Immune Pharm and HIV pharm

• Immunocompromised patients should not receive live vaccinations. 
• Pregnancy
• hypersensitivity to any component of vaccine
• Precautions: persons with moderate or severe acute illness with or without fever.

natural bodies defense-Skin, mucous membranes, cilia in airways, lyosozymes

• hematopoietic stem cell in bone marrow creates all cells. 
• Non specific defenses: innate immunity: generalized protective mechanisms-example inflammation to contain infection.
• specific defenses: Humoral immunity: B cells secrete specific antibodies to specific antigens
• Memory B-cells will remember antigens.

• BRM
• Vaccines
• interferon alpha 2B /Intron A
• aldesleukin IL2

• steroidal anti-inflammatory: prednisone
• Calcineurin inhibitor: cyclosporine/sandimmune
• cytotoxic agents: azathioprine/imuran
• MAB antibodies: infliximab

• Attenuated live vaccines: Microbes weakened unable to cause disease (MMR)
• Inactivated killed vaccines: microbes inactivated by heat or chemicals, boosters often necessary. (Influenza)
• Toxiods: Contain inactivated bacterial toxins-incapable of causing disease. (Diphtheria & tetanus) 
• subunit (recombinant): contain partial organism or microbial proteins. (Hep B)

• primary use: prevention of Hep B
• Preg: C
• MOA:Conveys active immunity-stimulates endogenous antibodies-long lasting.
• Contraindications: hypersensitivity
• Caution: avoid vaccinating during active infections
• Adverse effects: pain and inflammation at injection site, transient fever, fatigue. 

• antibody response lower in persons >60 years
• reduced response with concurrent use of immunosuppressants.

• Therapeutic class: antiviral, antineoplastic, Immunostimulant
• Preg: C
• MOA: Produced by infected lymphocytes & macrophages»Attach to nearby cells stimulating production of protective antiviral proteins»“Warn” surrounding cells  that infection has occurred-suppresses cancer growth, increased phagocytosis, enhanced immune response. 
• Indications: Hairy cell leukemia, malignant melanoma, non-hodgkin, HPV, aids related to kaposi sarcoma, chronic hep b/c
• Contraindications: hypersensitivity, autoimmune hep, not for use with infants and neonates causes brain damage. 
• Caution: fever/active infection, compromised cardiopulmonary system, elevated LFP (Liver function panel) may need D/C, herpes zoster recent exposure to chickenpox.
• Adverse: Flulike symptoms >50%, neurotoxic-severe depression, aggression, SI, Cardiotoxic, GI-Anorexia/N/V, neutropenia, thrombocytopenia.
• Monitor: Blood work each month hydration status=2500+, CBC, LFT, renal function, assess flu symptoms, daily body weight, oral cavity.

MS

• an Exaggerated IgE-mediated immune response: Type 1 hypersensitivity 
• Four types.

• Therapeutic class: calcineurin inhibitor, immunesuppressant 
• Preg: C
• Alert: Do not eat grapefruit-juice with medication, Do not breast feed with medication, practice good oral hygiene.
• MOA: reduces activity of the immune system, interferes with the activity and growth of T-cells.
• Indications: prevention of transplant rejection, psoriasis, chronic immune urticaria, other autoimmune.
• Contraindications: hypersensitivity, active infection
• Adverse: acute headache, unusual hair growth, mouth sores, n/v, abd pain, muscle pain, weight gain.
• Interactions: Many with drugs and herbs.

• IgE mediated hypersensitivity
• inflammatory response can range from uncomfortable or life threatening.

• Antibody dependent cytotoxic hypersensitivity
• hyperacute graft rejection of organ transplant
• hashimoto thyroiditis is an example

• Immune complex disease: leads to antibodies attaching to tissue causing inflammation and scarring.
• Acute transplant rejection

• Delayed hypersensitvity
• T-cell mediated
• contact dermatitis
• chronic transplant rejection

Exogenous glucocorticoids are much higher than what our body produces. affects almost every aspect of immune response.

