IMMUNE MODULATOR

They are used to modify the actions

of the immune system.
Problems that may arise
involving the immune system

 Neoplasm occur when mutant cells escape

the normal surveillance of the immune
system and start to grow and multiply.
 Viral invasion of cell- viruses are parasite
only invading the host cell that provide
nourishment necessary for viral replication
 Autoimmune disease when the body
respond to specific self antigens to provide
antibodies or cell mediated immune
response against it own self cell.
 Transplant rejection-it is more of the
foreign cell introduced in the body.
IMMUNE STIMULANT
 Are used to energize the immune
system when it is exhausted from
fighting prolonged invasion or needs
help in fighting a specific pathogen or
cancer cells.
 In doing so they cause flue like
symptoms
IMMUNE SUPPRESSANTS
 Are used to block the normal effects
of the immune system.
 In cases of organ transplantation (in
which non-self-cells are transplanted
into the body and destroyed by the
immune reaction)
 In autoimmune disorder (in which the
body’s defenses recognize self-cells
as foreign and work to destroy them)
Kinds of Immune Stimulants
 Interferon, which are release by human
cells in response to viral invasion
 Interleukins, synthetic compounds that
communicate between lymphocytes, which
stimulates cellular immunity and inhibit
tumor growth.
 T- and B cells modulator called
levamisole (Ergamisol), which restores
immune function and also stimulate
immune system activity.
Therapeutic Actions of
Interferons
 They act to prevent virus particles from
replicating inside other cells.
 They also stimulate interferon receptor
sites on non-invaded cells to produce
antiviral proteins, which prevent virus
from entering the cells.
 It inhibit tumor growth and replication
 Interferon gamma- 1b also acts like
an interleukins, stimulating
phagocyte to be more aggressive
Indications of interferon
 Interferon’s are indicated for treating selected
leukemia’s (alfa-2a, alfa 2b)
 Multiple sclerosis (beta 1a, beta 1b)
 Intra-lesional treatment of warts (alfa-n3, alfa-2b)
 Chronic hepatitis B or chronic hepatitis C (alfa-2b)
 Chronic hepatitis C (alfacon-1,peginteferon)
 Acquired immune deficiency syndrome (AIDS)-
related Kaposi’s sarcoma
 And severe infection cause by granumalotous disease
(gamma-1b)
Pharmacokinetics of interferon
 Generally absorbed after SQ and IM
injection
 Excreted in the kidneys
 They are teratogenic in animals
 Use of barrier contraceptive is advised
for woman in child bearing age.
 It is advise not to be given during
lactation
Contraindication and caution of
interferon
 Presence of allergy to any interferon
or product component
 Pregnancy and lactation
 Caution in patient with cardiac
disease because hypertension and
arrhythmias have been reported with
the use of these drugs.
 These drugs may further suppress
bone marrow
INTERLEUKINS
 They are chemicals secreted by active
leukocytes to influence other leukocytes.
 IL 1 stimulates T and B cells to initiates an
immune response.
 IL 2 is release from active T cells to
stimulate production of more T cells and to
increase the activity of B cells, cytotoxic
cells and natural killer cells.
 Interleukins also cause fever, myalgia,
arthalgia, and slow wave sleep induction all
things that help to conserve energy for use
in fighting off invader
Therapeutic Action of
interleukins
 Natural IL2 is produced by helper T cells to activate
cellular activity and inhibit tumor growth by increasing
lymphocyte numbers and their activity.
 When interleukins are administer,there are increases
in the number of natural killer cells and lymphocytes,
in cytokine activity and in number of circulating
platelets.
 Aldesleukin is indicated for treatment of specific
renal carcinoma and possibly AIDS
 Oprelvekin is indicated for prevention of severe
thrombocytopenia (an abnormal decrease in platelets)
after myelosuppressive chemotheraphy in select
patient.
