DRUGS THAT

AFFECT THE
IMMUNE
SYSTEM
GROUP 12
 ACTIVE
IMMUNITY
Active immunity occurs when the body’s
immune response is stimulated by an
antigen or when a pathogen enters the
body.
Antibodies (also called
immunoglobulins) - defend the body
against pathogens.
Immune response is slow, taking several
days or weeks to develop immunity. Yet
the immunity is often long-lasting.
 ACTIVE
IMMUNITY
During this process, the immune system
retains memory of the pathogen then
produces antibodies to defend against
the disease.
Natural acquired active immunity-
occurs from exposure to a pathogen or
disease.
Active acquired artificial immunity-
occurs when a weakened antigen or
immunoglobulin (Ig) is injected into an
individual as a vaccination, which then
ACTIVE
IMMUNIZING
AGENTS
Protection acquired through active
immunizing agents is produced by one’s
own immune response.
Protection takes longer than with passive
immunizing agents, but is stronger and
may be permanent.
 ACTIVE
IMMUNIZING
AGENTS
REPLICATING NON-REPLICATING
VACCINES – LIVE VACCINES
ATTENUATED
VACCINES
These vaccines contain whole, Vaccines that do not
living virus or bacteria that replicate
induce immunity by actively
replicating within the host.
 ACTIVE IMMUNIZING
AGENTS
I. REPLICATING VACCINES – LIVE
ATTENUATED VACCINES

These vaccines contain whole, living virus or bacteria that induce

immunity by actively replicating within the host.
Attenuated means the vaccine strains are weakened so that
infection is usually inapparent or very mild.
Because these vaccines replicate, the immune response is both cell
mediated and humoral and therefore protection is long-lasting,
probably life-long.
 ACTIVE IMMUNIZING
AGENTS
I. REPLICATING VACCINES – LIVE
ATTENUATED VACCINES
LIMITATIONS
Circulating antibodies can interfere with vaccine virus
replication
Sensitive to exposure to heat and light
Use with caution/contraindicated in immunocompromised
persons
Live vaccines must be given on the same day or 28 days
apart because circulating interferon may interfere with the
 M-M-R II is a live virus vaccine for
M-M-R II vaccination against measles, mumps,
(MEASLES, MUMPS, and rubella (German measles).
AND RUBELLA M-M-R®II is a vaccine indicated for
VACCINE) active immunization for the prevention
of measles, mumps, and rubella in
individuals 12 months of age or older.
This vaccine contains live viruses that
have been weakened. It works by
causing the body to produce its own
protection (antibodies) against the
viruses that cause measles, mumps,
and rubella.
 COMMON SIDE EFFECTS
M-M-R II
(MEASLES, MUMPS, injection site reactions (pain, redness,
AND RUBELLA swelling, or a lump)
VACCINE) fever
rash
headache
dizziness
joint or muscle pain
nausea
vomiting
diarrhea
 ADVERSE EFFECTS
M-M-R II a light-headed feeling, like you might pass
out;
(MEASLES, MUMPS,
high fever (within a few hours or a few days
AND RUBELLA
after the vaccine);
VACCINE)
new or worsening cough, trouble breathing;
a febrile seizure; or
nervous system problems--numbness,
pain, tingling, weakness, burning or prickly
feeling, vision or hearing problems, trouble
breathing.
anaphylaxis and anaphylactoid reactions
arthritis
thrombocytopenia
encephalitis and encephalopathy
 DOSAGE
M-M-R II
(MEASLES, MUMPS, 0.5 mL, subcutaneously, once
AND RUBELLA In children, 1st shot: 12 to 15 month old.
VACCINE) Booster shots: 4 to 6 years of age
Where there has been a measles
outbreak, local health departments
may recommend 1 or 2 doses of MMR
vaccine for children as young as 6
months old
 DOSAGE
M-M-R II
(MEASLES, MUMPS, Adults who are not already immune to
AND RUBELLA measles, mumps, or rubella should
VACCINE) receive MMR vaccine in a series of 2
shots separated by at least 28 days (4
weeks).
If you have been exposed to measles,
mumps, or rubella, you should receive
an MMR vaccine within 72 hours after
exposure.
 CONTRAINDICATIONS
M-M-R II
(MEASLES, MUMPS, M-M-R®II is contraindicated in certain
AND RUBELLA individuals, including those with:
VACCINE) a history of hypersensitivity to any
component of the vaccine, including
gelatin
a history of anaphylactic reaction to
neomycin
individuals who are immunodeficient
or immunosuppressed due to disease
or medical therapy
an active febrile illness
 CONTRAINDICATIONS
M-M-R II M-M-R®II is contraindicated in certain
(MEASLES, MUMPS, individuals, including those with:
AND RUBELLA active untreated tuberculosis
VACCINE) those who are pregnant or are
planning to become pregnant within
the next month.
 M-M-R II Due caution should be employed in
(MEASLES, MUMPS, administration of M-M-R®II to persons
AND RUBELLA with: a history of febrile seizure or
VACCINE) family history of febrile seizures;
immediate-type hypersensitivity
reactions to eggs; thrombocytopenia.
Immune globulins (IG) and other blood
products should not be given
concurrently with M-M-R®II.
 VARIVAX The varicella virus (Chickenpox)
(VARICELLA VIRUS vaccine is used to protect against
VACCINE LIVE) Chickenpox (varicella).
It is a live attenuated vaccine, which
means it contains a weakened form of
the virus.
It is for varicella prophylaxis
 THERAPEUTIC EFFECTS/USES
VARIVAX
(VARICELLA VIRUS For prevention of chickenpox
VACCINE LIVE) When administered to susceptible
individuals, vaccine results in complete
protection from chickenpox for the
majority of persons. For the minority in
whom breakthrough chickenpox
develops after vaccination, the disease
is typically very mild.
Mechanism of Action: Stimulates active
immunity against natural diseases
 COMMON SIDE EFFECTS
VARIVAX
(VARICELLA VIRUS Pain and redness at injection site
VACCINE LIVE) Fever
Chickenpox-like rash (generalized or
confined to area surrounding injection
site)

ADVERSE REACTIONS

Anaphylaxis
Thrombocytopenia
Encephalitis
Steven-Johnson Syndrome
 DOSAGE
VARIVAX
(VARICELLA VIRUS 0.5 mL subcut x 2 doses
VACCINE LIVE) First dose: 12-15 onths; Second dose: 4-
6 years old
Catch-up initiated anytime after 12-15
months
 CONTRAINDICATIONS
VARIVAX Previous anaphylaxis to this vaccine or
(VARICELLA VIRUS to any of its components
VACCINE LIVE) Pregnancy or possibility of pregnancy
within 1 month
Immunocompromised vaccine
recipient
Presence of moderate to severe acute
illness
Active untreated tuberculosis
 DRUG-LAB-FOOD INTERACTIONS
VARIVAX Separate from other live virus vaccines
(VARICELLA VIRUS (e.g. MMR, intranasal flu) by 4 weeks if
VACCINE LIVE) not given on the same day.
delay Varicella Vaccine for up to 11
months after blood transfusion or Ig
Delay Ig for 2 montys after Varicella
Vaccine, high-dose
immunosuppressant medications
Avoid salicylates for 6 weeks after
Varicella Vaccine
 INFLUENZA ROTAVIRUS
TYPHOID VACCINE LIVE, VACCINE, LIVE,
VACCINE INTRANASAL ORAL
(VIVOTIF ORAL) (FLUMIST (ROTARIX)
QUADRIVALENT)
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

