Republic of the Philippines

Bulacan State University

City of Malolos

NCM 106 - Pharmacology

Drugs acting on the Immune System

Prepared by:

Christopher E. Olipas, Ph.D.

Carmina O. Fabonan, RN

Marlyn Molina, MAN

A.Y. 2020-2021- 1st Semester

Introduction

Immune system plays a major role in keeping your body healthy. The immune
system distinguish signals from invading pathogen including viruses, bacteria or any other
microorganism not merely present to the body. If the immune system cannot respond,
infection may occur. On the other hand when immune system is activated without the
presence of invading pathogen problem arise including allergic reactions and
autoimmune disease. In some cases immune system is suppress to prevent organ
transplant rejection.
In this module, you will learn drugs affecting our immune system. It is a vital
information because immune system is our defense and ground soldier to keep our body
healthy. Any drugs inadvertently given without prior knowledge will cause deterioration of
immune system especially to most susceptible clients.

This particular module is divided into 4 lessons:

Lesson 1 Anti-Inflammatory agents

Lesson 2 Immune Modulators

Lesson 3 Vaccines

Lesson 4 Sera

The module includes pre-test, post-test, that helps you assess and evaluate your
understanding on each lessons. You are encouraged to take time in answering the
question. It will also help you to build your study style along the way.

Objectives/Competencies
Upon completion of this module, you are expected to:
1. Explain the importance of the different drugs based on their classification, it’s
identified therapeutic actions, side effects and adverse effects.
2. Apply the nursing process in drug therapy and patient safety.
3. Formulate a health teaching plan.
Pre Test
Match the description by placing the letter of the concept in the space provided.
Column A Column B

1. Process of exposing the body to an antigen

to generate an adaptive immune response A. Chrysotherapy

2. Transfer of active humoral immunity of B. Autoimmune disease

ready-made antibodies
C. Immune system
3. Drugs that suppress, or reduce, the strength
of the body's immune system D. Antibodies
4. Coordinate activation of signaling pathways
that regulate inflammatory mediator levels in resident E. Vaccine
tissue cells
F. Inflammatory response
5. Protective protein produced by the immune
system in response to the presence of a foreign G. Immune stimulant
substance
H. Immune suppressant
6. Substances that stimulate the immune
system by inducing activation or increasing activity of I. Active immunity
any of its components.
J. Passive immunity
7. Complex network of cells and proteins that
defends the body against infection.
8. The body's immune system attacks and
destroys healthy body tissue by mistake
9. Treatment by injection of gold salts
10. Biological preparation that provides active
acquired immunity to a particular infectious disease.
Title of the Lesson: Anti-Inflammatory Agents

Duration: 2 hours
By this time, I know you have already an idea how are immune system work from
your previous subjects. Your immune system protects you from invading pathogens. You
developed sign and symptoms of the disease from the reaction of your body’s chemical
composition against the pathogens, but once your immune system is bombarded resulting
to chronic diseases and severe damage your body’s immune system gets hyper active
leading to increased symptoms.
To alleviate the increased stimulation of inflammatory response, anti-inflammatory are
given. In this lesson we will deal with anti-inflammatory, including salicylates, antiarthritis,
and related agents to lessen the response of your body resolving some of the sign and
symptoms experiencing of your client. See table below that summarized anti-
inflammatory agents.
Table 3.1 Anti-Inflammatory agents

Salicylates Generic Name

Aspirin Balsalazide Diflunisal
Mesalamine Olsalazine Salsalate
Choline magnesium trisalicylate

Actions Inhibit the synthesis of prostaglandin, an important mediator of

(Pharmacodynamics) the inflammatory reaction.
Also works as antipyretic and analgesic.

Pharmacokinetics Absorbed from the GI

Metabolized in the liver
Cross the placenta and enter breast milk
Excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
salicylates, nonsteroidal anti-inflammatory drugs
(NSAIDs) or tartrazine.
● Patient with bleeding abnormalities, impaired renal
function, chickenpox or influenza
● Pregnancy and lactating woman
Adverse Effect Nausea, dyspepsia, heartburn, epigastric discomfort.
blood loss, bleeding abnormalities

Salicylism includes dizziness, ringing in the ears, difficulty

hearing, nausea, vomiting, diarrhea, mental confusion, and
lassitude.

Salicylate toxicity include hyperpnea, tachypnea,

hemorrhage, excitement, confusion, pulmonary edema,
convulsions, tetany, metabolic acidosis, fever, coma, and
cardiovascular, renal, and respiratory collapse.

