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Types of Immunomodulators (6)
- Cyclosporine
- Tacrolimus
- Sirolimus
- OKT3
- ATG
- Rhogam
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Uses of Immunomodulators (8)
- Therapeutic immonosuppression (after an organ transplant or in autoimmune diseases eg lupus, MS).
- Antiproliferative (with coronary stents).
- Prevention of hemolysis (Rhogam).
- Immune system augmentation (with HIV, SCID).
- Antivenins (immunoglobulin preps for snake/insect bites).
- Antitumor (engineered monoclonal antibodies for targeted cancer therapies (VEGF, EGFR inhibitors).
- Antiinflammatory (for rheumatoid arthritis, inflammatory bowel disease).
- Prevention and post-exposure treatment of specific viral and bacterial diseases (vaccines, immune globulins, toxoids e.g. tetanus).
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Immunosuppression Side Effects 1of 2
- Susceptibility to infection (viral and bacterial)
- Recommended clients recieve pneumococcal vaccine (once) and killed flu vaccine (yearly)
- Carry hand sanitizer and use before eating and PRN.
- Handwashing after toileting.
- Avoid person (children especially) with infections.
- Thoroughly wash and/or cook fruits and vegetables.
- Avoid deli meats (Listeriosis).
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Immunosuppression Side Effects 2 of 2
- Diarrhea, emisis, abdominal pain.
- Hypertension (uncommon) (cyclosporine, tacrolimus).
- Drug interactions due to CYP 450 metabolism.
- Drug levels are monitored as they may become toxic to transplant due to a narrow therapeutic index (cyclosporine, tacrolimus).
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Innate Immunity
- Physical elements/barriers (skin, mucosa)
- Cellular elements (NK cells, macrophages)
- Chemical elements (cytokines, interferons/interleukins, complement proteins)
- Non-specific immunity
- Immediate action against pathogens
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Adaptive Immunity
- Triggered by the innate system
- Includes cell-mediated (T-cell activation) and humoral immunity (antibodies)
- Results in specific immunity
- Takes time
- Immunity is for life
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Types of transplant rejection
- Hyperacute: Immediate to hours (rare and very severe)
- -Host has pre-exsisting antibodies to donor antigens
- Accelerated: Within days
- -Reativation of a previously sensitized T-Cell to an antigen in the donor organ.
- Acute: Days to weeks
- -Primary activation of T-Lymphocytes (initial exposure to donor organ antigens causes T-Cells to respond)
- Chronic: Months to years (very common)
- -Low grade immune reaction in the setting of immunosuppressive therapy.
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Graft versus Host Disease (GVHD)
- Transplant has donors immune system which reacts with host's body.
- Causes skin changes (dry, thick, pigment changes)), liver dysfunction, severe diarrhea
- Very common in BMT
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Risks associated with immunosuppression
- Rejection
- GVHD
- Cytokine Release Syndrome
- Infection
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Client/Family teaching for immunosuppression therapy
- Symptom monitoring--Will vary with disorder and medication
- Relief of symptoms in rheumatoid diseases may take 2 weeks or more for relief.
- Must take medications regularly as perscribed
- Drug levels may need to be monitored (cyclosporine, tacrolimus, sirolimus)
- Signs of infection (may be blunted in immunosuppresed people)
- Infection prevention strategies (Hand washing, hand sanitizer, flu shot, avoid sick people)
- S/S of drug interactions
- Avoid pregnancy (both males and females)
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Acute Rejection versus Chronic Rejection
- Acute rejection: Several days to weeks to manifest. Is a primary activation of the T-Lymphocytes from a first exposure to the antigens in the donor organ/tissue.
- Chronic rejection: Months to years to manifest. Is a low grade immune
- reaction in the setting of immunosuppressive therapy, and is very
- common.
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Thalidomide
- First approved in 1957
- Removed from market in early 1960's
- Was perscribed for sleep and morning sickness
- Even a single dose was teratogenic (limb, genitalia, and heart deformities)
- Contributed to conservative approach toward medication use in pregnancy. Pregnancy Categories came as a result.
- Now: Controlled perscribing and dispensing; investigational use as an anti-angiogenesis agent
- Do not get pregnant or get anyone pregnant while taking Thalidomide! Birth controll/contraceptives/condoms are essential!
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