ati medication list
DESCRIPTION
immune systemTRANSCRIPT
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Natural Immunity
N203ATI (Unit 3)
Immune System -
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Present at birth
Protection provided by physical barriers: Skin, mucus membranes Phagocytic cells NK cells
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Specific Acquired Immunity
N203ATI (Unit 3)
Immune System -
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Production of antibodies against antigens
Active: Having the infection or a vaccine / toxoid
Takes weeks to months to take effect
Passive: Administration of preformed antibodies (immunoglobulins)
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Major Cells of the Immune System
N203ATI (Unit 3)
Immune System -
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B cells Macrophages & Dendritic Cells
Produce antibodies Phagocytosis
Helper T cells (CD4)
Activate B cells
Responsible for delayed hypersensitivity reaction
Cytotoxic T cells (CD8)
Directly destroy target cells
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MMR Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Measles, Mumps, Rubella
Adverse Effects: Local reactions (rash, fever, swollen glands) Anaphylaxis
Contraindications/Precautions: Allergies to eggs, gelatin, and neomycin Hx of thrombocytopenia Immunocompromised individuals Recently received blood products or immunoglobulins
Education:
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DTaP Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Diphtheria, Tetanus, Pertussis
Adverse Effects: Encephalopathy (fever, persistent crying) Seizures Local reaction at injection site
Contraindications/Precautions: Severe febrile illness Hx of anaphylaxis Hx of encephalopathy 7 days after DTaP vaccination Occurrence of seizures with 3 days of vaccination Inconsolable crying (>3 hrs) within 48 hrs of vaccination
Education:
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Hepatitis Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Hepatitis A & B viruses
Adverse Effects: Local reaction Anaphylaxis
Contraindications/Precautions: Hx of anaphylaxis Allergy to Baker’s yeast
Education:
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Varicella Virus Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Varicella zoster virus (chickenpox)
Adverse Effects: Varicella-like rash
Contraindications/Precautions: Pregnancy Cancer Hx of allergy to neomycin or gelatin Immunocompromised patients
Education: Slight risk of virus being transmitted. If child develops rash after vaccination
they should be presumed to be infected and appropriate precautions taken.
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Inactivated Polio Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Immune response to poliovirus
Adverse Effects: Vaccine-related paralytic poliomyelitis Local reaction
Contraindications/Precautions: None
Education:
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Influenza Vaccine
N203ATI (Unit 3)
Immune System -
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Therapeutic Uses: Immunity to influenza strains in the vaccine
Adverse Effects: Guillain-Barré syndrome (ascending paralysis, weakness of BLE, dyspnea) Local reaction Fever
Contraindications/Precautions: Acute febrile illness Hypersensitivity to eggs
Education:
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Immune Globulin
N203ATI (Unit 3)
Immune System -
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Expected Action: Proto: Gamma globulin (IgG)
Passive immunity
Therapeutic Uses: Immunodeficiency syndrome Bone marrow transplantation Measles, rubella, varicella exposure
Chronic lymphocytic leukemia Hep A, Hep B exposure
Adverse Effects: Local reaction / hypersensitivity
Contraindications/Precautions:
Interactions: Live viruses can lead to disease – avoid live viruses for 3 months following IgG
Education: Administer in deep muscle / Date of exposure must be known (6 days measles,
7 days Hep B, 14 days Hep B)
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Immunostimulants
N203ATI (Unit 3)
Immune System -
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Expected Action: Proto: Interferon Alfa, Aldesleukin, Interleukin 2
Enhance immune response / reduce proliferation of cancer cells
Therapeutic Uses: Leukemia / melanoma / Kaposi’s sarcoma
Adverse Effects: Flu-like symptoms / Marrow suppression, alopecia, cardiotoxicity,
neurotoxicity Hypotension
Contraindications/Precautions: Hypersensitivity / pregnancy and lactation (C)
Interactions: Theophylline (toxicity) Zidovudine or retrovir ( neutropenia) Antihypertensives ( hypotensive effect)
Education: Refrigerate / Do not shake vial
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Immunosuppressants(General)
N203ATI (Unit 3)
Immune System -
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Act on helper T lymphocytes to suppress proliferation of B cells and cytotoxic T cells
For treatment of autoimmune disorders and to prevent organ rejection
Rheumatoid arthritis
Early type 1 diabetes
Lupus