Nonsteroidal Anti-
inflammatory Propionic Acetic Acid Fenamate Oxicam Cyclo
Acid derative
oxygenate-
2 Inhibitor

Fenoprofen Diclofenac Meclofenamate Meloxiacam Celecoxib

Flurbiprofen Etodolac Mefenamic Acid Piroxicam

Ibuprofen Ketorolac

Ketoprofen Sulindac

Naproxen Nebumetone

Indomethacin

Tolmetin

Actions Use as anti-inflammatory, analgesic, and antipyretic effects by

(Pharmacodynamics) inhibiting prostaglandin synthesis.
NSAIDs block two enzymes, known as COX-1 and COX-2.
COX-1
Indicated for relief of the signs and symptoms of rheumatoid
arthritis and osteoarthritis, for relief of mild to moderate pain, for
treatment of primary dysmenorrhea, and for fever reduction

Pharmacokinetics Absorbed from the GI

Metabolized in the liver
Cross the placenta and enter breast milk
Excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to any
NSAID, salicylate, Celecoxib, Sulfonamides.
● Patient with CV dysfunction, hypertension, peptic ulcer
or known GI bleeding.
● Pregnancy and lactating woman
Adverse Effect Nausea, dyspepsia, GI pain, constipation, diarrhea, or
flatulence

Headache, dizziness, somnolence, and fatigue

Bleeding, platelet inhibition, hypertension, and even bone

marrow depression

Rash and mouth sores

Drug-Drug Decreased diuretic effect taken with loop diuretics.

Interaction Decreased antihypertensive effect of beta-blockers.
Lithium toxicity with ibuprofen

Related Agent Generic Name

Acetaminophen

Actions Acts directly on the thermoregulatory cells in the hypothalamus

(Pharmacodynamics) to cause sweating and vasodilation.
Treatment of pain and fever
Prophylaxis of children receiving diphtheria–pertussis–tetanus
immunizations
Relief of musculoskeletal pain associated with arthritis.

Pharmacokinetics Absorbed from the GI

Metabolized in the liver
Cross the placenta and enter breast milk
Excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
acetaminophen
Caution
● Pregnancy and lactating woman
● Hepatic dysfunction or chronic alcoholism

Adverse Effect Headache, hemolytic anemia, renal dysfunction, skin rash, and
fever
Hepatotoxicity is a potentially fatal adverse effect.

Drug-Drug Increased risk of bleeding with oral anticoagulants

Interaction Hepatotoxicity with barbiturates, carbamazepine, hydantoins, or
rifampin.
Arthritis is a potentially debilitating inflammatory process in the joints that causes pain
and bone deformities. Antiarthritis drugs are available to block the inflammation and tissue
damage.
Table 3.2 Antiarthritis agents

Gold Compounds Generic Name

Auranofin
Gold sodium thiomalate

Actions Chrysotherapy is a form of treatment with the use of gold

(Pharmacodynamics) salts it Inhibits phagocytosis by blocking the release of
lysosomal enzymes is inhibited and tissue destruction is
decreased

Pharmacokinetics Cross the placenta and enter breast milk

Excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
gold
● Patient with severe diabetes, congestive heart
failure, severe debilitation, renal or hepatic
impairment, hypertension, blood dyscrasias, recent
radiation treatment, history of toxic levels of heavy
metals
● Pregnancy and lactating woman

Adverse Effect Stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis,

diarrhea, and other GI inflammation

Drug-Drug Severe toxicity with penicillamine, antimalarials, cytotoxic

Interaction drugs, or immunosuppressive agents other than low-dose
corticosteroids

Disease-Modifying Tumor Necrosis Factor Blockers

Antirheumatic Adalimumab
Drugs (DMARDs) Certolizumab
Etanercept
Golimumab
Infliximab

Actions Decrease the locally released cytokine that can cause the
(Pharmacodynamics) death of tumor cells and stimulate a wide range of pro
inflammatory activities
Pharmacokinetics given subcutaneously
excreted in the tissues
cross the placenta and may enter breast milk

Contraindication/ Contraindication
Caution ● Etanercept cannot be used with a history of allergy
to Chinese hamster ovary products
● Patient acute infection, cancer, sepsis, tuberculosis,
hepatitis, myelosuppression or demyelinating
disorders
● Pregnancy and lactating woman

Adverse Effect Risk of serious to fatal infections and the development of

lymphomas and other cancers

Demyelinating disorders including multiple sclerosis and

various neuritis conditions. Myocardial infarction (MI), heart
failure, and hypotension