Because these vaccines do not replicate, protection takes longer to

achieve as more vaccine doses are needed to create a protective
immune response.
After the scheduled numbers of vaccine doses are given, the
immune response is strong and may be permanent.
With some vaccines, antibody levels may fall over time and as a
result, booster doses may be needed.
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

1. Whole-Cell Inactivated Vaccines

2. Subunit Vaccines
Proteins
Protein toxoid
Recombinant Vaccines
Polysaccharide Vaccines
Conjugate Vaccines
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

1. Whole-Cell Inactivated Vaccines

Whole-cell inactivated vaccines contain bacteria or viruses
that have been killed through a physical or chemical
process
Whole-cell inactivated viral vaccines against polio, hepatitis
A, and rabies.
POLIOVIRUS
VACCINE Vaccine used to help prevent the
INACTIVATED disease polio in children.
(IPOL) Ipol works by exposing you to a small
dose of the bacteria or a protein from
the bacteria, which causes the body to
develop immunity to the disease.
Mechanism of Action: Poliovirus
vaccine, inactivated, IPV stimulates the
immune system to produce antibodies
against poliovirus wild-types 1, 2, and
3.
 SIDE EFFECTS
POLIOVIRUS
VACCINE injection site reactions (redness,
INACTIVATED swelling, tenderness, pain, or a lump)
fever
(IPOL) irritability
tiredness
drowsiness
joint pain
body aches
vomiting
 ADVERSE EFFECTS
POLIOVIRUS
VACCINE anaphylactic shock
INACTIVATED anaphylactoid reactions
angioedema
(IPOL) Guillain-Barre syndrome
seizures
erythema
wheezing
 DOSAGE
POLIOVIRUS
VACCINE The primary series of Ipol vaccine
INACTIVATED consists of three 0.5 mL doses
administered intramuscularly or
(IPOL) subcutaneously, preferably eight or
more weeks apart and usually at ages
2, 4, and 6 to 18 months.
The first immunization may be
administered as early as six weeks of
age. A booster dose is administered at
4 to 6 years of age.
 DRUG INTERACTIONS
POLIOVIRUS
VACCINE Ipol may interact with steroids,
INACTIVATED medications to treat psoriasis,
rheumatoid arthritis, or other
(IPOL) autoimmune disorders, or medicines to
treat or prevent organ transplant
rejection.
Patients receiving immunosuppressant
medications may have a diminished
response to non-live vaccines.
 CONTRAINDICATIONS
POLIOVIRUS
VACCINE persons with a history of hypersensitivity
INACTIVATED to any component of the vaccine,
including 2-phenoxyethanol,
(IPOL) formaldehyde, neomycin, streptomycin,
and polymyxin B.
No further doses should be given if
anaphylaxis or anaphylactic shock
occurs within 24 hours of administration
of one dose of vaccine.
Vaccination of persons with an acute,
febrile illness should be deferred until
after recovery.
 Havrix is a vaccine used to help prevent
HEPATITIS A the Hepatitis A disease in adults.
VACCINE, It is recommended for adults who have
INACTIVATED risk factors for getting Hepatitis A,
(HAVRIX) including: being a homosexual male;
having chronic liver disease; using
intravenous (IV) drugs; receiving
treatment for hemophilia or other
bleeding disorders; working in a
research laboratory or around animals
(especially monkeys) where you may be
exposed to the hepatitis A virus; or being
in an area where there has been an
outbreak of hepatitis A.
 SIDE EFFECTS
HEPATITIS A
VACCINE, hives
INACTIVATED difficulty breathing
swelling of your face, lips, tongue, or
(HAVRIX) throat
extreme drowsiness
fainting
high fever (within a few hours or a few
days after the vaccine)
 ADVERSE REACTIONS
HEPATITIS A
VACCINE, seizures
INACTIVATED Guillain-Barre syndrome
myelitis
(HAVRIX) anaphylactic shock
vasculitis
angioedema
serum sickness
anaphylactoid reactions
erythema multiforme
 DOSAGE
HEPATITIS A
VACCINE, Primary immunization for adults consists
INACTIVATED of a single 1-mL dose of Havrix and a 1-
mL booster dose administered anytime
(HAVRIX) between 6 and 12 months later.

CONTRAINDICATIONS

HAVRIX should not be administered to

subjects with known hypersensitivity to
any component of the vaccine, or to
subjects having shown signs of
hypersensitivity after previous
administration of HAVRIX.
 DRUG INTERACTIONS
HEPATITIS A
VACCINE, Havrix may interact with drugs or
INACTIVATED treatments that can weaken the
immune system, such as steroids,
(HAVRIX) medications to treat psoriasis,
rheumatoid arthritis, or other
autoimmune disorders, or medicines to
treat or prevent organ transplant
rejection.
Patients receiving immunosuppressant
medications may have a diminished
vaccine response.
RABIES VACCINE
(IMOVAX)
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

2. Subunit Vaccines
Subunit vaccines contain a portion of the bacteria or virus.
The portion of the organism selected is the part needed to
produce a protective immune response.
Antigens in subunit vaccines can be protein,
polysaccharide, or a combination of polysaccharide and
protein molecule
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

2.1 Conjugate Subunit Vaccines

Conjugate subunit vaccines are produced by chemically
attaching a polysaccharide from the surface of bacteria to
a protein molecule through a process called conjugation.
Conjugating a polysaccharide antigen to a protein
molecule produces long-lasting protective immunity to the
polysaccharide antigen.
PNEUMOCOCCAL
It is a suspension for intramuscular
13-VALENT
injection is indicated for active
CONJUGATE immunization for the prevention of
VACCINE disease caused by Streptococcus
(PREVNAR 13) pneumoniae.
This vaccine contains 13 different types
of pneumococcal bacteria which can
infect the sinuses and inner ear.
Prevnar 13 works by exposing you to a
small amount of the bacteria or a
protein from the bacteria, which causes
the body to develop immunity to the
disease
PNEUMOCOCCAL INDICATIONS
13-VALENT
CONJUGATE Active immunization for the prevention of:
VACCINE Invasive disease caused by
(PREVNAR 13) Streptococcus pneumoniae serotypes
Otitis media caused by S. pneumoniae
serotypes
Invasive disease caused by S.
pneumoniae serotypes
Pneumonia and invasive disease
caused by S. pneumoniae serotypes
PNEUMOCOCCAL SIDE EFFECTS
13-VALENT fatigue, headache, muscle and joint
CONJUGATE pain, decreased appetite, injection site
VACCINE reactions (pain, redness, swelling,
(PREVNAR 13) tenderness, or a hard lump), limitation
of arm movement, chills, skin rash,
drowsiness, vomiting, diarrhea, low
grade fever (102 degrees or less)

ADVERSE EFFECTS
allergic reactions, swelling of the face,
lips, or tongue, and breathing problems.
PNEUMOCOCCAL DOSAGE
13-VALENT 0.5mL/syringe, IM
CONJUGATE Children 6 weeks through 5 years should
VACCINE receive a four-dose immunization
(PREVNAR 13) series.
Adults 50 years and older should receive
a single dose.

