended daily fluid intake for a client receiving methotrexate to prevent renal damage?

2 to 3 liters per day.

What syndrome, characterized by fever, myalgia, and malaise, can occur within 6 to 12 hours after Cytarabine administration?

Cytarabine syndrome.

Which medication's absorption is reduced when administered concurrently with Cytarabine?

Digoxin.

Clients taking Mercaptopurine should be monitored closely for which specific organ toxicity?

Liver toxicity (hepatotoxicity).

What is the 'lifetime cumulative dose' limit for Doxorubicin to prevent permanent cardiac damage?

$550\text{ mg/m}^2$.

A client receiving Doxorubicin notes that their sweat and urine have turned red; what should the nurse tell them?

This is a harmless, expected effect of the medication.

Which non-anthracycline antitumor antibiotic is specifically associated with the risk of pulmonary fibrosis?

Bleomycin.

Vincristine is unique among many cytotoxic agents because it is NOT toxic to which physiological system?

Bone marrow (it is not bone marrow toxic).

What is the most significant dose-limiting toxicity associated with Vincristine?

Peripheral neuropathy (nerve injury).

A nurse should monitor for which cardiac adverse effect during the administration of Paclitaxel?

Bradycardia (or heart block/hypotension).

What is the purpose of administering Mesna to a client receiving Cyclophosphamide?

It is a uroprotectant that detoxifies metabolites to reduce the risk of hemorrhagic cystitis.

Which alkylating agent is especially useful for treating brain tumors because it crosses the blood-brain barrier?

Carmustine (a nitrosourea).

A client receiving Cisplatin should have which sensory function assessed regularly?

Hearing (due to the risk of ototoxicity and tinnitus).

Topotecan interrupts DNA synthesis during which specific cell cycle phase?

S-phase.

Which chemotherapy agent can cause fatal anaphylaxis and may require a test dose before the full dose is given?

Asparaginase.

A client taking Procarbazine must avoid which type of food to prevent a hypertensive crisis?

Foods containing tyramine.

What is the mechanism of action for Leuprolide in the treatment of prostate cancer?

It is a GnRH agonist that prevents the release of luteinizing hormone, thereby stopping testosterone production.

What is a 'disease flare' in a client starting Leuprolide, and how is it prevented?

A temporary worsening of prostate cancer manifestations prevented by adding an androgen receptor blocker (like Flutamide).

A client taking Leuprolide should be instructed to increase the intake of which two nutrients?

Calcium and Vitamin D.

Tamoxifen is used to treat breast cancers that are _____.

Estrogen-dependent

What serious adverse effect of Tamoxifen involves the overgrowth of the uterine lining?

Endometrial cancer.

Beyond cancer, what major risk does Tamoxifen increase for the vascular system?

Thromboembolic events (DVT, PE, stroke).

Anastrozole is specifically used for breast cancer in which patient population?

Postmenopausal clients.

Trastuzumab is only effective against breast cancer tumors that have which specific genetic marker?

HER2-positive.

What is the most common adverse effect of Interferon alfa-2b therapy?

Flu-like manifestations (fever, fatigue, headache, chills).

A nurse should monitor a client on Interferon alfa-2b for which serious psychological complication?

Depression or suicidal thoughts.

Which targeted antineoplastic agent is an angiogenesis inhibitor that deprives solid tumors of blood supply?

Bevacizumab.

A client receiving Rituximab is at risk for which metabolic complication caused by rapid cancer cell death?

Tumor lysis syndrome.

What are the three components of the 'triple threat' in tumor lysis syndrome that can lead to kidney failure?

Hyperkalemia, hypocalcemia, and hyperuricemia.

Which medication should be withheld for 12 hours prior to a Rituximab infusion to prevent severe hypotension?

Antihypertensive medications.

A nurse should instruct a client taking Imatinib to take the medication with _____ to minimize GI upset.

Food

What should a client do if they experience shortness of breath while taking Bevacizumab?

Notify the provider immediately (risk of pulmonary emboli or thromboembolism).

Which chemotherapy agent can cause a disulfiram-type reaction if alcohol is consumed?

Procarbazine.

Safe handling of chemotherapy includes following institutional procedures for spills; for a large spill, which organization should be contacted?

Occupational Safety and Health Administration (OSHA).

For a client on cyclophosphamide, the nurse should monitor the urine specifically for the presence of _____.

Blood (hematuria)

Which noncytotoxic medication is associated with 'flu-like manifestations' in 40% of clients after the first infusion?

Trastuzumab.

A client receiving cetuximab should be instructed to limit _____ to prevent increased skin toxicity.

Sun exposure

What is the purpose of performing bone density testing for a client on Leuprolide?

The medication causes decreased bone density, increasing the risk for fractures.

Which vaccine is contraindicated if the infant weighs less than $2\text{ kg}$?

Hepatitis B (precaution).

If a child has a history of thrombocytopenia, which vaccine requires extra precaution?

MMR.

In the context of immunity, what is 'Active-artificial' immunity?

Immunity developed when a vaccine is administered and the body produces its own antibodies.

What finding in a client receiving hydroxyurea would require the nurse to withhold the medication?

WBC count less than $2,500/\text{mm}^3$ or platelet count less than $100,000/\text{mm}^3$.