Drug-Drug Live vaccines should not be given while on these drugs

Interaction

Other Disease- Anakinra Leflunomide

Modifying Tofacitinib Penicillamine
Antirheumatic Hyaluronidase derivative Sodium hyaluronate
Drugs

Actions Anakinra responsible for the degradation of cartilage in

(Pharmacodynamics) rheumatoid arthritis.
Hyaluronidase derivatives to cushion and lubricate the joint
and relieve the pain associated with degenerative arthritis

Leflunomide directly inhibits an enzyme relieving signs and

symptoms of inflammation and blocking the structural
damage this inflammation

Penicillamine lowers the immunoglobulin M rheumatoid

factor levels
Tofacitinib is a kinase inhibitor that blocks signaling
pathways within immune cells to prevent their activity

Pharmacokinetics Metabolized in the tissues and excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to the drugs
or to the animal products from which they were
 derived (chicken products in hylan G-F 20 and
sodium hyaluronate)
● Patient acute infection, liver or renal impairment
● Pregnancy and lactating woman

Adverse Effect Pain with injection, and increased risk of infection.

Severe hepatic toxicity
Tofacitinib risk of serious to fatal infections and the
development of lymphomas and other cancers.

Drug-Drug Anakinra and tofacitinib should not be used with other

Interaction immune suppressants

Leflunomide increase risk of hepatoxicity with other

hepatotoxic drugs.

Table 3.3 Nursing Process for salicylates, antiarthritis, and related agents

Nursing Assessment
Process 1. Assess for known allergy to drugs
2. History of renal or hepatic disease, bleeding disorder,
3. Current pregnancy or lactation status.
4. Perform a physical assessment
5. Assess vital signs: Respiratory rate and adventitious sounds
6. Monitor renal and hepatic function tests, CBC

Nursing Diagnosis (Possible)

● Acute pain related to CNS and GI effects.
● Ineffective breathing pattern if toxic effects occur.
● Disturbed sensory perception (auditory, kinesthetic) if toxic effects
occur.
● Risk for infection related to drug effects
● Anxiety related to disease process and drug effects
● Deficient knowledge regarding drug therapy.

Planning
● The patient will receive the best therapeutic effect from the drug
therapy.
● The patient will have limited adverse effects to the drug therapy.
● The patient will have an understanding of the drug therapy,
adverse effects to anticipate and measures to relieve discomfort
and improve safety.
 Implementation Rationale
1. Administer with food if GI upset 1. To alleviate GI effects
is severe; provide small,
frequent meals
2. To avoid toxic levels
2. Monitor for severe reactions

3. Arrange for supportive care and 3. Alleviate inflammation

comfort measures.

4. Ensure that the patient is well 4. Decrease the risk of

hydrated during therapy toxicity.

5. Provide thorough patient

teaching, including measures to 5. Increase knowledge
avoid adverse effects and about drug therapy
warning signs of problems, as and to increase
well as proper administration compliance with the
drug regimen.

Evaluation
● Monitor patient response to the drug (improvement in condition
being treated, relief of signs and symptoms of inflammation).
● Monitor for adverse effects (GI upset, CNS changes, bleeding).
● Evaluate effectiveness of the teaching plan (patient can name
drug, dosage, possible adverse effects to watch for, and
specific measures to help avoid adverse effects).
● Monitor effectiveness of comfort and safety measures and
compliance with the therapeutic regimen.

Self-Check 1

1. Acetylsalicylic acid (aspirin) is prescribed for a client with coronary artery disease
before a percutaneous transluminal coronary angioplasty (PCTA). The nurse
administers the medication, knowing that it is prescribed to:

a) Relieve post procedure pain

b) prevent thrombus formation
c) prevent post procedure hyperthermia
d) Prevent inflammation of the puncture site.
2. A nurse reviews a physician’s orders and notes that a topical nitrate is
prescribed. The nurse notes that acetaminophen is also prescribed to be
administered before nitrate. The nurse plans to implement the order, knowing that
the acetaminophen is prescribed because:

a) Headache is a common side effect if nitrates

b) Fever usually accompanies myocardial infarction
c) Acetaminophen potentiates the therapeutic effect if nitrates
d) Acetaminophen does not interfere with platelet action as aspirin does.