Myasthenia gravis
Adverse Effects
Teratogenesis risk of infection
Medications:
Cyclosporine (Gengraf, Neoral) Tacrolimus
Glucocorticoids (prednisone) Methotrexate
Cytotoxics (azathioprine)
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Cyclosporine
N203ATI (Unit 3)
Immune System -
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Adverse Effects: Hepatotoxicity Nephrotoxicity (BUN, Creatinine, I&O)
Contraindications/Precautions: Pregnancy / Recent live virus vaccination / Recent contact ĉ chickenpox or herpes
Interactions: Phenytoin, phenobarbital, rifampin, carbamazepine, TMP-SMZ ([cycl] ) Ketoconazole, erythromycin, amphotericin ([cycl] toxicity) Amphotericin, aminoglycosides, NSAIDs (all nephrotoxic renal damage) Grapefruit juice ( [cycl] by 50%)
Nursing Mix oral dose ĉ milk or OJ to palatability Admin initial dose over 2-6 hours Monitor for hypersensitivity, stay ĉ pt. for 30 mins
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Glucocorticoids
N203ATI (Unit 3)
Immune System -
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Adverse Effects: Proto: Prednisone, prednisolone
Osteoporosis (use Ca2+& vitamin D supplements Renal insufficiency (stop drugs immediately) Fluid retention
Contraindications/Precautions: Systemic fungal infections Recurring live virus vaccines
Interactions: K+-depleting diuretics ( hypokalemia) NSAIDs ( GI ulceration) Glucocorticoids (Promote hyperglycemia)
Education:
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Azathioprine
N203ATI (Unit 3)
Immune System -
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Adverse Effects: Bone marrow depression neutropenia & thrombocytopenia
Contraindications/Precautions: None listed in ATI
Interactions: Allopurinol (delays inactivation of azathioprine)
Education:
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Antihistamines(General)
N203ATI (Unit 3)
Immune System -
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Action is on H1 receptors which blocks histamine release
Medications
1 st Generation: Diphenhydramine (Benadryl) Promethazine (Phenergan) Dimenhydrinate (Dramamine)
2 nd Generation: Loratadine (Claritin) Cetirizine (Zyrtec) Fexofenadine (Allegra) Desloratadine (Clarinex)
Therapeutic Uses:
Mild allergic reactions Anaphylaxis
Motion sickness Insomnia
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Antihistamines(1st Generation)
N203ATI (Unit 3)
Immune System -
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Expected Action: Proto: Diphenhydramine, promethazine, dimenhydrinate Block H1 receptors - prevent histamine release into small blood vessels & nerves
Therapeutic Uses: Mild allergic reactions Motion sickness
Anaphylaxis Insomnia
Adverse Effects: Sedation GI discomfort
Anticholinergic effects (dry mouth, constipation)
Acute toxicity (flushed face, fever, tachycardia), children can have hallucinations, incoordination and seizures Induce vomiting and give activated charcoal.
Contraindications/Precautions: 3rd trimester, lactation, newborns / use cautiously in kids and elderly Caution ĉ asthma, urinary retention, open angle glaucoma, & hypertension.
Interactions: CNS depressants EtOH Benzodiazepines
Opioids Barbiturates
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Chemotherapy Agents(Medications)
N203ATI (Unit 3)
Immune System -
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Nitrogen mustards.....................................................cyclophosphamide
Platinum compounds.................................................................cisplatin
Folic acid analog................................................................methotrexate
Pyrimidine analog...................................................................cytarabine
Purine analogs................................................................mercaptopurine
Antitumor antibiotics...........................................................doxorubicin
Mitotic inhibitors..................................................vincristine, paclitaxel
Topoisomerase inhibitors.......................................topotecan, irinotecan
Breast cancer....................................................tamoxifen (antiestrogen)
Prostate cancer........................................................................leuprolide
Progestins....................................................................megestrol acetate
Cytotoxic medications
Asparaginase Hydroxyurea Procarbazine
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Chemotherapy Agents(Side Effects)
N203ATI (Unit 3)
Immune System -
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Bone marrow suppression Avoid crowds, check for bleeding
gums
GI discomfort Give antiemetic (ondansetron) with dexamethasone,
metoclopramide or granisetron at outset
Alopecia Occur 7-10 days after, persist max of 2 months after
Mucositis Frequent oral care, soft toothbrush, EtOH mouthwash
Reproductive toxicity Sperm banking, Avoid gravid on meds.
Hyperuricemia or uric acid fluids, I&O Give allopurinol if uric acid
Extravasation of vesicants such as carmustine, dactinomycin, daunorubicin, and vincristine