Pharmacokinetics of
Interleukins
 They are rapidly distributed after
injection
 They where shown to be embryocidal
and teratogenic in animal studies
 Primarily cleared from the body by
the kidneys
Contraindication and caution of
Interleukins
 Contraindicated in the presence of
drug allergy to interleukin or E. coli-
produced products and during
pregnancy and lactation
 Caution should be used with renal,
liver, or cardiovascular impairment
because of the adverse effect of
drugs.
Adverse effects of Interleukins
 The adverse effect can be attributed
to their effect on the body during
inflammation (e.g., lethargy, myalgia,
arthralgia, fatigue, fever), respiratory
difficulties, CNS changes and cardiac
arrhythmias.
T and B-cell Modulator
 The drug levamisole (Ergamisol) is
an immune stimulant that restore
suppressed immune function in
certain situation
Therapeutic Actions and
Indications of levamisole
 Levamisole stimulates B cells, which
in turn stimulate antibody formation,
enhance T cell activity, and increase
the activity of monocytes and
macrophages.
 Levamisole is indicated for treatment
of dukes’ stage C colon cancer after
surgical resection and in conjunction
with fluorouracil therapy.
Pharmacokinetics of Levamisole
 It is absorbed at the GI tract reaching
the peak levels of 1.5 to 2 hours
 It is metabolize in the liver and
excreted in the urine.
 With half life of 16 hours
 It is embryotoxic in animal studies
and should not be used in pregnancy.
 Drugs should not be used in lactation.
Adverse Effects of levamisole
 Flu- like effects: lethargy, myalgia,
arthralgia, fever.
 G I upset, nausea, taste perversions,
and diarrhea; headache, and
depression; bone marrow depression;
dermatitis and hair loss
Clinically important Drug-Drug
Interactions of Levamisole
 This drug should be avoid to be
combine with alcohol (Disulfiram-type
reaction)
 Do not combine with phenytoin. (it
will increase the phenytoin level and
toxicity level)
Nursing Consideration for
patient receiving Immune
stimulants
 Assessment: History and Examination
 Any allergies to any of these drugs or
their components
 Pregnancy or lactation
 Hepatic and renal function
 Cardiac disease
 Bone marrow depression
 CNS disorder, including seizure
Nursing diagnoses
 Acute pain related to CNS, G I upset,
and flu-like effect
 Imbalance in nutrition: less than Body
Requirements related to flu-like effect.
 Anxiety related to diagnosis and drug
therapy
 Deficient Knowledge regarding drug
therapy
Implementation for
administration of immune
stimulants
 Arrange for laboratory test before and periodically during therapy
including CBC and differential count, to monitor for drug effects
and adverse effect.
 Administer drug as indicated; Instruct the patient and a significant
other if injection is required to ensure that the drug will be given
even if the patient is not able to administer it
 Monitor severe reaction and arrange to discontinue drug
immediately if they occur.
 Arrange for supportive care and comport measures
 For flu-like symptoms (e. g., rest, environmental control,
acetaminophen) to help the patient to cope with the drug effect.
 Instruct female patient to use barrier contraceptives to avoid
pregnancy during drug therapy because of the potential for
adverse effect on the fetus.
 Provide drug education
 Offer support and encouragement to deal with the diagnosis and
drug regimen
Evaluation For immune
stimulant administration
 Monitor patient response to the drug
 Monitor for adverse effects
 Evaluate for the effectiveness of the
teaching plan
 Monitor for effectiveness of comport
measures and compliance with the
regimen.
IMMUNE SUPPRESSANTS
 Are used in conjunction with
corticosteroids, which block the
inflammatory reaction and decrease
initial damage to the cells.
 They are especially beneficial in cases
of organ transplantation and in the
treatment of autoimmune diseases
Types of immune suppressants
 T- and B cells suppressors
 Interleukin receptor antagonist
 Monoclonal Antibodies- antibodies
produced by a single clone of B cells that
react with specific antigen.