Great! Hope you answered the question correctly. For further reading you can check
Chapter 16 of the book entitled “Focus on nursing pharmacology” (7th ed.). by Karch, A.
M., (2013) or other references. You can also watch the video about Pharmacology –
NSAIDs for a quick review at: https://www.youtube.com/watch?v=qhiMmNZjHRg.
Title of the Lesson: Immunomodulators

Duration: 2 hours
Immunomodulators include: Immune stimulants increasing the power of immune
system in case of prolonged invasion of pathogen, while Immune suppressants are
used to block immune response in cases for autoimmune disorder or to prevent organ
transplant.
Immune stimulants is classified into three actions: 1. Interferons 2. Interleukins 3.
Colony-stimulating factors
Table 3.4 Immune stimulants

Interferons Interferon alfa-2b Interferon beta-1a

Interferon alfa-n3 Interferon beta-1b
Peginnterferon alfa-1b

Actions ● prevent virus particles from replicating inside cells

(Pharmacodynamics) ● stimulate interferon receptor sites on non-invaded
cells to produce antiviral proteins
● inhibit tumor growth and replication

Pharmacokinetics Subcutaneous or intramuscular injection

Metabolized in liver and kidneys
Excreted in kidney

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to any
interferon
Caution
● Patient with cardiac disease, Central nervous
system (CNS) dysfunction, myelosuppression
● Pregnancy and lactating woman

Adverse Effect Flu-like syndrome with lethargy, myalgia, arthralgia,

anorexia, nausea
Headache, dizziness, bone marrow depression, depression
and suicidal ideation, photosensitivity, and liver impairment

Drug-Drug no reported clinically important drug–drug interactions

Interaction

Interleukins Aldesleukin
Oprelvekin

Actions Stimulate cellular immunity by increasing the activity of

(Pharmacodynamics) natural killer cells and inhibit tumor growth
Pharmacokinetics Subcutaneous or IV injection
Excreted in kidney

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to any
interleukin or Escherichia coli–produced product
Caution
● Patient with renal, liver, cardiac disease
● Pregnancy and lactating woman

Adverse Effect Flu-like effects: lethargy, myalgia, arthralgia, fatigue, fever

Respiratory difficulties, CNS changes, and cardiac
arrhythmias

Drug-Drug no reported clinically important drug–drug interactions

Interaction

Colony-Stimulating Filgrastim Pegfilgrastim

Factors Tbo-filgrastim Sargramostim

Actions ● Increasing the production of white cells

(Pharmacodynamics) ● Reduce the incidence of infection
● Decrease the neutropenia
● Treatment of various blood-related cancers

Pharmacokinetics Subcutaneous or IV injection

Metabolism and excretion are not known.

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to
component of the drug or to Escherichia coli–
produced products
● Sargramostim is contraindicated in neonates
Caution
● Pregnancy and lactating woman

Adverse Effect Nausea, vomiting, diarrhea, constipation, anorexia

Headache, fatigue, generalized weakness, alopecia and
dermatitis, and generalized pain and bone pain.

Drug-Drug increase in the myeloproliferative effects of sargramostim

Interaction with lithium or corticosteroids

The immune suppressants include the immune modulators, T and B cell suppressors, an
interleukin receptor antagonist, and monoclonal antibodies
Table 3.5 Immune Suppressants

Immune Fingolimod Lenalidomide Thalidomide

Modulators Apremilast Dimethyl fumarate Pomalidomide
Teriflunomide

Actions Block the release of various cytokines involved in the

(Pharmacodynamics) inflammatory response and activation of lymphocytes,
decreasing immune activity

Pharmacokinetics Absorb in GI
Metabolized in the liver
Excretion in both urine and feces

Contraindication/ Contraindication
Caution ● Pregnancy and lactating woman
● Teriflunomide is contraindicated with severe hepatic
impairment

T and B Cell Abatacept Alefacept Azathioprine

Suppressors Cyclosporine Glatiramer Mycophenolate
Pimecrolimus Sirolimus Tacrolimus

Actions Prevention and treatment of specific transplant rejections

(Pharmacodynamics)

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to drug or its
components
● Patient with known neoplasms

Adverse Effect Increased risk for infection and for the development of
neoplasms
Hepatotoxicity, renal toxicity, renal dysfunction, and
pulmonary edema
Headache, tremors, secondary infections such as acne, GI
upset, diarrhea, and hypertension.

