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Chapter 4
Immunologic Drugs and
Vaccines
© Paradigm Publishing, Inc.
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Chapter 4
Topics
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Physiology of Acquired Immunity
Immunization
Interferon Therapy
Immunosuppression
Immunoglobulins, Antitoxins, and Antivenoms
Herbal and Alternative Therapies
© Paradigm Publishing, Inc.
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Physiology of Acquired Immunity
Acquired Immune
Response
• Body’s built-in defense
mechanism against
pathogens
• Systemic response
Pathogens are carried
to the lymph nodes
Lymphocytes then
detect and destroy
pathogens
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Physiology of Acquired Immunity
Acquired Immunity
• Helper T cells
Detect specific antigens (molecules on foreign
pathogens)
Stimulate killer T cells and B cells to become active
• Killer T cells attack cells infected with foreign antigens
• B cells make antibodies or immunoglobulins (Ig)
• Immunoglobulins fight infection by binding viruses and
preventing them from infecting healthy cells
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Physiology of Acquired Immunity
Immunoglobulins (Ig)
IgA
In mucous membranes of digestive system and respiratory
tract, tears, sweat, and saliva
IgD
In plasma and on surface of lymphocytes; possibly involved in B
cell maturation
IgG
Most common antibody; small amounts produced after first
exposure to pathogen, large amounts produced subsequently
IgE
In basophils and mast cells; mounts allergic response; fights
parasites
IgM
First antibody produced after exposure to pathogen; activates
complement system; on surface of red blood cells; responsible
for A, B, and O blood typing
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Physiology of Acquired Immunity
Autoimmune Disorders
• The immune system can malfunction and begin producing
antibodies against normal, healthy cells
• Examples: SLE, myasthenia gravis, rheumatoid arthritis,
MS, and type 1 diabetes
Each disorder affects specific tissues, depending on the
type of antibodies produced and the cells they attack
Type 1 diabetes is caused by an autoimmune process
that destroys beta cells that produce insulin in the
pancreas
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Physiology of Acquired Immunity
Allergic Reactions
• Immune system mediates allergic reactions; also called
hypersensitivity reactions
• Four types of hypersensitivity reactions (Type I, II, III, IV)
• Type I reactions cause anaphylaxis; can be life threatening
if not treated immediately
Anaphylaxis: process mediated by antibodies,
basophils, and mast cells
Causes swelling of airways, blood vessel dilation, shock
• Type II reactions stimulate the complement system; occur
when the wrong type of blood is given to a patient
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Physiology of Acquired Immunity
Allergic Reactions (continued)
• Type III reactions involve toxins and antibodies
• Type IV reactions involve killer T cells
Also called delayed responses; take 12–72 hours to
occur
Example: tuberculin skin test for tuberculosis
When drugs cause Type IV reactions, hives or itchy rash
occur
Not harmful if drug is stopped
Can progress to anaphylaxis if drug is continued
© Paradigm Publishing, Inc.
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Immunization
Immunization
• Uses acquired immunity to fight specific diseases
• Natural immunization occurs when the body is exposed to
foreign antigens in daily life
Produces antibodies against foreign antigens
Can quickly defend and protect from getting sick again
• Artificial immunization occurs when an antigen is
intentionally introduced to the body via vaccination
Builds a defense in advance of disease exposure
Can be accomplished through active or passive means
© Paradigm Publishing, Inc.
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Immunization
Two Types of Artificial Immunization
• Active immunity
The body is exposed to an antigen or part of an antigen;
natural immune response makes antibodies
Vaccines use active immunity to prevent disease; body
introduced to killed, weakened, or partial antigens
Some vaccines (called live attenuated vaccines) use live,
weakened pathogens to produce an immune response
• Passive immunity
Antibodies introduced into bloodstream naturally
(pregnancy) or artificially (injecting immunoglobulins)
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Immunization
Vaccination
• Used to reduce and prevent life-threatening diseases
Polio, smallpox, measles, and influenza
• Several vaccines require multiple doses
• CDC publishes an Immunization Schedule for Adults (see
Figure 4.2)
• Healthcare professionals should be informed of
immunization schedules and stay current
Recommended: hepatitis B and annual influenza shot
BCG vaccine for tuberculosis may be required
© Paradigm Publishing, Inc.
