Drugs acting

on the
immune
system
zcmiraflores,rn,mn

Anatomy of the Immune

System
Lymphatic

system consist of
containing lymphoid tissues,
lymph, and a network of
lymphatic vessels

Lymph

tissues - found in the

lymph nodes, spleen, thymus
gland,
tonsils, adenoids,
appendix and intestinal
payers patches

Physiology
Lymphatic

system

LYMPH

carries foreign substances that

enter tissue fluids to lymph nodes, where
lymphocytes acts on them

Lymphocytes

are WBC that develop from

stem cells in bone marrow and
differentiate into lymphocyte precursor
cells (B cells or T helper cells)

Immunity refers to mechanisms that

protect the body against microorganisms
and other
potentially harmful
substances
2 types:
1. NONSPECIFIC RESISTANCE
use general protective mechanism that
function without prior exposure to ward off
a wide range of pathogen
ex. Skin and mucus membranes,
antimicrobials subs, inflammation,
fever

2.

Acquired immunity
consist of specific immune
responses provided by the
lymphatic system and directed
against specific organisms or toxins
-requires previous exposure to
foreign substance
-causes antibody formation
(humoral immunity) or
lymphatic activation ( cellmediated immunity)

Functions
1.Serves as the bodys
circulatory
system
E.g -drain excess fluid from
interstitial spaces and return it to the
blood
-absorbs fats from GI tract and
transport them to blood stream

2. Performs immune functions

a. B lymphocytes
functions:
a. synthesizes antibodies that
functions as B cell receptors on the
surface of lymphocytes
b. produce humoral immunity
(main defense against bacteria and
bacterial toxins)
c. secretes antibodies

b. T lymphocytes
functions:
1. initially seek , recognize, and
attach to antigens that fit their
surface receptors
2. later produce cell- mediated
immunity(does not involve antibodies,
but rather involves the activation of
phagocytes, antigen- specific cytotoxic
T-lymphocytes, and the release of various
cytokines in response to an antigen.

 3.

provides acquired immunity

CELL MEDIATED IMMUNITY

-relies on sensitized T lymphocytes
-serves as the bodies defense
against
virus, fungi,parasites and
some
bacteria
HUMORAL IMMUNITY
-relies on B lymphocytes functions
-provides major defence against
bacteria and bacterial toxins by
producing immunoglobulin antibodies
and an allergic response to the antigen

ANTIHISTAMINES

Action:

Compete with histamine to bind with

H1receptors throughout the body

Blocks histamines effects on body in

hypersensitivity or allergic reactions

H1 receptor -activated by thebiogenic amine

histamine, is expressed throughout the body,

Drug examples:
Cetirizine

(Zytec)
Clemastine (Dayhist-1)
Dimenhydrate (Dimetaps)
Diphenhydramine(Benadryl)
Fexofenadine( Allegra)
Loratadine (Claritin)
Promethazine (Phenergan)

Indications:
1.
2.
3.
4.

Seasonal allergic rhinitis

Urticaria ( hives,raise itchy
bumps on skin)
Adjunctive therapy for
anaphylactic reactions
Treatment for motion
sickness
(diphenhydramine and
promethazine)

contraindications
Pts

with
previous history
of allergic
reactions

Adverse reactions:
1.

CNS depressant /CNS Effect (disturb

coordination and muscle weakness)
2. GI upset (epigastric distress,loss of
appetite
( LORATADINE- increase appetite)
3. dry mouth, nose and throat
4. hypotension/hypertension
5. arryhtmias
6. fever
7. fever
9. rash
10.myalgia (pain in a muscle or group of muscles)
11. angioedema (swelling of the deep dermis in
any parts of the body)

Interactions:
If

use with alcohol

and other CNS
depressants increases
depressants
effects

Nursing
responsibilities:
1.

Observe for
hypersensitivity
reactions
2. Administer with food or
milk
3. Withhold before an
allergic skin tests

CORTICOSTEROIDS
(adrenocorticoids)

Key facts:
A.

