Chapter 32 Vaccines and Immunomodulators

Antigen

Substance, usually a protein fragment, that causes an immune response.

Cold chain

Safe handling practices maintaining vaccines at required temperatures from manufacture to administration.

Conjugate vaccine

Vaccine linking antigens/toxoids to bacterial polysaccharide molecules to bypass protective disguises.

Immunomodulator

Agent that modifies the immune response or functioning of the immune system.

Immunosuppressant

Agent that inhibits rapid increase of immune cells; also called immunopharmacologic agent.

Immunization

Deliberate artificial exposure to disease to produce acquired immunity.

Inactivated killed vaccine

Killed vaccine; provides less immunity than live vaccines but has fewer risks.

Interferons

Antiviral proteins enhancing T-cell recognition (γ) or producing immune suppression (α, β).

Live attenuated vaccine

Nonvirulent, live, weakened invader that does not cause disease in nonimmunocompromised individuals.

Subunit vaccine

Vaccine containing an isolated part of the bacterium or its coating.

Toxoid vaccine

Vaccine stimulating the immune system to produce antibodies to a specific illness-causing toxin.

Vaccine

Substance preventing disease by priming the body to make antibodies and killer cells.

Common ending for monoclonal antibody immunomodulators

-mab

cyclosporine — Clinical Uses

Heart and kidney transplantation prophylaxis.

cyclosporine — Key Warning Labels

Avoid pregnancy; avoid grapefruit juice; do not refrigerate; swallow capsules whole; dilute oral solution.

tacrolimus — Clinical Uses

Heart and kidney transplantation prophylaxis; atopic dermatitis.

tacrolimus — Key Warning Labels

Avoid grapefruit juice; take on an empty stomach.

everolimus — Clinical Use & Warning Labels

Kidney transplant prophylaxis. Avoid pregnancy, grapefruit juice, sunlight, aspirin, acetaminophen, and NSAIDs.

sirolimus — Clinical Use & Warning Labels

Kidney transplant prophylaxis. Avoid pregnancy, grapefruit juice, sunlight; dilute oral solution; refrigerate.

antithymocyte globulin — Clinical Use & Warning Labels

Bone marrow/kidney transplant prophylaxis. Gently rotate (do not shake); refrigerate diluted solution.

intravenous immunoglobulin (IVIG) — Clinical Use & Warning Labels

Primary immunodeficiency. Protect from light; do not freeze.

Rh o immune globulin — Clinical Use & Warning Labels

Rh isoimmunization prophylaxis. Refrigerate; do not freeze; protect from light.

mycophenolate mofetil — Clinical Uses

Heart, kidney, and liver transplant prophylaxis.

mycophenolate mofetil — Key Warning Labels

Shake suspension well; swallow whole; take on empty stomach; store reconstituted suspension at room temp.

Monoclonal Antibodies (golimumab, infliximab, rituximab, tocilizumab) — Mixing Warning

Mix gently; do not shake.

Regen-COV & Evusheld — Storage Warning

Protect from light.

belatacept — Clinical Use & Warning Labels

Kidney transplant prophylaxis. Avoid prolonged sunlight; refrigerate (do not freeze); protect from light.

glatiramer — Clinical Use & Warning Labels

Multiple sclerosis. Refrigerate (do not freeze); protect drug from light.

Tacrolimus vs. Sirolimus (T-cell activation)

Tacrolimus interferes with phase 1 activation; sirolimus interferes with phase 2 activation and proliferation.

T-cell depletion (Antithymocyte globulin)

Persists several days after a single dose; takes approximately 2 months to return to normal.

Mycophenolate mofetil mechanism

A prodrug that inhibits both T-cell and B-cell proliferation.

Intravenous immunoglobulin (IVIG) source and use

Collected from human plasma; treats various infections and chronic lymphatic leukemia.

Rh o (D) immune globulin indication

Administered to Rh-negative pregnant women exposed to Rh-positive blood.

COVID-19 vaccine types

mRNA, plant-based, protein subunit, and viral vector.

Cold chain breach warning signs

Thawed freezer packs or evaporated dry ice in the transport container.

Mpox/smallpox vaccine storage

A live virus vaccine that must be stored frozen.

What happens the first time a body is exposed to a harmful virus or bacterium

The immune system releases macrophages, cytotoxic t-cells, and b-cells

Examples of live, attenuated vaccines

Polio, measles, mumps, rubella

Examples of inactivated, killed vaccines

Flu, hep A, polio

Examples of toxoid vaccines

Tetanus, diptheria

Examples of subunit vaccines

Hep B, HPV

Example of conjugate vaccines

Haemophilus influenzae type B (Hib)

Cold chain temperatures

2 degrees to 8 degrees C

Cyclosporine is produced by

A fungus (Tolypocladium inflatum)

Cyclosporine use

Improve survival rates for organ transplants by suppressing cell destruction in graft-versus-host reactions

Common ending for macrolids

-limus

Tacrolimus is derived from

A fungus (Streptomyces tsukubaensis)

Everolimus and sirolimus use

Prevent transplant rejections

MOA of mycophenolic acid

Inhibits enzyme required for synthesis of purines needed for t-cell and b-cell proliferation

Immunomodulator that provides immediate protection

Intravenous y-immune globulin

MABS indictation

To prolong the life of transplanted organs

Horse immune globin

Atgam

Rabbit immune globulin

Thymoglobuline

Antithymocyte globulin (ATG) use

Reduce rejection associated with organ and bone marrow transplantation

IV gamma immunoglobulin (IVIg) is collected from

Human plasma