Focus on Patient Safety in
administration of immune
suppressants
 Patient receiving is immune suppressant are high risk
for infection and cancer.
 They should be warned in situation that may expose
themselelf to infection.
 They should avoid activity that may cause injury
which lead to infection
 They should be educated for protective strategies.
 This includes wearing masks and heavy gloves.
 Delaying vaccinations
 Knowing S/S of infection
 Obtaining regular physical examination and
screenings for diseases of developing neoplasm
T- and B- cells Suppressors
 T-cells- they destroy foreign cells and stimulate
immune and inflammatory reactions.
 T suppressor cells they dampen the immune and
inflammatory response to conserve energy and
prevent cellular damage.
 Lymphokine- are activated killer cells or Natural killer
cells- they are anti-neoplastic and stimulate rapid
cellular death
 B-cells- they recognize specific proteins and produce
antibodies (immunoglobulin)
 Cyclosporine (Sandimmune, Neoral)- used to
suppress rejection in a variety of transplantation
scenarios.
Action of T-and B-Cells
Suppressor
 Reversely inhibits immuno competent
lymphocytes; inhibits T- Helper cells
and T suppressor cells, Lymphokine
production, and release of
interleukin-2 and T-cell growth factor.
Adverse effects of T- and B Cells
suppressors
 Tremors, hypertension, gum
hyperplasia, renal dysfunction,
diarrhea, hirtuism, acne, bone
marrow depression.
 Cyclosporine is embryotoxic in
animals and crosses breast millk.
 Should not be used during pregnancy
and lactation.
T-and B Cells available in the
market
 Neoral- is also used to treat rheumatoid arthritis and psoriasis.
Alefacept- is used to treat adult patient with severe, chronic
psoriasis who are candidates for systemic therapy.
 Azathioprine (imuran)- is used specifically to prevent rejection
in renal homotransplant and to treat rheumatoid arthritis
(autoimmune disorder) in selected patients.
 Glatitramier acetate (Cepaxone) is used specially to reduce
relapses multiple sclerosis. which is thought to be related to
autoimmune reaction.
 Mycophenolate (CellCept) –is an oral drug that is used with
cyclosporine and corticosteroid to prevent organ rejection after
renal, hepatic, or heart transplantation.
 Tacrolimus (Prograf)- is used to prevent liver and renal
transplant rejection and being studied for multiple other transplant
scenarios.
 Sirolimus ( Rapamune)- is used to prevent organ rejection in
patient receiving renal transplants and should be used with
cyclosporine and corticsteriod .
INTERLEUKIN RECEPTOR
ANTAGONIST
 INTERLEUKIN 1- they simulate T- and B
cells to stimulate immune response.
 Anakira (Kineret)- specially antagonizes
interleukin 1 receptors, blocking the activity
of interleukin 1 levels are elevated in
response to inflammation and immune
reactions and are thought to be responsible
for the degradation of cartilage that occur
in rheumatoid arthritis.
Therapeutic Actions and
Indications
 They are used to reduce the S/S of
moderately to severely active
rheumatoid arthritis in patients who
have not responded to the traditional
anti- rheumatic drug.
Pharmacokinetics
 Dosage: 100mg/ day
 Peak level 3 to 7 hours
 Half life 4 to 6 hours
 They cross the placenta and may
enter breast milk
 It is excreted in the urine
Adverse effects
 Headache, sinusitis,nausea,
diarrhea, upper respiratory and
infection
 Injection site reaction
Drug-Drug Interactions
 Should not be given in patient
receiving etaranecept (enbrel)
because of severe infection
Always Remember this
Students, Fellow Nurses:
 The use of immune suppressants may
increase the susceptibility to infection
and increase risk to neoplasm
associated with the use of this drugs.
Patient need to be protected to
infection, injury, and invasive
procedure
SALAMAT PO
 GO IN PEACE