2 types:

1.GLUCOCORTICOIDS

- produce various metabolic effect, suppress

inflammation, alter normal immune response and
promote Na and H2O retention and K excretion
-that are involved in the metabolism of carbohydrates,
proteins, and fats and have anti-inflammatory activity.

2. Mineralocorticoid
-Enhance reabsorption of sodium and
chloride
and promote excretion of K and hydrogen to help
maintain flouride and electrolyte balance (ex.
Aldosterone)
-influences salt and water
B. Metabolized in liver and excreted in the urine

Indication:
1.

replacement therapy for

adrenocortical insufficiency
(glucocorticoids)
2. neoplastic diseases
3. septic shock
4. autoimmune diseases
5. inflammation of the joints, GI
tract. respiratory tract, or skin

Contraindications:
Glucocorticoids

( extreme caution in pts

with serious infection
Mineralocorticoids
( cautions with CVD and
HPN)

Adverse reactions:
Glucocorticoids
muscle wasting
osteoporosis
growth retardation (in children)
Peptic ulcer
Increase serum glucose leve
HPN
Seizures
Mood swings ;cataract
Glaucoma
Fragile skin;hirsutism
Increased appetite

 Mineralocorticoids

Na and fluid retention

euphoria
depression
hypokalemia
hyperglycemia
acute adrenal insufficiency (abrupt
withdrawal) dec. cortisol (metabolism
and immune responses
insomnia; hirsutism and GI
distress(ulcers)
CORTISOL (stress hormone)

Interaction:
Phenobarbital

, phynetoin ,
rifampicin (enhanced
metabolism of
glucocorticoids ) decreasing
the effects of glucocorticoids

Nursing
responsibilities:
Administer

daily doses in the morning

Assess pt for symptomatic improvement
and adverse effects
Adm. additional doses during period of
stress or infection
Monitor regularly for weight changes and
fluid and electrolyte imbalance
Instruct the pt to consult with
practitioner before receiving
vaccinations

Teaching about
glucocorticoids
Included in the teaching plan:
1. medication regimen (drugs name ,
dosage,freq,duration and adverse
effectscomply with the therapy
2. signs and symptoms
3. avoidance of abrupt drug discontinuation
4. avoidance of alcohol,cigarettes,caffeine and
aspirin containing products
5. dietary restrictions and allowances; mood
alterations
6. carry an identification describing disease
and drug regimen and follow up care

Immunosuppressants

Weakens the
immune system,
immunosuppressant
drugs decrease the
bodys reaction to
the foreign organ.

Indication:
Organ

or

bone
marrow
transplant

Contraindicated:
Hypersensitivity

to castor oil
derivatives (pregnant and
breastfeeding mothers)
GI disorders
Bone marrow
depression,infection or cancer
Lymphomas
hyperlipidemnia

 DRUGS:
azathioprine

(Imuran)
cyclosporine (Neoral, Sandimmune,
SangCya)
monoclonal antibodies
.basiliximab (Simulect),
.daclizumab (Zenapax), .muromonab
(Orthoclone OKT3)
corticosteroids :
. prednisone (Deltasone, Orasone)

Adverse reactions:
Peptic

ulcer

Edema
Altered

fat distribution
Increase serum glucose levels
Mood swings
Fragile skin
n/c
Anemia, leukopenia
Hepatotoxicity
Anaphylaxis
HPN
Infection
Nephrotoxocity
tremor

Nursing responsibilities
1.

Monitor for adverse effects, toxicity and s/sx

of infections
2. maintain isolation precautions as
ordered
3. Monitor fluid intake and output
4. Instruct pt to report unusual bleeding or s/sx
or infection or transplant rejection
5. Urge the pt to used contraception to prevent
pregnancy
6. Teach to avoid fresh flower plants,fresh fruits,
and raw veges increase risk of infection
7. Teach the importance of lifelong compliance
with immunosupressive therapy to prevent
organ rejection