IMMUNOLOGIC AGENTS

Prepared by:
Prof. Florence D. Villarias

Reference:

LeFever Kee, Joyce; Hayes, Evelyn; McCuistion, Linda (2015). PHARMACOLOGY. A Patient- Centered
Nursing Process Approach. 8th ed. Elsevier. Inc. Pages 469 - 570
IMMUNOLOGIC AGENTS

•HIV– and AIDS–Related Drugs

• Transplant Drugs
•Vaccines
INFECTION
Infection
- is the invasion and multiplication of
microbes in or on body tissues of the
host, resulting in signs and symptoms as
well as immunologic response.
Microbial reproduction injures the patient either by

a. competing with host metabolism

b. causing cellular damage from toxins produced by

the microbe or

c. from intracellular multiplication.

The patients’ own immune response may compound the
tissue damage: such damage may be localized ( as in an
infected pressure ulcer) or systemic.

The severity of the infection varies with the disease

producing ability and number of the invading microbes,
the strength of host defenses, and various other factors.
Infection is a common problem in persons with cancer.
Persons with cancer are at increased risk of infection as a
result of:

• The underlying disease, for example leukemia or

lymphoma affects the body's normal defense against
infection.
• Side effects of treatment that interfere with the body's
normal defense against infection.
CLASSIFICATIONS of Infections

1. Extent of involvement
a. Local infection: limited to one locality of the body, such as boil;
may have systemic repercussions such as fever and
malaise.
b. Focal infection: a local infection from which the organisms
spread to other parts of body (e.g a tooth abscess that
seeds organisms into the blood)
c. Systemic infection: infectious agent is spread throughout the
body (e.g. typhoid fever)
2. Length of infectious process

a. Acute infection: one that develops rapidly, usually resulting

in a high fever and severe sickness; resolves in a short
period of time.

b. Chronic infection: one that develops slowly, with mild but

longer-lasting symptoms; sometimes an acute
infection becomes chronic and vice versa.
3. Etiology of infectious process
a. Primary infection: develops after initial exposure to antigen,
unrelated to other health problems.
b. Secondary infection: develops when antigens take advantage of
the weakened defenses resulting from a primary
infection (e.g. staphylococcal pneumonia as a sequela of
measles)
c. Opportunistic infection: develops when host defenses are
diminished because of disease process or therapeutic
modalities (e.g. urinary tract infection following
antibiotic therapy)
Vaccines/ Transplant Drugs
Immune
System
 White blood
cells attacking
bacteria,
viruses…
Global situation and trends:
Since the beginning of the epidemic, 76 million people have been
infected with the HIV virus and about 33 million people have died of
HIV/AIDS.
Globally, 38.0 million [31.6–44.5 million] people were living with HIV
at the end of 2019. An estimated 0.7% [0.6-0.9%] of adults aged 15–49
years worldwide are living with HIV, although the burden of the epidemic
continues to vary considerably between countries and regions.
The WHO African region remains most severely affected, with nearly
1 in every 25 adults (3.7%) living with HIV and accounting for more than
two-thirds of the people living with HIV worldwide.

https://www.who.int/gho/hiv/en/
 The Philippines is a low-HIV-prevalence country, with
0.1 percent of the adult population estimated to be HIV-
positive, but the rate of increase in infections is one of the
highest. As of August 2019, the Department of Health
(DOH) AIDS Registry in the Philippines reported 69,629
cumulative cases since 1984.

https://en.wikipedia.org/wiki/HIV/AIDS_in_the_Philippines#:~:text=The%20Philippines%20is%20a%20low,69%2C629%20cumulative%20cases%20since%201984.
Case Study

D.D. 28 years old, works as a registered nurse in the trauma unit. He

sustains a needle stick from a patient with HIV.

1. What should the nurse do first?

Answer: Although occurring less frequently than in years past,

exposure to HIV still occurs to health care workers. The
first step the nurse should take is to completely wash the
exposed area with soap and water and report the
incident.
2. What is involved in postexposure prophylaxis (PEP), and how
long does treatment last?

Answer: Postexposure prophylaxis (PEP) should start within

72 hours of exposure and continue for 4 weeks.

3. What are potential side effects associated with PEP.

Answer: The common side effects mostly reported include

nausea, malaise, and fatigue.
• HIV is transmitted via contact
with blood and body fluids,
such as semen, vaginal fluids,
and breastmilk; this also
includes donated sperm from
an HIV-infected person.

• Increased risk factor occurs in

those who have unprotected
sex; those who have sex with
multiple partners; and IV drug
users who share contaminated
personal care items, such as
razors.
When HIV enters the body, the body
tries to kill the virus by creating
chemicals called 'antibodies‘

This process from the moment the person

is infected until the moment antibodies
appear in the blood – takes an average of
6 weeks but may take as long as 1 year.
 Unfortunately,
HIV antibodies do not kill HIV.....