CONTRAINDICATIONS
Anyone with a history of severe allergic
reaction to any component of Prevnar 13
or any diphtheria toxoid–containing
vaccine.
Children with weakened immune systems
PNEUMOCOCCAL DRUG INTERACTIONS
13-VALENT
Concomitant administration of
CONJUGATE
antipyretics, such as acetaminophen,
VACCINE may decrease an individual's
(PREVNAR 13) immunological response to the
pneumococcal vaccine.
HAEMOPHILUS B
CONJUGATE
VACCINE
(ACTHIB)
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

2.2 Toxoid Vaccines

Toxoid vaccines are made using inactivated toxins
produced by bacteria. These protein-based toxins are
inactivated using heat, chemicals, or other methods.
Some bacteria (e.g., tetanus, diphtheria) cause disease by
producing toxins. The ability of the immune system to
recognize and eliminate these toxins provides protection
from the disease.
 MECHANISM OF ACTION
TETANUS Clostridium tetani culture is grown in a
TOXOID VACCINE peptone-based medium containing an
(TETANUS) extract of bovine muscle tissue and
detoxified with formaldehyde. Tetanus
Toxoid for intramuscular injection, is a
sterile suspension of alum-precipitated
toxoid in an isotonic sodium chloride
solution.
 INDICATIONS
TETANUS Tetanus-active protection
TOXOID VACCINE Wounds if last Tetanus vaccine was
(TETANUS) mote than 5 years ago
CONTRAINDICATIONS
Hypersensitivity to any component of the
vaccine, including thimerosal
In case of anaphylaxis or other serious
allergic reaction following a previous
dose of this vaccine, any other tetanus
toxoid-containing vaccine, or any
component of this vaccine.
 DOSING
TETANUS IM: 0.5 mL
TOXOID VACCINE
(TETANUS) INTERACTIONS
Immunosuppressive therapies: May
reduce the immune response to
vaccines
 SIDE EFFECTS
TETANUS mild fever, joint pain, muscle aches,
TOXOID VACCINE nausea, tiredness, general ill feeling,
lightheadedness, or injection site
(TETANUS)
reactions

ADVERSE EFFECTS
redness, warmth, edema, urticaria, rash
Malaise, transient fever, pain,
hypotension
 ACTIVE IMMUNIZING
AGENTS
I. NON-REPLICATING VACCINES

2.3 Recombinant Vaccines

Are produced by recombinant DNA technology which
enables the combination of DNA from two or more sources.
Hepatitis B, human papillomavirus, and influenza vaccines
are produced by insertion of a segment of the respective
viral gene into the gene of a yeast cell or virus.
The modified yeast cell or virus produces pure hepatitis B
surface antigen, HPV capsid protein, or influenza hemagglutinin
when it grows.
 Hepatitis B is a highly contagious liver
infection caused by the hepatitis B virus
HEPATITIS B (HBV).
VACCINE INDICATION
(ENGERIX B) Active immunization against hepatitis B
virus infection.
The vaccine will not protect against
infection caused by hepatitis A and non-
A non-B hepatitis viruses.
As hepatitis D does not occur in the
absence of hepatitis B infection or carrier
state, it can be expected that hepatitis D
will also be prevented by vaccination
with hepatitis B virus vaccine.
 MECHANISM OF ACTION
HEPATITIS B It induces specific humoral antibodies
VACCINE against HBsAg (anti-HBs antibodies). It is
generally accepted that an anti-HBs titre
(ENGERIX B) greater than 10 IU/L correlates with
protection against hepatitis B virus
infection.

DOSAGE
0.5 mL IM up to age 20 years or 1 mL IM
for adults (≥ 20 years)
The vaccine is typically given to children
in a 3-dose series at age 0 months, at 1
to 2 months, and at 6 to 18 months.
 CONTRAINDICATION
HEPATITIS B
severe allergic reaction (eg,
VACCINE
anaphylaxis) after previous dose or to
(ENGERIX B) baker's yeast or any vaccine
component
The main precaution with HepB vaccine
is moderate or severe illness with or
without a fever (vaccination is
postponed until the illness resolves)
 SIDE EFFECTS
HEPATITIS B The hepatitis B vaccine may cause some
VACCINE mild side effects. The most common
symptom is redness, swelling, or
(ENGERIX B) soreness where the injection was given.
Some people also experience headache
or fever.

ADVERSE EFFECTS
hives, swelling in your face and throat,
dizziness, weakness, difficulty breathing,
rapid heartbeat
HUMAN
PAPILLOMAVIRUS
VACCINE,
RECOMBINANT
(GARDASIL 9)
PASSIVE IMMUNITY
Antibodies from another person or animal
that can be injected or transfused.
Called passive because the individual did
not create the antibodies, but instead
received pre-formed antibodies.
Protection is effective, but duration is short
lived and no memory is created.
Examples of passive immunity are
maternal antibodies (trans-placental and
breast milk) and injected antibodies (e.g.,
rabies, varicella, and tetanus immune
globulins).
 TYPES OF PASSIVE
IMMUNIZING AGENTS:
1. Standard immune globulin – pooled
antibody from thousands of donors. It is
now primarily used for post-exposure
prophylaxis against measles.
2. Hyperimmune globulins – made from
donated plasma of persons with high
levels of specific IG (e.g., Hepatitis B
Immune Globulin).
3. Hyperimmune serum – produced in
animals (e.g., botulism and diphtheria
antitoxins).
 PASSIVE IMMUNIZING
AGENTS
I. STANDARD IMMUNE GLOBULIN

Standard immune globulin (formerly called gamma globulin) is a

concentrated solution of antibodies prepared from pooled human
plasma.
It is used for patients who have primary humoral immunodeficiency
(PI), idiopathic thrombocytopenic purpura (ITP), chronic immune
thrombocytopenic purpura, chronic inflammatory demyelinating
polyneuropathy (CIDP), or dermatomyositis (DM). It is also used to
improve muscle strength and disability in patients with multifocal
motor neuropathy (MMN).
HUMAN This medication is used to strengthen the
IMMUNOGLOBULIN body's natural defense system to lower
G the risk of infection in persons with a
weakened immune system.
It is made from healthy human blood
that has a high level of certain defensive
substances (antibodies), which help fight
infections.
It is also used to increase the blood
count (platelets) in persons with a
certain blood disorder (idiopathic
thrombocytopenia purpura-ITP).
 MECHANISM OF ACTION
HUMAN IVIg competitively blocks gamma Fc
IMMUNOGLOBULIN receptors, preventing the binding and
G ingestion of phagocytes and
suppressing platelet depletion.
IVIg contains a number of different
antobodies, which prevent infection by
attaching to the surface of invading
pathogens and aiding in their disposal
before they can infect cells.
 INDICATIONS
HUMAN For treatment of primary
IMMUNOGLOBULIN immunodeficiency, acute or chronic
G immune thrombocytopenic purpura,
Chronic Inflammatory Demyelinating
Polyneuropathy (CIDP)
To improve muscle strength and disability
in adult patients with Multifocal Motor
Neuropathy (MMN)
Exposure to measles for susceptible
individuals who cannot receive live
attenuated measles-containing vaccine;
exposure to Hepatitis A for individuals who
cannot receive Hepatitis A vaccine
 CONTRAINDICATIONS
HUMAN In people with a history of severe, life-
IMMUNOGLOBULIN threatening reactions to human
G immunoglobulin.
In IgA-deficient individuals with
antibodies to IgA and a history of
hypersensitivity.
Some immune globulin products should
not be used in people who have a
certain metabolic hereditary problem
 SIDE EFFECTS
HUMAN Flushing, headache, dizziness, chills,
IMMUNOGLOBULIN muscle cramps, back/joint pain, fever,
G nausea, or vomiting