Drug-Drug increased risk of toxicity with hepatotoxic or nephrotoxic

Interaction drug

Interleukin Generic Name

Receptor Anakinra
Antagonist
Actions ● block the activity of the interleukins that are released
(Pharmacodynamics) in an inflammatory or immune response

Pharmacokinetics Subcutaneous injection

Metabolized in the tissues
Excreted in the urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to
component of the drug or to Escherichia coli–
produced products
Caution
● Pregnancy and lactating woman
● patients with renal impairment, immunosuppression,
active infection

Adverse Effect Headache, sinusitis, nausea, diarrhea, upper respiratory

and other infections

Drug-Drug Potential for serious infections with abatacept

Interaction Severe and even life-threatening infections etanercept

Monoclonal Alimumab Alemtuzumab Basiliximab

Antibodies Belimumab
Bevacizumab Blinatumomab Brentuxumab
Canakinumab
Certolizumab Cetuximab Daclizumab
Denosumab
Eculizuma Erlotinib Golimumab
Ibritumomab
Infliximab Ipilimumab Natalizumab
Nivolumab
Obintuzumab Ofatumumab Omalizumab
Palivizumab
Pegaptanib Pembrolizumab Ramucirumab
Ranibizumab
Raxibacumab Rituximab Siltuximab
Tocilizumab
Vedolizumab Ustekinumab Trastuzumab
Tositumomab combined with iodine-131 tositumomab

Actions Antibodies that attach to specific receptor sites to suppress

(Pharmacodynamics) immune

Pharmacokinetics IV, IM, or subcutaneously (except erlotinib as oral)

Metabolized in liver
Excreted in urine
Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to drug or
murine products
Caution
● Pregnancy and lactating woman
● Patients with fever and patients who received
monoclonal antibodies before.

Adverse Effect Acute pulmonary edema (dyspnea, chest pain, wheezing)

fever, chills, malaise, myalgia, nausea, diarrhea, vomiting,
and increased susceptibility to infection and cancer
development

Drug-Drug Severe immune suppression with increased infections and

Interaction neoplasms with any other immunosuppressant drug

Table 3.6 Nursing Process for Immunomodulators agents

Nursing Assessment
Process 1. Assess for known allergy to drugs
2. History of renal or hepatic disease, cardiac disease; bone
marrow depression; leukemic states; and CNS disorders,
including seizures,,
3. Current pregnancy or lactation status.
4. Perform a physical assessment
5. Assess vital signs: Respiratory rate and adventitious sounds
6. Monitor renal and hepatic function tests, CBC

Nursing Diagnosis (Possible)

● Acute pain related to CNS, GI, and flu-like effects
● Imbalanced nutrition: Less than body requirements related to
flu-like effects
● Anxiety related to diagnosis and drug therapy
● Risk for infection related to immune suppression
● Deficient knowledge regarding drug therapy

Planning
● The patient will receive the best therapeutic effect from the drug
therapy.
● The patient will have limited adverse effects to the drug therapy.
● The patient will have an understanding of the drug therapy,
adverse effects to anticipate and measures to relieve discomfort
and improve safety.
Implementation Rationale
1. Arrange for laboratory tests 1. Monitor for drug
before and periodically during effects and adverse
therapy, including CBC and effects.
differential
2. Ensure that the drug
2. Administer drug as indicated; will be given even if
instruct the patient and a the patient is not able
significant other if injections are to administer it.
required
3. discontinue the drug
3. Monitor for severe reactions, immediately if they
such as severe hypersensitivity occur
reactions

4. Arrange for supportive care and 4. Help the patient cope

comfort measures for flu-like with the drug effects.
symptoms
5. Decrease the risk of
5. Ensure that the patient is well toxicity.
hydrated during therapy

6. Provide thorough patient 6. Increase knowledge

teaching, including measures to about drug therapy
avoid adverse effects and and to increase
warning signs of problems, as compliance with the
well as proper administration drug regimen.

Evaluation
● Monitor patient response to the drug (improvement in condition
being treated).
● Monitor for adverse effects (flu-like symptoms, GI upset, CNS
changes, bone marrow depression).
● Evaluate effectiveness of the teaching plan (patient can name
drug, dosage, possible adverse effects to watch for, and
specific measures to help avoid adverse effects).
● Monitor effectiveness of comfort and safety measures and
compliance with the therapeutic regimen.
Self-Check 2
1. Patient Ana is taking Aldesleukin for treatment of Metastatic renal cell carcinoma.
Aldesleukin belongs to the class of interleukins used as immunostimulants. Which of the
following statement made by Patient Ana needs further understanding?

a. “ I may experience flu-like symptoms like malaise, rigor, chills, arthralgia,

myalgia will taking this medication”
b. “This drug may cause hallucination, somnolence, syncope, and
convulsions, if I experienced any of this, I will not drive or operate
machinery”
c. “It is okay to be pregnant while taking this medication, because it will not
affect my baby”
d. “I will inform my doctor if I’m taking any other drug to prevent drug interaction
and side effects.”
2. Differentiate Immune Stimulant to Immune Suppressant