The antibodies and HIV remain

in the bloodstream for the
rest of one's life and can be
detected only by a
special blood test.
Once inside the body, HIV slowly destroys the body's natural
defenses against illness

This process of steady, secret

destruction usually takes as long
as 6 to 8 years. If you do
not get sick during this period,
your body has no way of knowing
it is in danger.
 Why is it that secret
destruction takes as long as
6 – 8 years ?
 DISARMED
• The HIV attacks the body by stripping away
the protective armor of the immune system
specifically the ‘host’ cell: the T-cell.
• In time HIV ravages the T-cell population,
destroying a vital link in the immune
response.
 ATTACKED
• Out in the open without protection, the body
becomes easy prey to invading bacteria.

• With the T-cells effectively destroyed,

macrophages are unable to arouse the body’s
mighty arsenal of chemical weapons against the
attackers.

• Small incursions are free to grow into full-

fledged invasions.
OVERWHELMED
• Wave after wave of infectious organisms race
through the body (opportunistic infections).
• The remaining elements of the ravaged system
fight on valiantly, but without the T-cells, no
defense is possible for very long.
• The body is simply overrun by the vast number of
invaders.
• Finally, exhausted and debilitated ,
the vital organ systems of the body
begin to fail, and the battle is over.
Or simply means:
The person’s immune system stops
working; as a result, the individual’s body
cannot fight off disease.

With this, it will result to….

What is AIDS ?

A - cquired

I - mmune

D - eficiency

S - yndrome
Meaning: the

Immune System becomes

Deficient therefore the person

Acquires diseases

(Syndrome – characteristic patterns of signs and

symptoms of a disease)
 What is the difference between HIV infection and AIDS?

HIV infection
refers to the period from the time HIV enters the body to
the time the infected person becomes sick. Most
infected people have no symptoms and no illness for many
years after they are first infected.

AIDS – is the last and most serious stage HIV infection.

What I can see in a person
with AIDS?
• Anorexia
Fatigue
Weakness
Constant fever

Night sweats
Memory loss

Mental deterioration

Lack of coordination
 Constant Cough

Sore throat

Presence of associated opportunistic infections

Malignancies
CD4+ T-cell count can be used
to determine when to initiate
drug therapy and to monitor
the efficacy of therapy.

Other laboratory tests include

plasma HIV RNA quantitative
assay (or viral load) and HIV
resistance testing.
 Two laboratory tests used to
determine the efficacy of
treatment include CD4+ count and
HIV viral load.
CD4+ count reflects the immune
status and should increase in
response to ART.
HIV viral load is indicative of the
virus circulating in the blood,
which should decrease in response
to ART.
It is recommended that all who are HIV positive be
treated. Tools to promote medication adherence should
be provided, which include using a pill planner and
setting alarms.

Adherence improved because newer drug formulations

decreased dosing frequency or pill burden. Also, some
ARTs have been combined into one pill, to further
reduce pill burden. Newer ARTs have increased potency
and/ or have fewer side effects.
ADHERENCE to the HIV DRUG Regimen
Zidovudine can cause hepato-
toxicity, lactic acidosis, pancyto-
penia, and myelosuppression.

Therefore, ABC with differentials

will be monitored for indications
of pancytopenia and
myelosuppression.

A metabolic panel will be

checked for signs of
hepatotoxicity (elevated
ALT/AST) and lactic acidosis
(creatinine).
Efavirenz is the only NNRTI that crosses
the blood-brain barrier (cerebrospinal
fluid); neural tube defects to fetuses
can occur.

Neuropsychiatric symptoms can also occur,

such as dizziness, sedation, nightmares,
euphoria, and loss of concentration.

Efavirenz has effects on the liver and

increases the potential for liver failure.
Alcohol can increase the risk of
hepatotoxicity & neuropsychiatric
symptoms and should not be consumed
while taking efavirenz.
The patient should discuss the use of any herbal preparations with the
health care provider. St. John’s wort should not but taken with efavirenz.

Most of the side effects associated with efavirenz are CNS side effects
such as dizziness, insomnia, agitation, and hallucinations.

Gastrointestinal side effects include nausea and diarrhea. Vomiting is one

of the common side effects, not an adverse reactions.

Other side effects include rash. Seizures are adverse reactions, not side
effects.
All NNRTIs can cause hepatotoxicity, including hepatic failure; therefore,
liver panels should be monitored.
Transplant Drugs
 PASSIVE ACTIVE
• An antitetanus antibody that • The patient’s body will be the
comes from animal source one to develop an antibody
• e.g. Horse. There is a need for a • No need for a skin test
SKIN TEST for allergic reaction.
Cold Chain System
IMMUNOLOGIC AGENTS

Prepared by:
Prof. Florence D. Villarias
Reference:

LeFever Kee, Joyce; Hayes, Evelyn; McCuistion, Linda (2015). PHARMACOLOGY. A Patient- Centered
Nursing Process Approach. 8th ed. Elsevier. Inc. Pages 469 - 570