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Immunization
Common Vaccines
• Most administered in physician’s office and inpatient
settings
Vaccines Commonly Handled by Pharmacy Technicians
(see Table 4.2)
• More now administered in pharmacies: flu shots, travel
vaccines, pneumonia, and shingles
• Many pharmacies operate travel immunization clinics
Common travel vaccines: hepatitis A, cholera, malaria
• Vaccines are fragile proteins
Routes: usually injection; few in oral form
• Pharmacy technicians order, store, and prepare vaccines
© Paradigm Publishing, Inc.
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Immunization
Common Vaccines (continued)
• Many patients
now get their
annual flu shots
at their local
pharmacies
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Immunization
Common Vaccines (continued)
• Side Effects: fever, headache, stomach upset, local
injection site irritation, mild rash, and irritability
Take acetaminophen 24–48 hours after immunization
to reduce symptoms
• No link between autism and preservatives in vaccines
• Cautions (prior to administration of vaccines):
Patients receive written risk information; see VIS
Patients sign consent form
No vaccine for patients with egg allergy
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Immunization
Common Vaccines (continued)
• Cautions: storage and preparation unique for each vaccine
Refrigerate or freeze most
Check for required temperature range
Warm frozen vaccines to room temperature; then use
right away
Take daily temperatures of refrigerators and freezers
Use prepared vaccines within minutes to hours
Do not prepare multiple doses
© Paradigm Publishing, Inc.
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Your Turn
Question 1: Many employers require pharmacy technicians to
get the BCG vaccine. What is the purpose of this vaccine?
Answer: The BCG vaccine immunizes healthcare workers who
have high risk of exposure to active tuberculosis.
Question 2: A traveler received a vaccine for cholera. During his
trip, the patient became ill with cholera. What may have caused
this to happen?
Answer: The patient may not have waited long enough to
allow the immune system to provide full immunity.
© Paradigm Publishing, Inc.
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Interferon Therapy
Interferons
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•
Used for variety of conditions, including MS and hepatitis
Costly; usually dispensed in specialty pharmacies
Protein products that degrade easily
Store in the refrigerator
Administration: inject when at room
temperature
Slowly roll the product between
palms of hands to warm it
© Paradigm Publishing, Inc.
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Interferon Therapy
Multiple Sclerosis (MS)
• Autoimmune disorder; antibodies destroy myelin sheath
surrounding nerve cells
Scars form, interfering with signal conduction of nerves
Numbness in limbs, loss of nerve axons and white
matter in the brain, vision loss, and paralysis
Relapsing-remitting MS is the most common type
Drugs for MS
• Interferons prevent progression and relapse
• No flu shot with interferon therapy
© Paradigm Publishing, Inc.
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Interferon Therapy
Hepatitis
• Inflammation of the liver caused by viral disease, alcohol
use, medications, poisons, or autoimmune diseases
• Hepatitis A transmitted by consuming contaminated food
or liquids; short-term, acute infection only
• Hepatitis B transmitted by sexual activity, contaminated
needles, infected blood products, or mother to infant
Begins as acute infection that mimics flu-like symptoms
or is asymptomatic
Can lead to chronic liver infection such as cirrhosis, liver
cancer, and liver failure
© Paradigm Publishing, Inc.
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Interferon Therapy
Hepatitis (continued)
• Hepatitis C transmitted by blood-to-blood contact
High-risk populations include injection drug users,
homeless, and prison inmates
Most patients develop chronic liver infection
Drugs for Hepatitis
• No treatment required for hepatitis A
• Vaccines prevent hepatitis A and B; healthcare workers
receive three-injection series for hepatitis B
• Interferons used for chronic infection in hepatitis B and C
© Paradigm Publishing, Inc.
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Immunosuppression
Organ Transplant
• When someone receives an organ transplant
T cells detect and attack the foreign tissue
B cells make antibodies against it
The body will reject the implanted organ unless
immunosuppression starts right away
• Tissue typing is performed to match organ donation
Reduces chance of organ rejection, but risk remains
• Graft versus host disease is when T cells in transplanted
organ attack the recipient’s body after transplant
© Paradigm Publishing, Inc.
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Immunosuppression
Immunosuppressants
• Medications that suppress immune system activity to
prevent rejection of a transplanted organ
• Indications: taken for life after receiving a transplant
Also suppress autoimmune disorders such as
rheumatoid arthritis, SLE, and psoriasis
• Mechanism of Action: inhibit T cell and B cell activity
• Side Effects: sore throat, cough,
dizziness, nausea, muscle aches,
fever, chills, itching, and headache
© Paradigm Publishing, Inc.
