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Immune modulators are agents that can modify the actions of the immune system, either by stimulating or suppressing immune responses. Interferons, interleukins, and colony-stimulating factors are important examples of immune modulators with specific indications and pharmacokinetic profiles. Interferons are naturally released in response to viral invasion and are used in conditions like cancers and hepatitis. Interleukins communicate between lymphocytes and have indications in conditions like renal carcinomas. Colony-stimulating factors boost white cell production to reduce infection risk. Immune suppressants, like monoclonal antibodies, block specific immune responses and have various indications, such as in the treatment of certain cancers.
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Chapter 17 Immune Modulators
Immune Modulators Terms •Modify the actions of the immune system Immune Stimulants •Energize the immune system Immune Suppressants •Block the normal effects of the immune system
Interferons Immune Stimulants Naturally release from human cells in response to viral invasion Interleukins Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
Interferons Actions •Prevent virus particles from replicating •Stimulate interferon receptor sites •Inhibit tumor growth Indications •Cancers •Hepatitis B & C •AIDS •Multiple sclerosis
Interferons Pharmacokinetics Metabolized in the liver and kidneys Excreted through the kidneys Contraindications Pregnancy Lactation Caution with cardiac disease, myelosuppression, and with central nervous system dysfunction
Interferons Drug-to-Drug Interactions None reported
Interferons Adverse effects Lethargy Myalgia or muscle pain Arthralgia or joint pain Anorexia/Nausea Headache Dizziness Bone marrow depression
Nursing Considerations Assess and Monitor Effectiveness Client Teaching: • Avoid pregnancy • Report any adverse effects • Correct techniques to prepare and inject the medication • Take the medication as prescribed
Actions Activate cellular immunity Inhibit tumor growth Interleukins Indications Renal carcinomas Thrombocytopenia
Interleukins Pharmacokinetics Contraindications Excreted by the kidneys. Pregnancy Lactation Caution with renal, liver, or cardiac impairment
Interleukins Drug-to-Drug Interaction None reported
Adverse effects Lethargy Myalgia Arthralgia Interleukins Fatigue Fever Respiratory difficulties Depression with suicidal ideation
Assess and Monitor Effectiveness Nursing Considerations Client Teaching: •Avoid pregnancy •Report any adverse effects •Correct techniques to prepare and inject the medication •Take the medication as prescribed
Colony-Stimulating Factors Actions Indications Increases production of white cells Reduce infection Myeloid reconstitution Reduce neutropenia
Colony-Stimulating Factors Pharmacokinetics Contraindications Metabolism unknown Excretion unknown Pregnancy Lactation Renal or Hepatic disease Radiation and Chemotherapy
Colony-Stimulating Factors Drug-to-Drug Interactions Lithium Corticosteroids
Prototype Prototype Summary: Filgrastim Indications: Reduction of the incidence of infection and reduction in time to neutrophil recovery with myelosuppressive chemotherapy, leukemia, bone marrow transplants. Actions: Increases the production of neutrophils in the bone marrow. Pharmacokinetics: Route Peak Duration IV 2 h 4 d Subcutaneous 8 h 4 d T½: 210 to 231 minutes Adverse Effects: Headache, fatigue, alopecia, rash, nausea, vomiting, diarrhea, stomatitis, anorexia, bone pain, cough, generalized pain.
Adverse Reactions GI effects Headache Colony- Stimulating Factors Fatigue Generalized weakness Alopecia and dermatitis Generalized pain and bone pain
Assess and Monitor Effectiveness Nursing Considerations Client Teaching: Correct techniques to prepare and inject the medication Take the medication as prescribed Report any adverse effects Avoid pregnancy
Immune Modulators Immune Suppressants T and B Cell Suppressors Interleukin Receptor Antagonist Monoclonal Antibodies
Action •Immune Modulators - Block release of various cytokines •T and B Cell Suppressors - Block antibody production •Interleukin Receptor Antagonist - Blocks activity of interleukins •Monoclonal Antibodies - React with specific cell antigens Immune Suppressants Indications •See Table 17.2, pages 292-295
Immune Suppressants Pharmacokinetics Contraindications Absorbed from GI tract Metabolized in the liver Excreted through kidneys Pregnancy and Lactation Caution with Immunosuppressed
Drug-to-Drug Interactions Hepatotoxic agents Nephrotoxic agents Immunosuppressive agents Immune Suppressants
Prototype Prototype Summary: Bevacizumab Indications: Treatment of metastatic colorectal cancer, non-squamous cell non-small cell lung cancer, glioblastoma, renal cell carcinoma, cervical cancer, ovarian cancer. Actions: Monoclonal antibody that binds to and inhibits vascular endothelial growth factor leading to decreased angiogenesis and cell proliferation. Pharmacokinetics: Route Peak Duration IV 2-7 d 7-10 days T½: 20 days Adverse Effects: Headache, back pain, hypertension, GI perforation, hemorrhage, surgery and wound complications, thrombotic events.
Nursing Considerations Assess and Monitor Effectiveness Client Teaching: Avoid pregnancy High risk for infection Lifelong drug treatment Report adverse effects Do not take other drugs without consultation with healthcare provider Protection from sun