Immune
Stimulant:__________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

Immune
Suppresant:________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
______________________

Take a break for a while. If you need further reading you can check Chapter 17 of
the book entitled “Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or
other references. You can also watch the video about Immunomodulators and
Immunosuppressives https://www.youtube.com/watch?v=2wawYBRwmLY
Title of the Lesson: Vaccines

Duration: 2 hours
Vaccines are immunizations containing weakened or altered protein antigens that
stimulate the formation of antibodies against a specific disease. Vaccines can be made
from chemically inactivated microorganisms or from live or weakened viruses or bacteria.
Toxoids are vaccines that are made from the toxins produced by the microorganism. The
toxins are altered so that they are no longer poisonous but still have the recognizable
protein antigen that will stimulate antibody production. (Karch 2013)
In the Philippines, DOH released a program called Expanded Program on
Immunization (EPI) that ensure infant or children including the mothers have access to
routinely recommended infant/childhood vaccines. Six vaccine-preventable diseases
were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis
and measles and later on mandates Republic Act No. 10152 “Mandatory Infants and
Children Health Immunization Act of 2011Signed by President Benigno Aquino III in July
26, 2010. The mandatory includes basic immunization for children under 5 including other
types that will be determined by the Secretary of Health.
Figure 3.1 Sample Immunization Card in the Philippines
Figure 3.2 Recommended Adult Immunization Schedule for ages 19 years or older
by Center for Disease Control and Prevention (CDC)

Vaccine is classified in to two:

1. Live Attenuated Vaccines meaning the virus or bacteria is weaken to produce a vaccine
and perform a natural immunity when given to patients.
Viral: Measles, Mumps, Rubella, Varicella, Yellow fever, Oral Polio,
Influenza nasal spray
Bacterial: BCG, Oral typhoid
2. Inactivated Vaccines is not live and cannot replicate.
Whole cell vaccines
Viral: Influenza, Polio, Rabies, Hepatitis A
Bacterial: Pertussis, Typhoid, Cholera
Fractional vaccines
Subunit: Hepatitis B, Influenza, Acellular Pertussis, Typhoid Vi
Toxoid: Diphtheria, Tetanus
For the detailed explanation of vaccines available in the Philippines you can check
the handbook published by the Philippine society for microbiology and infectious diseases
with the Philippine foundation for vaccination entitled “handbook on adult immunization
for Filipinos 2009” Public education efforts should be directed at providing parents with
information about pediatric immunization and encouraging them to act on that information,
Nurses are often in the ideal position to provide this information.
Table 3.7 LIST OF VACCINE AVAILABLE IN THE PHILIPPINES
Vaccine Description/Indication
Cholera For travelers visiting areas with ongoing
epidemics/outbreaks

Hepatitis A Inactivated Hepatitis A virus adsorbed to aluminum

hydroxide as adjuvant, administered
intramuscularly in the deltoid muscle
Hepatitis B Monovalent Hepatitis B vaccine uses recombinant
DNA technology to express HBsAG in yeast, and
purified from cells by biochemical and bio-physical
separation techniques.
Human Papilloma Virus Use for Human Papilloma Virus infection
(HPV)
Influenza Anyone who wants to reduce the chance of falling ill
with influenza

Measles, Mumps, Rubella A live attenuated virus vaccine given routinely for 9
(MMR) months old
Meningococcal Use for Meningococcal infection
 Pneumococcal Use for pneumonia, to invasive disease
characterized by bacteremia, meningitis, and/or
endocarditis
Rabies Use as Pre-exposure prophylaxis and Post-
exposure to rabies virus

Tetanus-Diphtheria- Use for Tetanus-Diphtheria-acellular Pertussis

acellular Pertussis (Tdap)
Typhoid Fever Oral vaccine is a live-attenuated vaccine
Parenteral vaccine is a polysaccharide extracted
from bacterial capsule of S.typhi strain Ty 2
Varicella Use for chicken fox
Yellow Fever A live-attenuated virus vaccine for yellow fever

The use of vaccines is contraindicated in the presence of immune deficiency and

patients with known allergies to any of the components of the vaccine (refer to each
individual vaccine for specifics, sometimes including eggs, where some pathogens are
cultured)
Adverse effects of vaccines includes Moderate fever, rash, malaise, chills,
fretfulness, drowsiness, anorexia, vomiting, and irritability. Pain, redness, swelling, and
even nodule formation at the injection site are also common. In rare instances, severe
hypersensitivity reactions.