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Immunosuppression
Immunosuppressants (continued)
• Serious Side Effects (rare): heart rhythm or blood pressure
changes, chest pain, unusual bleeding, bruising, anemia,
and hyperlipidemia
Muromonab can cause severe pulmonary edema (fluid
accumulation in the lungs) on first dose
• Cautions: patients must minimize exposure to infection
due to higher risk
• Routes: IV; also oral, IM injections, and SC injections
IV dosage forms require special handling and mixing
© Paradigm Publishing, Inc.
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Immunosuppression
Immunosuppressants (continued)
• Some IVs refrigerated; some protected from light
• Do not shake IVs; use within limited time from mixing
Cyclosporine should be prepared in glass containers
• Special administration instructions
Oral tacrolimus should not be taken with antacids
Sirolimus can be taken with or without food consistently
Some agents given as IV infusions; some given as IV
bolus injections
• Some agents have serious drug interactions
© Paradigm Publishing, Inc.
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Immunosuppression
Oral Corticosteroids
• Systemic oral agents with anti-inflammatory and
immunosuppressant properties; decrease fever, redness,
and swelling
• Modify immune response by slowing leukocyte function
• Indications (short term, high doses): hypersensitivity,
allergic reaction, and asthma exacerbations
• Indications (long term): protection from organ transplant
rejection and used for treatment of rheumatic and some
autoimmune disorders
• Side Effects: headache, dizziness, insomnia, and hunger
© Paradigm Publishing, Inc.
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Immunosuppression
Oral Corticosteroids (continued)
• Side Effects (long-term): change in normal metabolism,
facial swelling (moon face), major weight gain, fluid
retention, and fat redistribution to back and shoulders
(buffalo hump)
• Severe Side Effects: high blood pressure, loss of bone mass
(osteoporosis), electrolyte imbalance, cataracts, glaucoma,
insulin resistance (diabetes), and steroid-induced psychosis
• Routes: all oral; some IM and IV
• Cautions: do not stop using abruptly;
causes increased risk of infection
Can stunt growth in children if used long term
© Paradigm Publishing, Inc.
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Immunoglobulins, Antitoxins, and Antivenoms
Immunoglobulins
• Provide artificial passive immunity quickly through injected
exogenous antibodies
Immunity only lasts a few months; no boosters required
• Indications: rabies, tetanus, chickenpox, shingles, and RSV
Antitoxins and Antivenoms
• Antibodies in agents combine with the toxin or venom to
neutralize it
Example: Rh factor immune globulin used for negativeblood-type woman carrying a positive-blood-type
child
© Paradigm Publishing, Inc.
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Immunoglobulins, Antitoxins, and Antivenoms
Antivenoms (continued)
• Also called antivenins
• Indications: spider bites (black widow spiders); snakebites
(rattlesnakes, copperheads, and North American coral
snakes)
• Route: most by IV within 4 hours of the bite
• Prepare orders immediately and rush to ER for
administration
Warm refrigerated agents by gently
rolling vials between the palms of the
hands
© Paradigm Publishing, Inc.
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Your Turn
Question 1: What is the purpose for storing interferons in the
refrigerator?
Answer: Interferons are fragile proteins that easily degrade.
Refrigerating these agents helps keep the proteins from
breaking down.
Question 2: A patient is at a county fair. She is wearing a face
mask and often uses a hand sanitizer. What is the likely reason
for her precautions?
Answer: The patient is likely being treated with
immunosuppressants and is at increased risk of infection.
© Paradigm Publishing, Inc.
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Herbal and Alternative Therapies
• Limited herbal and alternative therapies available for
autoimmune disorders, hepatitis, or immunosuppression
• Vitamin D supplementation may help decrease risk of MS
in women; no recommended dose
© Paradigm Publishing, Inc.
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Summary
• Immunization uses acquired immunity to protect against
specific diseases
• Vaccinations trigger production of antibodies to protect
against specific diseases
• Interferon therapy is used to treat autoimmune disorders
• Immunosuppressants inhibit the immune system from
attacking transplanted tissue after organ transplant
• Immunoglobulins in antitoxins and antivenoms provide
rapid immunity for specific diseases
© Paradigm Publishing, Inc.
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