ADVERSE EFFECTS
easy bleeding/bruising, fainting,
fast/irregular heartbeat, unusual
tiredness, severe headache, stiff neck,
drowsiness, high fever, sensitivity to light,
eye pain, or severe nausea/vomiting.
 DRUG INTERACTIONS
HUMAN Some products that may interact with
IMMUNOGLOBULIN this drug include: drugs that may harm
G the kidneys (for example,
aminoglycosides such as gentamicin),
"water pills" (diuretics such as
furosemide).
This medication may interfere with
certain lab tests (such as certain blood
sugar tests, blood type), possibly causing
false test results. The blood sugar
interference can lead to serious (possibly
fatal) consequences.
 PRECAUTIONS
HUMAN Some immune globulin products are
IMMUNOGLOBULIN made with maltose which can cause
G false high blood sugar levels when your
blood sugar is normal or even low
This drug may make you dizzy. Alcohol or
marijuana (cannabis) can make you
more dizzy. Do not drive, use machinery,
or do anything that needs alertness until
you can do it safely. Limit alcoholic
beverages.
 PASSIVE IMMUNIZING
AGENTS
II. HYPERIMMUNE GLOBULIN

Hyperimmune immunoglobulin products are similar to IVIg but

are prepared from the plasma of donors with high titres of
antibody against a specific organism or antigen.
made from donated plasma of persons with high levels of
specific IG (e.g., Hepatitis B Immune Globulin).
 It is a solvent/detergent-treated sterile
liquid preparation of purified human
HUMAN VARICELLA- immune globulin G (IgG) containing
ZOSTER IMMUNE antibodies to varicella zoster virus (anti-
GLOBULIN VZV).
It is prepared from pools of healthy human
donors' plasma via anion-exchange
column chromatography and was
approved in 2012 under the name VariZIG to
reduce the disease severity in high-risk
patients who lack evidence of immunity to
varicella and for whom varicella vaccine is
contraindicated. The therapeutic efficacy is
proven if administered within 4 days of
exposure to varicella zoster virus.
 INDICATIONS
HUMAN VARICELLA- VarIg is recommended for high risk
ZOSTER IMMUNE susceptible people with significant
GLOBULIN exposure to varicella
Indicated for preventing and reducing the
severity of chicken pox (varicella zoster
virus) infections in high risk individuals
within 4 days of exposure to varicella zoster
virus.
CONTRANDICATIONS
History of anaphylactic reaction to a
previous dose of any immune globulin
product or any component of Varicella-
Zoster Immune Globulin
 SIDE EFFECTS
HUMAN VARICELLA- Pain, bruising, and pruritus at the injection
ZOSTER IMMUNE site
GLOBULIN Headache, rash
Myalgia, rigors, fatigue, nausea and
flushing
ADVERSE EFFECTS
Localized pain
chills
headache
rash
nausea
myalgia, fatigue, flushing
 DOSAGE
HUMAN VARICELLA- Give VarIg IM as soon as possible following
ZOSTER IMMUNE exposure to varicella or zoster, and ideally
GLOBULIN within 96 hours after first exposure for
maximal benefit. If more than 96 hours but
less than 10 days has elapsed since the last
exposure, VarIg may still be given but may
attenuate rather than prevent disease.
All indications: Given as 125 IU/10 kg of body
weight IM.
The minimum dose is 125 IU (1 vial) and the
maximum dose is 625 IU (5 vials).
 PRECAUTIONS
HUMAN VARICELLA- Persons with IgA deficiency have the
ZOSTER IMMUNE potential for developing antibodies to IgA
GLOBULIN and could have an anaphylactic reaction
to subsequent administration of blood
products that contain IgA. VarIg should be
administered in an emergency room
setting.
Special measures should be considered
when administering IM injections to people
with bleeding disorders. A smaller gauge
needle (23 gauge or smaller) should be
used.
RABIES IMMUNE TETANUS IMMUNE HEPATITIS B
GLOBULIN GLOBULIN (TIG) IMMUNE
(RABIG) GLOBULIN
(HBIG)
 PASSIVE IMMUNIZING
AGENTS
III. HYPERIMMUNE SERUM

produced in animals (e.g., botulism and diphtheria

antitoxins).
Diphtheria antitoxin is made from equine (horse)
blood. It is not a vaccine. It's used as a treatment for
diphtheria disease caused by Corynebacterium
diphtheriae bacteria.
 THERAPEUTIC INDICATIONS
DIPHTHERIA It is used for treatment of diphtheria
ANTITOXIN (EQUINE) The diphtheria toxin antibodies present in
antitoxin bind to a toxin and netralize toxin
that is produced by a toxogenic species
Corynebacterium diphtheriae.

CONTRAINDICATIONS
Injection of the antitoxin to persons with a
history of allergic reactions to equine
protein and to allergic individuals.
Sensitivity to horse serum
Must not be administered during
pregnancy
 SIDE EFFECTS
DIPHTHERIA generalized erythema, urticaria, itching,
ANTITOXIN (EQUINE) occasionally fever, pain and edema of the
joints and lymph nodes

ADVERSE REACTIONS
Anaphylactic reaction
Thermal Reaction
Serum Sickness
 PRECAUTIONS
DIPHTHERIA Prior to administering the antiserum, a
ANTITOXIN (EQUINE) detailed anamnesis should be taken and
an inquiry should be made concerning
previous application of horse proteins; as
well as an inquiry concerning any allergic
manifestations (asthma, eczema, etc)
If the patient did not previously receive
horse proteins, a complete dose can be
administered at once, except in patients
with allergic diseases in their personal or
family anamnesis
BOTULISM
ANTITOXIN
(EQUINE)
IMMUNOSUPPRESANT
A class of medicines that inhibit or
decrease the intensity of the immune
response in the body.
Most of these medications are used
to allow the body less likely to resist a
transplanted organ.
HYDROXYCHLOROQUINE Treats autoimmune conditions, such as
rheumatoid arthritis and lupus. It works by
slowing down an overactive immune
system. It may also be used to prevent and
treat malaria.

MAJOR ADVERSE EFFECTS

Retinal damage & vision problems

Teach: Regular eye appt
Every 6 – 12 months
 It’s used to reduce activity of the immune
system for people who have certain
METHOTREXATE conditions. The immune system normally
protects the body from infections by
causing inflammation to fight them.
Inflammation can cause swelling, heat,
redness and pain.

MECHANISM OF ACTION

Stop folic acid metabolism which stop

cellular reproduction in the fastest
replicating cells.
 Infection and Bleeding
Infection Risk
METHOTREXATE - report fever (over 100.3 F, 38°C)
- avoid crowds & sick people
- avoid fresh fruits & flowers
Thrombocytopenia (platelets under
100,000)
- report bleeding;
* Petechiae (bleeding under skin)
* Purpura (purple spots ok skin)
* Melena (black tarry stool)
* Hematemesis (vomiting of blood)
* bleeding gum
 Suppresses B and T lymphocytes
Teach:
METHOTREXATE - Get flu/pneumonia vaccines that are
inactivated
- flu vaccine is OK!
- no live vaccine (herpes zoster)
No pregnancy – not baby safe. Just use
birth control
* no pregnancy until one menstrual cycle
after treatment is resolved*
* no pregnancy until 3 months after
treatment is finished*
*men no trying for a baby until months
after treatment with Methotrexate is
complete*
 TUMOR NECROSIS FACTOR
INHIBITORS

ETANERCEPT INFLIXIMAB ADALIMUMAB

Intercepts the immune mad immunosuppression
response causing
immunosuppression
 TUMOR NECROSIS FACTOR
INHIBITORS

PRIORITY TO REPORT
Elevated WBC
Fever (over 100.3 F, 38°C)
PATIENT EDUCATION
Tuberculosis (TB) Reactivation
Neg. TB skin test needed to start thereby
Vaccines:
- yearly flu vaccine
- No live vaccine (herpes zoster or shingles)
 TUMOR NECROSIS FACTOR
INHIBITORS