Self-Check 3
Case Scenario:
During your community visit, as a rural health nurse. You’ve noticed an increase
incidence of measles in the community of brgy Sumapang Matanda. Upon evaluation
revealed that most of the children did not received the immunization because the mother’s
lack of proper knowledge about vaccine and are afraid that their children might get sick.
As part of your nursing intervention formulate a Health Teaching Plan for the community
of brgy Sumapang Matanda about Expanded Program of Immunization
Health Teaching Plan
Learning Learning Strategi Time Resources Evaluation
Objectives Content es Allotment

If you need further reading you can check Chapter 18 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Vaccination
https://www.youtube.com/watch?v=YlKLpQEWILg
Title of the Lesson: Sera

Duration: 2 hours
Serum provide passive immunity to a specific antigen, which could be a pathogen,
venom, or toxin The term immune sera is usually used to refer to serum that contain
antibodies to specific bacteria or viruses. The term antitoxin refers to immune sera that
have antibodies to very specific toxins that might be released by invading pathogens. The
term antivenin is used to refer to immune sera that have antibodies to venom that might
be injected through spider or snake bites.
Immune sera are contraindicated in patients with a history of severe reaction to
any immune sera or to products similar to the components of the sera.
Adverse effects include local reactions, such as swelling, tenderness, pain, or
muscle stiffness at the injection site, are very common. Rash, nausea, vomiting, chills,
fever or allergic reactions including chest tightness, falling blood pressure, difficulty
breathing.

Patients/parents should be advised to keep a written record of all immunizations

or immune sera used. Booster doses for various vaccines may be needed to further
stimulate antibody production.

Table 3.8 Immune Sera

Antithymocyte A purified form of rabbit anti-thymocyte antibodies used
immunoglobulin (rabbit) for immunosuppression in patients receiving kidney
transplants.
Rabies virus inactivated Inactivated rabies virus antigen B is indicated for pre-
antigen, B and post-exposure prophylaxis against rabies.
Rabies virus inactivated Rabies virus inactivated antigen, A is an inactivated
antigen, A virus vacine for the intramuscular injection. It is an
active immunization against rabies that can be
administered pre- or post-exposure
Obiltoxaximab A monoclonal antibody used for prophylaxis or
treatment of inhalational anthrax.
Table 3.9 Antitoxins and antivenins
Antivenin (crotalidae) Treat a person who has been bitten by a poisonous
polyvalent systemic snake such as a rattlesnake or water moccasin.
 Antivenin (black widow Used to treat black widow spider bites
spider) systemic
Antivenin (micrurus Treatment of poisoning caused by bites of north
fulvius) systemic American coral snakes, such as the eastern coral
snake, the Texas coral snake, and some other related
species of coral snakes.
Antivenom (centruroides Treat a person who has been stung by a scorpion
scorpion) systemic
botulism antitoxin treat symptoms of botulism in patients who are
systemic exposed to botulinum toxin
diphtheria antitoxin Prevent and/or treat diphtheria infection in persons
systemic exposed to the disease.

Self-Check 4
Differentiate Immune sera, Anti toxins and Antivenins.

Anti Toxins
________________
________________
________________
_______________
Immune Sera Antivenins
________________ ________________
________________ ________________
________________ ________________
________________ _______________

SERA

If you need further reading you can check Chapter 18 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Vaccination
https://www.youtube.com/watch?v=YlKLpQEWILg
Post test
1. A client with a fractured femur who has had an open reduction-internal fixation is
receiving ketorolac (Tramadol). The nurse evaluates the effectiveness of the medication
by monitoring the client’s:
a. Pain rating
b. Temperature
c. serum Calcuim level
d. White blood cell
2. Ibuprofen 400 mg orally four times daily has been prescribed for an older client with a
diagnosis of rheumatoid arthritis. The client asks the nurse about the amount of
medication prescribed. The nurse responds based on the understanding that this
prescribed dosage is:
a. The normal adult dose
b. Lower than the normal adult dose
c. Higher than the normal adult dose
d. An unusual dosage for this diagnosis
3. A home care nurse visits an older client with acute gouty arthritis. Indomethacin has
been prescribed for the client, and the nurse teaches the client about the medication.
Which statement by the client indicates that further teaching is necessary?
a. “I’ll rest if I am having pain”
b. “ I need to call the doctor if I notice a rash”
c. “I can take a pill whenever I need to for pain”
d. “I’ll watch for any swollen feet or fingers or any stomach distress”.
4. A client is hospitalized for ingesting an overdose of acetaminophen. The nurse
prepares to administer which specific antidote for this medication?
a. Protamine Sulfate
b. Acetylcysteine
c. Vitamin K
d. Naloxone hydrochloride
5. A client who regularly takes nonsteroidal anti-inflammatory drugs (NSAID’s) has been
taking misoprostol. The nurse would monitor the client to see if the client experienced the
relief of which of the following symptoms?
a. Diarrhea
b. Bleeding
c. Infection
d. Epigastric pain.
6. Which of the following is NOT a vaccine-preventable disease?
a. Hepatitis B
b. Asthma
c. Measles
d. Polio

