1. Types of Immunomodulators (6)
    • Cyclosporine
    • Tacrolimus
    • Sirolimus
    • OKT3
    • ATG
    • Rhogam
  2. 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).
  3. 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).
  4. 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).
  5. 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
  6. 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
  7. 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.
  8. 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
  9. Risks associated with immunosuppression
    • Rejection
    • GVHD
    • Cytokine Release Syndrome
    • Infection
  10. 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)
  11. 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.
  12. 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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