CONTRAINDICATION
Cannot take med: chronic, recurring, or recent infection!
LABS
REPORT! Elevated WBCs
Elevated CRP
- NOT the most important lab
CYCLOSPORINE/ Given to prevent organ transplant rejection
AZATHIOPRINE
ADVERSE EFFECT
BEFIRE giving
- check WBC + plus
* REPORT leukemia (low WBC <4000)
* Monitor for bleeding
* No pregnant patients – use
contraception

COMMON SIDE EFFECT

Cyclosporine- Gingival hyperplasia
IMMUNOSTIMULANTS
Also known as immunostimulators,
are substances (drugs and nutrients)
that stimulate the immune system
usually in a non-specific manner by
inducing activation or increasing
activity of any of its components.
INTERFERONS
these are naturally occurring proteins produced by
the host cells in response to viral infections. Hence,
they are used as individual agents
They are useful as immunostimulant in Hepatitis B,
multiple sclerosis, and human lymphoreticular cancer
THYMOSIN
It is a low molecular weight hormones, extracted from
bovine thymus
It is currently being studied as immunostimulant in
rheumatoid arthritis, systemic lupus erythematosus,
and cancer
LEVAMISOLE
It is an anthelminthic drug, that enhances the host
defense
It is thought to act by altering cell-mediated immune
response, increasing T cell immunity, and increasing
the phagocytic activity of macrophage
It is currently being tested in Hodgkin’s disease and
arthritis
INTERLEUKIN-2 (IL-2)
It is currently in clinical trial as immunostimulant in
AIDS patients
GLATIRAMER ACETATE
It is a polymer which bears some resemblance to
myclin basic proteins related to immunity
It was found to decrease the relapse of multiple
sclerosis

TRANSFER FACTOR
It is an RNA molecule derived from lymphoid cells,
specific towards antigens. It is under clinical study
from treatment of leprosy and chronic
mucocutaneous candidiasis
BCG VACCINE
It is a attenuated bovine tubercle bacilli, which is
thought to act as an immunostimulant by activating
the macrophage
It is being used as non-specific immunostimulant in
cancer therapy
IMMUNOGLOBULINS
Are tried for treatment of Congenital
agammaglobulinemias, idiophatic Thrombocytopenia
purpura, Hepatitis, measles, and primary humor all
immunodeficiency states
AGENTS USED
TO TREAT HIV
INFECTIONS
WHAT IS HIV?
HIV stands for human
immunodeficiency virus.
It harms your immune system by
destroying CD4 cells. These are a
type of white blood cells that fight
infection. The loss of these cells
makes it hard for your body to fight
off infections and certain HIV-related
diseases.
ANTIRETROVIRAL THERAPY
(ART)
The treatment of HIV with medicines is
called antiretroviral therapy (ART).
It involves taking a combination of
medicines every day. ART is
recommended for everyone who has
HIV.
The medicines do not cure HIV infection,
but help people with HIV live longer,
healthier lives. They also reduce the risk
of spreading the virus to others.
HOW DO HIV MEDICINES
WORK?
HIV medicines reduce the amount of HIV
(viral load) in your body, which helps by
giving your immune system a chance to
recover. Even though there is still some HIV in
your body, your immune system should be
strong enough to fight off infections and
certain HIV-related cancers reducing the risk
that you will spread HIV to others.
 DIFFERENT TYPES CLASSES OF
HIV MEDICINES

Some work by blocking or changing enzymes that HIV needs to

make copies of itself. This prevents HIV from copying itself,
which reduces the amount of HIV in the body
 1. NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTIS)
These block an enzyme called reverse transcriptase.
MECHANISM OF ACTION
NRTIs are taken as prodrugs and must be taken into the host cell and
phosphorylated before they become active. Once inside the host cell, cellular
kinases will activate the drug. The drug exerts its effect through its structure.
NRTIs lack a 3 hydroxyl group at the 2 deoxyribosyl moiety and will have either
a nucleoside or nucleotide as a base. Due to the missing 3’hydroxyl group, the
NRTI prevents the formation of a 3 -5’phosphodiester bond in growing DNA
chains and can prevent replication of the virus. An interesting feature of these
drugs is their incorporation during RNA-dependent DNA or DNA-dependent
DNA synthesis, which inhibits the production of either positive or negative
strands of the DNA.
 1. NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTIS)

USES
Blocking reverse transcriptase and reverse transcription
that prevents HIV from replicating.

INDICATION
Reverse transcriptase inhibitors have also been used for
post-exposure prophylaxis when concern exists for
potential patient infection with HIV.
 1. NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTIS)

USES
Blocking reverse transcriptase and reverse transcription
that prevents HIV from replicating.

INDICATION
Reverse transcriptase inhibitors have also been used for
post-exposure prophylaxis when concern exists for
potential patient infection with HIV.
 1. NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTIS)

CONTRAINDICATIONS

Nucleotide reverse transcriptase inhibitors are

contraindicated in those known to be hypersensitive to
them. Precaution should be exercised when there is hepatic
and renal impairment when administered with nephrotoxic
drugs or with drugs that compete for active tubular
secretion in the kidneys.
 1. NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NRTIS)

SIDE EFFECTS ADVERSE EFFECTS

headache severe rash
nausea decreased bone density
vomiting new or worsened kidney disease
diarrhea hepatic steatosis (fatty liver)
upset stomach lipodystrophy (abnormal distribution of body
fat)
nervous system effects, including anxiety,
confusion, depression, or dizziness
lactic acidosis
ABACAVIR LAMIVUDINE

NUCLEOSIDE
REVERSE
TRANSCRIPTASE
INHIBITORS
Oral Solution
(NRTIS) Oral Solution
- 20 mg/1ml - 10 mg/1ml
Tablet Tablet
- 300 mg - 150 mg
- 600 mg - 300 mg
 2. NON-NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NNRTIS)
These bind to and later change reverse transcriptase
MECHANISM OF ACTION
(NNRTIs) are the second class of reverse transcriptase inhibitors. The
primary mechanism of action is through the binding of the NNRTI to the
reverse transcriptase and the creation of a hydrophobic pocket
proximal to the active site. This pocket creates a new spatial
configuration of the substrate-binding site to reduce the overall
polymerase activity. By creating a different configuration, DNA
synthesis becomes slowed overall. Because of the non-competitive
inhibitor action of NNRTI, it is not effective against HIV-2 reverse
transcriptase
 2. NON-NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NNRTIS)

USES
Binds to and blocks HIV reverse transcriptase an HIV
enzyme. HIV uses reverse transcriptase to convert its
RNA into DNA (reverse transcription) Blocking reverse
transcriptase and reverse transcription prevents HIV
from replicating.
 2. NON-NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NNRTIS)

INDICATIONS
These are used in the management of the human
immunodeficiency virus (HIV) by forming a hydrophobic pocket
in HIV viral replication which slows HIV viral DNA Synthesis.
CONTRAINDICATIONS
Patients with elevated or abnormal baseline ALT or AST alanine
transaminase. should avoid the use of nevirapine-based
antiretroviral therapy due to severe hepatotoxicity and rash-
associated hepatotoxicity.
 2. NON-NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS (NNRTIS)

SIDE EFFECTS ADVERSE EFFECTS

·Rash ·Severe skin and hypersensitivity reactions
·Headache ·Stevens-Johnson syndrome
·Insomnia ·Toxic epidermal necrolysis
·Depression
·Nausea
·Vomiting
·Fatigue
·Abdominal pain
Dizziness
NEVIRAPINE ETRAVIRINE

NON-
NUCLEOSIDE
REVERSE
TRANSCRIPTASE
Oral Solution INHIBITORS
- 50 mg/5ml
Tablet (NNRTIS) Tablet
- 25 mg
- 50 mg
- 100 mg
- 200 mg
- 200 mg
- 400 mg
 3. INTEGRASE INHIBITORS