7. Which of the following statement made by patient Ana is true about immunization?
a. “Immunization is the process whereby a person is made immune or resistant to an
infectious disease, typically by the administration of a vaccine.”
b. “Serious complication may lead after I received a vaccine”
c. “You can have a vaccine even you are immunocompromised patient”
d. “I can receive vaccine shot from any individuals”

8. Nurse Ana is preparing Bevacizumab for a patient with Metastatic breast cancer.
The nurse understand that which of the following statement is not true about
Bevacizumab?

a. Belongs to the class of monoclonal antibodies that inhibits the angiogenesis that
occurs during tumor growth.
b. Bevacizumab is can be given to a pregnant patient or lactating woman.
c. Bevacizumab may cause sleepiness and fainting and should instruct the patient
not to drive or participate to activity that needs alertness.
d. notify the physician if the patient reports black, tarry stools or vomit coffee-
ground-like vomitus.

9. Infliximab is given intravenously to patient with Rheumatoid arthritis. Upon patient

assessment, you’ve noticed that the patient is taking anakinra. Which of action of the
nurse signify understanding with Infliximab medication?

a. The nurse will notify the physician about Infliximab and Anakinra because the
patient will have an increased risk of serious infection and neutropenia.
b. Infliximab is not contraindicated to pregnant and lactating woman.
c. Patient with tuberculosis or other severe infections can take Infliximab.
d. The nurse can give the medication regardless of low white blood cell count.

10. Which of the following vaccine is given to newborn at birth?

a. MMR vaccine
b. BCG vaccine
c. DPT Vaccine
d. Hepatitis C Vaccine
Final Requirement:
Case Scenario
During your community visit, as a rural health nurse. You’ve noticed an increase incidence
of measles in the community of brgy Sumapang Matanda. Upon evaluation revealed that
most of the children did not received the immunization because the mother’s lack of
proper knowledge about vaccine and are afraid that their children might get sick. As part
of your nursing intervention formulate A Drug Study about MMR Vaccine a Health
Teaching Plan for the community of Barangay Sumapang Matanda focusing with MMR
Vaccination. (Use a separate paper)
Drug Study

Date Route of
Mechani Clients Nursing
ordered/ Administration/Dos Indicati Contraindicat
Medication sm of Respon Responsibilit
Given/ age/ on ion
Action se ies
Taken Frequency

Generic Date Dosage: Before:

Name: ordere
d:

Brand Route; During:

Name: Date
given:

Classificatio Frequency: After:

ns: Date
Taken:

Health Teaching Plan

Learning Learning Strategies Time Resources Evaluation
Objectives Content Allotment
Suggested Readings and Website
Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Adult Immunization Schedule by Vaccine and Age Group. (2020).

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-shell.html
Expanded Program on Immunization | Department of Health website. (2011).
Doh.Gov.Ph. https://www.doh.gov.ph/expanded-program-on-immunization
Hasudungan, A. (2018). Pharmacology - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
[YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=qhiMmNZjHRg
NCLEX Study Guide. (2017). Immunomodulators & Immunosuppressives [NCLEX
Review] [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=2wawYBRwmLY
Shomu’s Biology. (2018). Vaccination [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=YlKLpQEWILg

References:
Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.
Adult Immunization Schedule by Vaccine and Age Group. (2020).
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-shell.html
Expanded Program on Immunization | Department of Health website. (2011).
Doh.Gov.Ph. https://www.doh.gov.ph/expanded-program-on-immunization
Hasudungan, A. (2018). Pharmacology - Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
[YouTube Video]. In YouTube. https://www.youtube.com/watch?v=qhiMmNZjHRg
NCLEX Study Guide. (2017). Immunomodulators & Immunosuppressives [NCLEX
Review] [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=2wawYBRwmLY
Shomu’s Biology. (2018). Vaccination [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=YlKLpQEWILg