• Therapeutic class: Corticosteroid
• Preg: C
• Alert: Must tapper off when used for longer than 10 days. 
• MOA: Metabolized to an active form of glucocorticoid, suppresses renal function, suppresses inflammatory response
• Indications: inflammation, neoplasia, asthma, arthritis, used for short and long term inflammation. 
• Contraindications: active infections,
• Adverse: Longterm-Mood changes, cushings, hyperglycemia, osteoporosis 
• Interactions: decreases efficacy of anti-seizure meds, increased GI toxicity with nsaid/ASA. many interactions.

• Human leukocyte antigen: HLA
• ABO type antigens
• Autograft: transplant of tissue to the same person
• Isograft: transplant from a donor to a genetically identical recipient
• allograft: transplant between two genetically non-identical members of same species.
• xenograft: transplant from different species.

• Therapeutic class: immunosuppressant
• Preg: D
• MOA: inhibits T-cell and B-cell proliferation
• Indications: prophylaxis of kidney transplant rejection, severe rheumatoid arthritis, other inflammatory disorders (off-label),
• Contraindications: hypersensitivity, pregnancy, caution with pre-existing hematological disease, hepatic impairment, recent exposure to chicken pox. 
• Adverse: Liver toxicity, n/v, neutropenia, fatigue, joint pain, diarrhea
• Interactions: Allopurinal-increases SE, ACE inhibitor- severe leukopenia, Warfarin- reduced blood level of drug.

• regulators of host response to inflammation, infection, trauma, immune response.
• Proinflammatory cytokines make disease worse-interleukin 1 (IL 1), tumor necrosis factor (TNF)

• Therapeutic class: MAB, TNF-inhibitor,
• Preg: B
• MOA: TNF blocker, Chimeric monoclonal antibody-binds to TNF receptors on synovial cells. delaying disease process
• Indications: moderate to severe Rheumatoid arthritis and chrons. 
• Contraindications: active infection, hypersensitivity, TB, HF
• Cation: Active infections, MS, renal or hepatic impairment, immunosuppression, elderly.

• Therapeutic class: antiretroviral
• Preg: C
• MOA: As the reverse transcriptase enzyme begins to synthesize viral DNA, it mistakenly uses zidovudine as one of the nucleosides, creating a defective DNA strand. 
• Indications: used for HIV, postexposure prophylaxis in health care workers, also for mother prior to birth to decrease the chances of the baby receiving the disease.
• Contraindications: hypersensitivity, suppresses bone marrow function, hematologic toxicity,
• Adverse: fatigue, malaise, anorexia, n/v, diarrhea, headache is prevalent. Rare cases of lactic acidosis. 
• Interactions: many, inerferon alfa, dapsone, flucystosine, vincristine should be avoided due to cumulative immunosuppression.
• Labs: MCV may increase during therapy. may also cause neutropenia.

• Therapeutic class: antiretroviral
• Preg: C
• MOA: inhibits reverse transcriptase, can penetrate the CSF, preferred drug for initial therapy of HIV infection.
• indications: HIV
• Contraindications: known teratogen to animals-must not be given to pregnant patients.
• Adverse: 50% of patients experience CNS adverse effects (sleep disorders, nightmares, dizziness, reduced concentration, delusions-these deminish after 3-4 weeks of treatment. can also causes rashes, bone marrow suppression. decreases seizure threshold
• interactions: LFT, may effect wafarin levels

• Therapeutic class: Antiretroviral
• Preg: C
• MOA: Block viral enzyme protease which is responsible for the final assembly of HIV virions. 
• Indications: HIV
• Contraindications: patients
• Adverse: diarrhea, headache, GI related effects, n/v, vomiting, dyspepsia(indigestion), DM.
• Interactions: lopinavir is extensively metabolized by hepatic enzymes. Statins should not be administered with this drug due to myopathies. Many interactions increased Adverse effects with SSRI, and other antidepressants.