Also called integrase strand transfer inhibitors (INSTIs), they

block an enzyme called integrase

MECHANISM OF ACTION
Integrase inhibitors rely on the fact that HIV needs integrase
to replicate. These drugs stop HIV from being able to make
integrase. Without the help of this enzyme, HIV can’t take over
CD4 cells to copy itself and the HIV life cycle is interrupted.
 3. INTEGRASE INHIBITORS

USES
Treatment with integrase inhibitors is one way to help stop
the virus from replicating and control HIV infection. Once the
virus is in the body, HIV attacks certain white blood cells,
called CD4 cells or T cells. These are the cells that tell the
immune system to attack harmful organisms such as
viruses and bacteria.
 3. INTEGRASE INHIBITORS

INDICATION

Mainly indicated for the treatment of HIV infection. Integrase

is an enzyme used by HIV for replication. This enzyme binds
with the viral DNA to form a complex structure to enter the
host cell. Integrase inhibitors block the integrase enzymes
with metallic ions to prevent the integration of viral DNA to
host DNA. Thus, it helps to prevent the replication of HIV,
which is crucial for its survival.
 3. INTEGRASE INHIBITORS

CONTRAINDICATION

Patients with a history of psychiatric illnesses should avoid

Dolutegravir. Patients of childbearing potential, pregnant, or
breastfeeding should avoid Dolutegravir
 3. INTEGRASE INHIBITORS

SIDE EFFECTS ADVERSE EFFECTS

Diarrhea Skin allergies
Nausea Liver toxicity
Fatigue Depression
Headache
Insomnia
Dizziness
DOLUTEGRAVIR

Tablet
- 10 mg
- 25 mg
- 50 mg
CYCLOSPORINE/ Given to prevent organ transplant rejection
AZATHIOPRINE
ADVERSE EFFECT
BEFIRE giving
- check WBC + plus
* REPORT leukemia (low WBC <4000)
* Monitor for bleeding
* No pregnant patients – use
contraception

COMMON SIDE EFFECT

Cyclosporine- Gingival hyperplasia
 4. PROTEASE INHIBITORS (PIS)

These block an enzyme called protease

MECHANISM OF ACTION

The antiretroviral protease inhibitors act by binding to the

catalytic site of the HIV protease, thereby preventing the
cleavage of viral polyprotein precursors into mature,
functional proteins that are necessary for viral replication.
 4. PROTEASE INHIBITORS (PIS)

USES

Medications that treat viral infections. They work by

preventing a virus from making more copies of itself.
They’re most commonly used as an antiretroviral to
manage HIV/AIDS.
 4. PROTEASE INHIBITORS (PIS)

INDICATION
Protease inhibitors are only approved to treat specific
viral infections. Protease inhibitors can be used as part of
treatments for HIV/AIDS, HEPATITIS C, COVID-19
CONTRAINDICATION
The protease inhibitors are contraindicated in those
known to be hypersensitive to them, and should be used
cautiously in patients with patients liver disease,
hemophilia, or Diabetes Mellitus
 4. PROTEASE INHIBITORS (PIS)

SIDE EFFECTS
Abdominal pain.
Nausea and vomiting.
Diarrhea.
Rash.
Cough.
Fatigue.
Kidney stones.
Redistribution of fat on your body (lipodystrophy).
 4. PROTEASE INHIBITORS (PIS)

ADVERSE EFFECTS
Liver damage.
Internal bleeding. This includes intracranial bleeding, or bleeding inside
your skull.
Stevens-Johnson syndrome. This causes a painful, blistering rash.
High blood sugar (hyperglycemia), a serious issue in people with
diabetes.
High cholesterol (hyperlipidemia, hypercholesterolemia).
Hemolytic anemia. A condition where your blood cells are destroyed
faster than your body can replace them.
Heart attack (myocardial infarction).
AMPRENAVIR ATAZANAVIR DARUNAVIR
 5. FUSION INHIBITORS

These block HIV from entering the cells

MECHANISM OF ACTION
Fusion inhibitors work by binding to the attachment sites of
the HIV-1 virus thus inhibiting the fusion of HIV-1 to the host
cell membranes.
USES
Fusion inhibitors block the fusion of the HIV virus to the human
cell and thereby reduce entry of the virus into the CD4 cell.
They are also called entry inhibitors.
 5. FUSION INHIBITORS

INDICATION
Fusion inhibitors are a class of drugs used to suppress HIV
in the body. When fusion inhibitors are used in combination
with other HIV-fighting medications and treatments.
CONTRAINDICATION
Systemic hypersensitivity reactions (<1%) include
combinations of rash, fever, nausea and vomiting, chills,
rigors hypotension, and/or elevated serum liver
transaminase.
 5. FUSION INHIBITORS

SIDE EFFECTS
burning, numbness, tingling, or painful sensations or
weakness in the arms, hands, legs, or feet
cough
headache
pain or tenderness around the eyes and cheekbones
stuffy or runny nose
tightness of the chest
troubled breathing
unsteadiness
 5. FUSION INHIBITORS

ADVERSE EFFECTS
Difficulty in swallowing
skin itching, rash, or redness
swelling of the face, throat, or tongue
ENFUVIRTIDE

ADULT-The
recommended dose is
90 mg (1 mL) twice daily
injected subcutaneously
into the upper arm,
anterior thigh, or
abdomen.
 6. CCR5 ANTAGONISTS AND POST-
ATTACHMENT INHIBITORS

MECHANISM OF ACTION
CCR5 antibodies work by binding to the extracellular domain
of the CCR5 receptor and thereby inhibit interaction between
gp120 and the coreceptor. The result of binding of either an
antagonist or an antibody is a blockade of the binding
interaction which prevents HIV from entering the host cell.
INDICATION
block different molecules on the CD4 cells. To infect a cell, HIV has
to bind to two types of molecules on the cell's surface. Blocking
either of these molecules prevents HIV from entering the cells.
 6. CCR5 ANTAGONISTS AND POST-
ATTACHMENT INHIBITORS

CONTRAINDICATION
those who have liver problems including hepatitis B virus
(HBV) or hepatitis C virus (HCV) infection
have heart problems
have kidney problems
have low blood pressure or take medicines to lower blood
pressure
 6. CCR5 ANTAGONISTS AND POST-
ATTACHMENT INHIBITORS

SIDE EFFECTS
·stomach pain, diarrhea, constipation, tiredness,
lightheadedness or dizziness while standing, cold symptoms
(stuffy nose, sneezing, cough, sore throat), sleep problems
(insomnia), swelling, problems with urination, muscle or joint
pain, or skin rash.
 6. CCR5 ANTAGONISTS AND POST-
ATTACHMENT INHIBITORS

ADVERSE EFFECTS
Allergic reaction, jaundice, dark-colored urine, vomiting,
abdominal pain, fever, fatigue, myopathy, mouth and skin
blisters, facial swelling, trouble breathing, upper respiratory
tract infections, cough, joint pain, myopathy, pain below ribs,
heart problems, and loss of appetite
MARAVIROC

25-mg, 75-mg, 150-mg,

and 300-mg tablets
20-mg/mL oral solution
 7. ATTACHMENT INHIBITORS

These bind to a specific protein on the outer surface of

HIV. This prevents HIV from entering the cell.
MECHANISM OF ACTION
Attachment inhibitors are a class of antiretroviral (ARV) drugs
that interfere with the early interaction between the gp120
protein on the outer surface of HIV and the CD4 receptor on
the host cell (CD4 T lymphocytes [CD4 cells]). This prevents
HIV from binding to and entering CD4 cells.
 7. ATTACHMENT INHIBITORS

