Immune System Flashcards
Drugs that help our immune system fight:
Drugs that affect the Immune System
● Anti-infectives/Antimicrobials
○ Antibiotics
■ TB drugs
○ Antivirals
○ Antifungals
● Immunizations
Drugs that turn our immune system down:
● Antihistamines
● COX-inhibitors
● Steroids
Antibiotics - General Information
● Narrow vs. Broad Spectrum
● Resistance
○ Superinfections
○ Healthcare Acquired Infections (HAIs)
Monitor for superinfections
Evaluate liver and renal function
Diarrhea management
Inform provider of other meds
Culture before first dose
Alcohol- no
Take entire course
Evaluate cultures, WBC, CRP, temp
Broad Spectrum Antibiotics
Ampacillin,Pipperacilin, Cephlosporins (3rd Gen), Tetracyclines, carbapenems, sulphonimides, floroquinolones
Antibiotics- Types
○ Penicillins –“-cillin”
○ Cephalosporins – “-Cef”
○ Carbapenems – “-penem”
○ Tetracyclines – “-cycline”
○ Macrolides“-mycin”
○ Aminoglycosides - : “-cin”
○ Sulfonamides – “Sulf-”
○ Fluoroquinolones – “-flo-“
○ Vancomycin
○ Anti-tuberculosis agents
■ Isoniazid
■ Rifampin
Penicillins
Narrow: penicillin G, penicillin V, nafcillin
Broad: ampicillin, amoxicillin, piperacillin
Indication: Infection
Action: Weakens the bacterial cell wall - bacteria dies and stops making you sick!
Nursing Considerations:
● Low toxicity, but allergic reactions are common
○ Most common cause of drug allergy!
○ Clients allergic to one penicillin should be considered allergic to all other
penicillins
● Side effects: Rash, diarrhea
● Caution in renal clients
ß-lactamase inhibitors
● Several types of antibiotics have a ‘ß-lactam ring’
● Antibiotics have developed an enzyme to destroy this
○ ß-lactamase
● ß-lactamase inhibitors stop this enzyme from destroying the antibiotic - making it more effective!
○ sulbactam, avibactam, tazobactam, and clavulanic acid
ampicillin/sulbactam → Unasyn
amoxicillin/clavulanate → Augmentin
piperacillin/tazobactam → Zosyn
Cephalosporins
1st Generation: cefadroxil, cefazolin, cephalexin
2nd Generation: cefaclor, cefotetan, cefoxitin, cefprozil
3rd Generation: cefdinir, cefditoren, cefixime, cefpodoxime, ceftazidime, ceftriaxone
4th Generation: cefepime, ceftolozane
5th Generation: ceftaroline
Indication: Wide variety of infections
Action: Disrupt cell wall synthesis. Bacteria dies and stops making you sick!
Nursing Considerations:
● Lower dose needed for renal clients
● Monitor for signs of C. diff
● Use with caution if known penicillin allergy – possibility of cross sensitivity
Carbapenems
imipenem, meropenem, ertapenem, and doripenem
Indication: Wide variety of infections
Action: Weakens the cell wall - bacteria dies and stops making you sick!
Nursing Considerations:
● Side effects: GI upset
● Reduces blood levels of valproate
○ Avoid in clients on valproate. If necessary, supplemental anticonvulsant treatment needed
Tetracyclines
tetracycline, demeclocycline, doxycycline, eravacycline, omadacycline, sarecycline,
and minocycline
Indication: Less commonly used; remains first line for: Rocky Mountain Spotted Fever, chlamydia, cholera, Lyme, anthrax, and H. pylori
Action: Inhibit bacterial protein synthesis - bacteria dies and stops making you sick!
Nursing Considerations:
● Can cause teeth staining - avoid in pregnancy and children under 8 years old
● Cause photosensitivity - avoid light
● Are poorly absorbed when taken with minerals
○ Avoid calcium, iron, and magnesium foods and medications
Macrolides
azithromycin (z-Pak), clarithromycin, erythromycin
Indication: Respiratory infections, alternatives to penicillin in clients with penicillin
allergy
Action: Inhibit bacterial protein synthesis - bacteria dies and stops making you sick!
Nursing Considerations:
● Administer with meals to reduce GI discomfort
● Can prolong the QT interval
● Inhibits synthesis of some drugs in the liver causing elevated levels of:
○ Theophylline, carbamazepine, and warfarin
Aminoglycosides
gentamicin, tobramycin, amikacin, neomycin, kanamycin, Ssreptomycin,
paromomycin, plazomicin
Indication: Treatment of serious infections caused by gram-negative aerobic
bacilli
Action: Weakens the bacterial cell wall - bacteria dies and stops making you sick!
Nursing Considerations:
● Ototoxicity - monitor for tinnitus
● Commonly used with penicillins
Sulfonamides
sulfadiazine, sulfamethoxazole + trimethoprim (Bactrim), silver sulfadiazine, sulfacetamide
Indications: Infections, especially UTIs
Action: Stop bacterial DNA replication - bacteria dies and stops making you sick!
Nursing Considerations:
● Hypersensitivity reactions - cross sensitivity
○ Rash, fever, photosensitivity. Avoid sunlight, wear protective clothing and sunscreen.
