PHARMACOLOGY

PART 3 Drugs Acting on the Immune System

1. Introduction to the Immune Response and Inflammation

 The body has several defense mechanisms in place to protect it from injury or foreign invasion: the
skin, mucous membranes, normal flora, gastric acid, and the inflammatory and immune responses.
 The inflammatory response is a general response to any cell injury and involves activation of
Hageman factor to stimulate the kinin system and release of histamine from injured cells to
generate local inflammatory responses.
 The clinical presentation of an inflammatory reaction is heat (calor), redness (rubor), swelling
(tumor), and pain (dolor).
 The inflammatory response is a nonspecific reaction to any cellular injury and involves the
activation of various chemicals and neutrophil activity. The immune response is specific to an
antigen or protein that has entered the body and involves B cells, antibodies, and T cells.
 Several types of T cells exist: effector or cytotoxic T cells, helper T cells, and suppressor T cells.
Effector or cytotoxic T cells immediately destroy foreign cells. Helper T cells stimulate the immune
and inflammatory reactions. Suppressor T cells dampen the immune and inflammatory responses to
conserve energy and prevent cellular damage.
 B cells are programmed to recognize specific proteins or foreign antigens. Once in contact with that
protein, the B cell produces antibodies (immunoglobulins) that react directly with the protein.
 Reaction of an antibody with the specific receptor site on the protein activates the complement
cascade of proteins and lyses the associated protein or precipitates an aggressive inflammatory
reaction around it.
 Other chemicals are involved in communication among parts of the immune system and in local
response to invasion. Any of these chemicals has the potential to alter the immune response.
 The T cells, B cells, and inflammatory reaction work together to protect the body from invasion, limit
the response to that invasion, and return the body to a state of homeostasis.
 Patient problems that occur within the immune system include the development of neoplasms, viral
invasions of cells that trigger immune responses, autoimmune diseases, and rejections of
transplanted organs.
 2. Anti-Inflammatory, Antiarthritis, and Related Agents

 The inflammatory response, which is important for protecting the body from injury and invasion,
produces many of the signs and symptoms associated with disease, including fever, aches and pains,
and lethargy.
 Chronic or excessive activity by the inflammatory response can lead to the release of lysosomal
enzymes and tissue destruction.
 Anti-inflammatory drugs block various chemicals associated with the inflammatory reaction. Anti-
inflammatory drugs also may have antipyretic (fever blocking) and analgesic (pain-blocking)
activities.
 Salicylates block prostaglandin activity. NSAIDs block prostaglandin synthesis. Acetaminophen
causes vasodilation and heat release, lowering fever and working to relieve pain. Gold salts prevent
macrophage phagocytosis, lysosomal release, and tissue damage. DMARDs alter the course of the
inflammatory process and treats arthritis by aggressively affecting the process of inflammation.
 Salicylates can cause acidosis and eighth cranial nerve damage. NSAIDs are most associated with GI
irritation and bleeding. Acetaminophen can cause serious liver toxicity. The gold salts cause many
systemic inflammatory reactions. Other anti-arthritis drugs are associated with local injection-site
irritation and increased susceptibility to infection; leflunomide is associated with severe hepatic
toxicity.
 Many anti-inflammatory drugs are available OTC, and care must be taken to prevent abuse or
overuse of these drugs.
 3. Immune Modulators

 Immune stimulants boost the immune system when it is exhausted from fighting off prolonged
invasion or needs help to fight a specific pathogen or cancer cell. They include interferons and
interleukins.
 Interferons are naturally released from cells in response to viral invasion; they are used to treat
various cancers and warts.
 Interleukins stimulate cellular immunity and inhibit tumor growth; they are used to treat very
specific cancers.
 Adverse effects seen with immune stimulants are related to the immune response (flu-like
symptoms, including fever, myalgia, lethargy, arthralgia, and fatigue).
 Immune suppressants are used to depress the immune system when needed to prevent transplant
rejection or severe tissue damage associated with autoimmune disease. Research is ongoing to
extend the use of various immune suppressants to other situations, including various autoimmune
disorders.
 Increased susceptibility to infection and increased risk of neoplasm are potentially dangerous effects
associated with the use of immune suppressants. Patients need to be protected from infection,
injury, and invasive procedures.
 4. Vaccines and Sera

 Immunity (relative resistance to a disease) may be active or passive. Active immunity results from
the body making antibodies against specific proteins for immediate release if that protein reenters
the body. Passive immunity results from preformed antibodies to a specific protein, which offers
protection against the protein only for the life of the circulating antibodies.
 Immunizations are given to stimulate active immunity in a person who is at high risk for exposure to
specific diseases. Immunizations are a standard part of preventive medicine.
 Vaccines can be made from chemically inactivated microorganisms or from live, weakened viruses
or bacteria. Toxoids are vaccines that are made from the toxins produced by the microorganism that
are altered so that they are no longer poisonous but still have the recognizable protein antigen that
will stimulate antibody production.
 Immune sera provide preformed antibodies to specific proteins for people who have been exposed
to them or are at high risk for exposure.
 The term immune sera typically refers to sera that contain antibodies to specific bacteria or viruses.
Antitoxins are immune sera that have antibodies to very specific toxins that might be released by
invading pathogens. Antivenins are immune sera that have antibodies to venom that might be
injected through spider or snake bites.
 Serum sickness—a massive immune reaction— occurs more frequently with immune sera than with
vaccines. Patients need to be monitored for any history of hypersensitivity reactions, and
emergency equipment should be available.
 Patients should be advised to keep a written record of all immunizations or immune sera used.
Booster doses for various vaccines may be needed to further stimulate antibody production.
Reference:
Karch, A. M. (2013). Focus on nursing pharmacology. Sixth edition. Philadelphia: Wolters Kluwer.