USES
HIV attachment inhibitors, when used in combination with
other anti-HIV drugs, are effective against multidrug-resistant
HIV infection.
INDICATION
Human immunodeficiency virus type 1 (HIV-1) infection in heavily
treatment-experienced patients with multidrug-resistant HIV-1
infection who have failed their current antiretroviral regimen due
to resistance, intolerance, or safety considerations (in
combination with other antiretroviral agents).
 7. ATTACHMENT INHIBITORS

CONTRAINDICATIONS
Hypersensitivity
Concurrent use of carbamazepine, enzalutamide, mitotane,
phenytoin, rifampin, and St. John's wort.
Lactation: Breastfeeding is not recommended for HIV-infected
patients.
 7. ATTACHMENT INHIBITORS

SIDE EFFECTS ADVERSE EFFECTS

Nausea dizziness
Diarrhea lightheadedness
Headache fainting
Abdominal pain irregular heartbeat
Indigestion
Fatigue
Rash
Sleep disturbance
Abnormal lab parameters
FOSTEMSAVIR
-RUKOBIA

Tablet
- Adults—600 mg
(mg) 2 times a day
 ALTERNATIVE
AND
COMPLEMENTARY
THERAPIES
HERBAL MEDICINE
¼ of prescription drugs are from herbs
Pharmaceutical indutry uses ~ 120 compounds derided from plants
which it discovered by studying folk remedies.
Quinine from South Ameican cinchona tre bark is use to treat malaria
Digitalis (digoxin), a widely prescribed heart medication, is from
foxglove plant
Salicylic acid, the soure of aspirin, from willow bark

Herbal Medicine - the of natural herbs and plants for

the treatment or prevention of diseases, disorders
and for the promoton of good health.
NURSES ROLE IN
THE USE OF HERBS
Not to discourage their use but to
ensure the MD knows about them
prior to ordering regular
pharmaceuticals.
 HERBS AND THE NURSING
PROCESS

ASSESSMENT
Plant and other allergies
List of herbal/vitamin supplements used
Client’s understanding of the indications for their use
Check for the doctor’s history/progress notes
 HERBS AND THE NURSING
PROCESS

PLANNING
Ask client/family if herbs are being used
Locate resources for client teaching
Check facility policy/MD/facility pharmacist for
administration & documentation policies
Clients or their family members sometimes store herbs in
the room & don’t think to alert the nurse/doctor
 HERBS AND THE NURSING
PROCESS

IMPLEMENTATION/EVALUATION
Advise doctor of use of products, allergies
Teach client importance of advising MD/nurse about use of
herbal products
Teach client about the products being used – what source
will you use?
Assess client’s complaints and therapeutic response to
supplemental products
Consult with team for appropriate action
10 PHILIPPINE
HERBAL MEDICINES
APPROVED BY DOH
 1. AKAPULKO (CASSIA ALATA)

also known as “bayabas-bayabasan” and “ringworm bush”

in English, this herbal medicine is used to treat ringworms
and skin fungal infections.
This plant is about 1 to 2 meters tall
The leaves are embraced with 8 to 20 oblong-elliptical
shaped leaflets. It has flowers with oblong sepals
·Uses:
- Anti-fungal:
*Tinea Flava, Ringworm
*Athlete’s Foot
* Scabies
 2. AMPALAYA (MOMORDICA
CHARANTIA)
known as “bitter gourd” or “bitter melon” in English, utmost
known as a treatment of diabetes (diabetes mellitus), for
the non-insulin dependent patients.
A climbing vine with tendrils that grow up to 20 cm long.
Leaves are heart-shaped, which are 5 to 10 cm in diameter
Fruits have ribbed and wrinkled surface that are fleshy
green with pointed ends at length and has a bitter taste.
·Uses:
- Lowers blood sugar levels
- Diabetes Mellitus (Mild-non insulin dependent)
 3. BAWANG (ALLIUM SATIVUM)

A low herb and grows up to 60 cm high

Leaves are flat and linear
Bulbs consist of several tubers
·Uses:
- For hypertension
- Toothache
- Lowers cholesterol levels in the blood
May be fried, roasted, soaked in vinegar for 30 minutes, or
blanched in boiled water
CAUTION: Take on full stomach to prevent stomach and intestinal
ulcers.
 4. BAYABAS (PSIDUOM DIADENT)

“guava” in English. It is primarily used as an antiseptic, to

disinfect wounds. Also, it can be used as a mouthwash to
treat tooth decay and gum infection.
A tree about 4 to 5 meters high with tiny white flowers with
round or oval fruits that are eaten raw.
·Uses:
- For washing wounds
- For toothache
- For diarrhea
Preparation is warm decoction or through pounding
 5. LAGUNDI (VITEX NEGUNDO)

A shrub growing wild in vacant lots and waste land.

The flowers are blue and bell-shaped
The small fruits turn black when ripe. It is better to collect the
leaves when are in bloom.
·Uses:
- Asthma and cough
- Fever, Dysentery, Colds & Pain
- Skin diseases and wounds
- Headache
- Rheumatism, sprain, contusions, insect bites
-Aromatic bath for sick patients
 6. NIYOG-NIYOGAN (QUISQUALIS
INDICA L.)
is a vine known as “Chinese honey suckle”.
It is effective in the elimination of intestinal worms, particularly
the Ascaris and Trichina.
Only the dried matured seeds are medicinal -crack and ingest
the dried seeds two hours after eating (5 to7 seeds for children
& 8 to 10 seeds for adults).
If one dose does not eliminate the worms, wait a week before
repeating the dose.
·Uses:
- Anti-helminthic (used to expel parasitic worms)
 7. SAMBONG (BLUMEA
BALSAMIFERA)
English name: Blumea camphora.
A diuretic that helps in the excretion of urinary stones. It can
also be used for an edema.
·A plant that reaches 1 ½ to 3 meters in height with rough hairy
leaves.
Young plants around mother plant may be separated when
they have three or more leaves.
·Uses:
- Anti-edema
- Diuretic
- Anti-urolithiasis
 8. TSAANG GUBAT (EHRETIA
MICROPHYLLA LAM.)
·Carmona retusa
Forest Tea or Wild Tea
A shrub with small, shiny nice-looking leaves that grows in wild
uncultivated areas and forests
Prepared like tea, this herbal medicine is effective in treating
intestinal motility and also used as a mouth wash since the
leaves of this shrub has high fluoride content.
·Uses:
- Diarrhea
- Stomach ache
 9. ULASIMANG BATO | PANSIT-
PANSITAN (PEPEROMIA PELLUCIDA)
·Peperomia pellucida
Silver bush or Shiny bush
A weed with heart-shaped leaves that grow in shady parts of the
garden and yard.
It is effective in fighting arthritis and gout.
The leaves can be eaten fresh (about a cupful) as salad or like
tea.
For the decoction, Boil a cup of clean chopped leaves in 2 cups of
water. Boil for 15 to 20 minutes. Strain, let cool and drink a cup
after meals (3 times a day).
Uses: Lowers uric acid (Rheumatism and Gout)
 10. YERBA BUENA (CLINOPODIUM
DOUGLASI)
Peppermint
A small multi-branching aromatic herb. The leaves are small,
elliptical and with toothed margin.
The stem creeps to the ground, and develop roots.
·Uses:
- For pain in different parts of the body as headache, stomach ache
- Rheumatism, arthritis and headache
- Cough and cold
- Swollen gums and toothache
- Menstrual and gas pain
- Nausea and fainting
- Insect bites and Pruritus
TIPS ON HANDLING MEDICINAL PLANTS / HERBS:
It is recommended that consumers buy herbs that are organic and
pesticides-free
Medicinal parts of plants are best harvested on sunny mornings. Avoid
picking leaves, fruits or nuts during and after heavy rainfall.
Leaves, fruits, flowers or nuts must be mature before harvesting. Less
medicinal substancesare found on young parts.
After harvesting, if drying is required, it is advisable to dry the plant
parts either in the oven orair-dried on screens above ground and never
on concrete floors.
Store plant parts in sealed plastic bags or brown bottles in a cool dry
place without sunlightpreferably with a moisture absorbent material
like charcoal. Leaves and other plant parts thatare prepared properly,
well-dried and stored can be used up to six months.
TIPS ON PREPARATION FOR INTAKE OF HERBAL
MEDICINES:
Use only half the dosage prescribed for fresh parts like leaves when
using dried parts.
Do not use stainless steel utensils when boiling decoctions. Only use
earthen, enameled,glass or alike utensils.
As a rule of thumb, when boiling leaves and other plant parts, do not
cover the pot, and boil inlow flame.
Decoctions loose potency after some time. Dispose of decoctions after
one day. To keep freshduring the day, keep lukewarm in a flask or
thermos.
Always consult with a doctor if symptoms persist or if any sign of
allergic reaction develops
COMMON HERBAL
MEDICINES USED BY
OTHER COUNTRIES
 1. HERB – GINGKO BILOBA