○ Most severe: Stevens-Johnson Syndrome
● Blood dyscrasias
○ Hemolytic anemia if G6PD deficiency is present - monitor CBC
● Kernicterus
○ Don’t administer to infants < 2 mo, after 32 weeks gestation during pregnancy or if breastfeeding
● Nephrotoxic
○ Drink 8-10 glasses of water per day
○ Lower dose needed for renal clients
Fluoroquinolones
ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, gemifloxacin
Indication: Wide variety of infections
Action: Stop bacterial DNA replication - bacteria dies and stops making you sick!
Nursing Considerations:
● Black box warning for tendinitis and tendon rupture
○ Not given to <18 y.o.
● Exacerbate muscle weakness in MG
● Phototoxicity
● Absorption reduced by cations… give ‘quins’ ALONE!
○ Antacids, iron, zinc, sucralfate, calcium
Misc: Glycopeptide Antibiotic
vancomycin
Indications: Clostridium difficile infection (CDI), MRSA infection, and treatment of serious infections with susceptible organisms in clients allergic to penicillins
Action: Inhibits cell wall synthesis and, therefore, promotes bacterial lysis and death - bacteria dies and stops making you sick!
Nursing Considerations:
● Nephrotoxic -monitor BUN & Creatinine
● Monitor trough levels
● Red Man syndrome
○ Flushing, rash, pruritus, urticaria, tachycardia, and hypotension
○ Give over 60 min; central line preferred
Anti-Tuberculosis Agents
● Isoniazid
● Rifampin
Isoniazid
Indication: TB
Action: Kills mycobacteria that are actively dividing; used for active and latent TB
Nursing Considerations:
● Hepatotoxicity
○ Avoid alcohol; use caution if preexisting liver problems
● Peripheral neuritis
○ Symmetric paresthesias of the hands and feet
● Can raise levels of some drugs:
○ Phenytoin, carbamazepine, diazepam
○ Monitor drug levels
Rifampin
Indication: TB
Action: Bactericidal to M. tuberculosis
Nursing Considerations:
● Accelerates metabolism of HIV drugs
● Causes bodily fluids to turn red-orange
○ Inform clients so they know to expect it; this is harmless!
○ Can stain soft contact lenses!
● Can reduce the effectiveness of several drugs:
○ Oral contraceptives → use non-hormonal birth control
○ Warfarin → Monitor PT/INR
Antivirals- Types
● HSV/Varicella Zoster
○ Acyclovir
○ Valacyclovir
○ Famciclovir
● Cytomegalovirus
○ Ganciclovir
○ Valganciclovir
○ Cidofovir
● Hepatitis C
○ Simeprevir
○ Daclatasvir
○ Ribavirin
○ Sofosbuvir
● Hepatitis B
○ Abacavir
○ Entecavir
○ Tenofovir
● Influenza
○ Oseltamivir (Tamiflu)
○ Zanamivir
Antivirals
Indication: Viral infection
Action: Inhibits viral synthesis, stops virus from replicating, causes virus to die…
and the virus stops making you sick!
Nursing Considerations:
● Many cause general GI upset (nausea, vomiting, diarrhea)
○ Giving with food can decrease side effects
● Many cause bone marrow suppression and warrant monitoring of CBC
Antifungals
● Amphotericin
● Azoles
○ Miconazole
○ Fluconazole
○ Ketoconazole
○ Itraconazole
○ Fosfluconazole
○ Voriconazole
○ Clotrimazole
○ Nystatin
● Fungins
○ Caspofungin
○ Micafungin
○ Anidulafungin
Amphotericin
Therapeutic class: Antifungal
Indication: Systemic fungal infections
Action: Kills fungi… stops making you sick!
Nursing Considerations:
● Highly renal toxic
● Give with one liter of saline
● IV only
-Azoles
Therapeutic class: Antifungals
Indication: Systemic or topical fungal infections
Action: Kills fungi… stops making you sick!
Nursing Considerations:
● Can be given PO
● Can increase the levels of many other drugs
● Can cause liver injury - monitor LFTs
● Do not give with acid reducers
Drugs that Affect the Immune System
Drugs that Affect the Immune System
Drugs that turn our immune system down:
● Antihistamines
● COX-inhibitors
● Steroids
H₁ Antagonists
Names: diphenhydramine, chlorpheniramine,, clemastine, promethazine,
hydroxyzine, loratadine, fexofenadine…
Indication: Allergy, anaphylaxis, sedation
Action: Blocks H₁ receptors: decreases flushing, edema, secretions, itching, and pain
Nursing Considerations:
● Monitor for drowsiness
● Anticholinergic effects
● Possible paradoxical excitation (also seen in OD)
● Education:
○ No alcohol
○ Take at night and avoid driving etc.
○ Take with food to reduce GI side effects
Ibuprofen
Indication: Inflammation (RA, OA, bursitis), mild to moderate pain, fever
Action: Block prostaglandin which causes inflammation, pain, and fever
Nursing Considerations:
● Side effects:
● Gastric ulceration
● Bleeding
○ Typically avoided in trauma and surgical clients
● Renal impairment
○ Monitor BUN/Cr
Glucocorticoids (steroids)
Names: betamethasone, dexamethasone, cortisone, methylprednisolone
Indication: Inflammation, allergy, autoimmune disorders
Action: Suppress inflammation and normal immune response
Nursing Considerations:
● Monitor for too much steroid
○ Cushing’s symptoms; buffalo hump
● Side effects
○ Immunosuppression
○ Hyperglycemia
○ Osteoporosis
○ Delayed wound healing