Action – relaxes smooth muscle (vasodilation with improved

arterial & capillary perfusion), free radial combatant, inhibits
platelet aggregation.
Uses –↑ cerebral blood flow in elders (Alzheimer’s, ST memory
↑
loss, HA, dizziness), walking distaNce in intermittent claudication,
↑ peripheral perfusion in diabetes, improved wound healing
Adverse Effects – diarrhea, nausea, vomiting, dizziness (in large
doses)
Interactions – caution in clients on platelet inhibitors &
anticoagulants
Nc – monitor:
 2. HERB – BLACK COHOSH

Action – compounds bind to estrogen receptors, suppress

luteinizing hormone
Uses – PMS symptoms, dysmenorrhea, menopause
Adverse Effects – well tolerated
Precautions – safety in breast cancer not established, do not
use for > 6 mo, not in first 2 pregnancy trimesters
Nc – do not confuse with BLUE cohosh
 3. HERB – FEVERFEW

Action – smooth muscle relaxant, ↓ prostaglandin &

leukotrienes, ? antiplatelet
Uses – prevention of migraine HA (smooth muscle relaxant), RA
(anti-inflammatory properties)
Adverse Effects – mouth ulcers, “post feverfew syndrome”
(insomnia, headache, myalgia, anxiety so DC use gradually)
↓
Nc – teach for migraine HA prevention only, avoid NSAIDs ( s
effectiveness of feverfew)
 4. HERB – ST. JOHN’S WORT

Action – inhibits reuptake of serotonin

Uses – mild depression, obsessive compulsive disorders(OCD),
topical (anti-inflammatory, wound healing)
Adverse Effects – “serotonin syndrome” (sudden onset of
→
confusion, nausea, vomiting, muscle spasm, tremor, fever
coma), photosensitivity
Nursing Considerations – NEVER USE other serotonin-active
drugs together, teach about serotonin syndrome
 FOOD / DRUG INTERACTIONS

The potency & effectiveness of many medications is altered by

the presence or absence of food/other medications in the
stomach
Read drug labels/orders carefully
Example: Grapefruit increases the potency of many
conventional medications, such as calcium channel blockers &
benzodiazepines
 DIETARY
SUPPLEMENTS
 According to the DSHEA, “dietary supplements”
are specifically exempted from the Food, Drug, and
Cosmetic Act. Dietary supplements are defined as
products intended to enhance or supplement the diet,
such as botanicals, vitamins, minerals, or other
extracts or metabolites that are not already approved
as drugs by the Food and Drug Administration (FDA). A
major strength of the legislation is that it gives the FDA
the power to remove from the market any product
that poses a “significant or unreasonable” risk to the
public. It also requires these products to be clearly
labeled by the manufacturer as “dietary
supplements.”
 In 2007, the FDA announced a final rule that
requires the manufacturers of dietary supplements to
evaluate the identity, purity, potency, and composition
of their products. The labels must accurately reflect
what is in the product, which must be free of
contaminants such as pesticides, toxins, glass, or
heavy metals.
NUTRITIONAL
SUPPLEMENTS
MINERALS
essential components of enzymes, hormones, bones
& teeth
regulate cell membrane permeability, pH, osmotic
pressure, muscle contractility, O2 transport

VITAMINS
essential chemicals that regulate metabolism
fat soluble are A, D, E & K
Water-soluble vitamins include ascorbic acid
(vitamin C), thiamin, riboflavin, niacin,vitamin B6
(pyridoxine, pyridoxal, and pyridoxamine), folacin,
vitamin B12, biotin, and pantothenic acid.
 MINERAL – CALCIUM SALTS

ACTIONS
activates nerve impulses (blood coagulation, essential for
cardiac, smooth and skeletal muscle function)
USES
treatment & prevention of hypocalcemia, Osteoporosis
ADVERSE EFFECTS
arrhythmia, constipation
NURSING CONSIDERATIONS
assess for hypocalcemia (paresthesias, arrhythmia, muscle
twitching), monitor VS & labs
 MINERAL – CALCIUM SALTS

SUPPLEMENTS
calcium carbonate, calcium gluconate
Best absorbed if taken with magnesium
 ANEMIA & IRON

ANEMIA
↓ ↓
in RBC number or in quantity of hgb
Iron is required for hgb synthesis
Only 5% - 10% of dietary iron is absorbed
Vitamin C increases absorption Ca+ inhibits absorption
TYPES OF ANEMIA
1. Iron-deficiency Anemia (nutritional anemia) – low or absent
iron stores due to diet
2. Pernicious Anemia – lack of intrinsic factor→↓ B12 absorption
& malformed RBCs
3. Megaloblastic Anemia – low folic acid
 MINERALS – FERROUS SULPHATE

ACTION
iron source for production of hgb
USES
prevention & treatment of iron deficiency anemia (only)

ADVERSE EFFECTS
dark stools, epigastric pain, diarrhea, constipation
NURSING CONSIDERATIONS
monitor hgb, hct, reticulocytes, monitor BMs
 MINERALS – FERROUS SULPHATE

SUPPLEMENTS
ferrous gluconate, ferrous sulphate
 VITAMIN B12 – CYANOCOBALAMIN

ACTION
coenzyme for RBC production
USES
pernicious anemia, prevention of B12 deficieNcy

ADVERSE EFFECTS
well tolerated
NURSING CONSIDERATIONS
IM route only in pernicious anemia
 MINERALS – ZINC

ACTION
cofactor for many enzyme reactions, wound healing
USES
replacement & supplemental for those with deficiency,
impaired wound healing
ADVERSE EFFECTS
well tolerated
NURSING CONSIDERATIONS
teach not to exceed RDA, dietary sources (wheat germ,
seafood, organ meat)
 MINERALS – ZINC

SUPPLEMENTS
zinc sulphate
 VITAMIN D

ACTION
converted to active form in liver/kidneys, promotes absorption
of Ca+ and phosphorus, helps regulate Ca+ levels
USES
treatment of hypocalcemia, some bone diseases, vitamin D
deficiency
ADVERSE EFFECTS
↓
toxicity (muscle pain, LOC arrhythmia, bradycardia) – why is
toxicity possible with this vitamin?
MEDS
calcifediol, calcitriol, cholecalciferol
THANK YOU!