1. Immunizing Drugs and Biochemical Terrorism
Chapter 49
Immunizing Drugs and Biochemical Terrorism
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Immunity
Immune response
Antigens
Antibodies
Active immunization
Passive immunization
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3. Artificial Active Immunization
The body is exposed to a relatively harmless form of an antigen
The immune system is stimulated and “remembers” this antigen if subsequent exposures occur
Does not cause a full-blown infection
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4. Natural Active Immunization
Person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism
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5. Biological Antimicrobial Drugs
Also called biologicals
Antitoxins
Antisera
Toxoids and vaccines (immunizing biologicals)
Used to prevent, treat, or cure infectious diseases
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Toxoids
Antigenic (foreign) preparations of bacterial exotoxins
Detoxified with chemicals or heat
Weakened or “attenuated”
Cannot revert back to a toxic form
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Toxoids (cont’d)
Stimulate one’s immune system to produce a specific antibody
Artificial active immune response
These antibodies protect against future exposures
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Vaccines
Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms
These slight alterations in the bacteria and viruses prevent the person injected from contracting the disease
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Vaccines (cont’d)
Also stimulate the production of antigens against a specific antibody
Vaccinations with live bacteria or virus provide lifelong immunity
Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically
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10. Active Immunizing Drugs: Examples
BCG vaccine (tuberculosis)
Diphtheria, tetanus, and pertussis toxoids, several forms
Haemophilus influenzae type B conjugate vaccine
Hepatitis A and B virus vaccines
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11. Active Immunizing Drugs: Examples (cont’d)
Measles, mumps, and rubella virus vaccine, live—several forms
Pneumococcal bacterial vaccines
Human papilloma virus vaccine (Gardasil)
Poliovirus vaccine; several forms
Rabies virus vaccine
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12. Active Immunizing Drugs: Examples (cont’d)
Smallpox virus vaccine
Tetanus toxoid
Varicella virus vaccine (chickenpox)
Yellow fever virus vaccine
Many others
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13. Classroom Response Question
A patient has an order for the varicella vaccine. It is most important for the nurse to assess the patient for
use of high dose systemic steroids in the past month.
allergy to aspirin.
allergy to eggs.
history of hypertension.
Correct answer: A
Rationale: Varicella vaccine is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month. It is also recommended that salicylates be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye’s syndrome.
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Passive Immunization
Serum or concentrated immunoglobulins from humans or animals are injected into a person
The substances needed to fight off invading microorganisms are given directly to a person
The immune system is bypassed
Short-lived compared with active immunization, but works faster
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15. Artificial Passive Immunization
Administration of serum or concentrated immunoglobulins
Provides the inoculated person the substance needed to fight off the invading microorganism
Bypasses the host’s immune system
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16. Natural Passive Immunization
Antibodies are transferred
From mother to fetus through the placenta
From mother to infant through breast milk
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17. Passive Immunizing Drugs
Antitoxins
Immunoglobulins
Snake and spider antivenins (antivenom)
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18. Passive Immunizing Drugs: Examples
Antivenins
Pit viper, coral snake
Black widow spider
Hepatitis B immune globulin
Immunoglobulin, various forms
Rabies immunoglobulin (human)
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19. Passive Immunizing Drugs: Examples (cont’d)
Rho(D) immune globulin (RhoGAM)
Tetanus immunoglobulin
Varicella-zoster immunoglobulin
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20. Classroom Response Question
A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was over 20 years ago. Which immunization therapy will he receive at this time?
He cannot receive any type of immunization therapy.
Tetanus immunoglobulin
Tetanus toxoid, adsorbed
Tetanus and diphtheria toxoid (Td) booster
Correct answer: B
Rationale: Vaccines and toxoids rely on a person’s immune system in order to work. Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount an immune response. In these situations, passive immunizing drugs such as immunoglobulins are warranted.
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Indications
Active immunization
Prevents infection caused by bacterial toxins or viruses
Provides long-lasting or permanent immunity
“Herd immunity”
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Indications (cont’d)
Passive immunization
Antitoxins, antivenins, immunoglobulins
Minimizes effects of poisoning by the venoms of spiders and certain snakes
Provides quick immunity before a person’s own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses)
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Indications (cont’d)
CDC/Department of Health and Human Services recommendations for adult and pediatric immunizations (U.S.)
Provide specific dosages and intervals for immunizations
Refer to the CDC website for current recommendations
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24. Classroom Response Question
The zoster vaccine (Zostavax) is used in which situation?
To prevent chickenpox in children
To prevent chickenpox in children who have been exposed to herpes zoster
To prevent postherpetic neuralgia in patients who have shingles
To prevent reactivation of the zoster virus that causes shingles in patients age 60 or older
Correct answer: D
Rationale: Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. The vaccine is recommended for patients 60 years or older to prevent reactivation of the zoster virus that causes shingles. The vaccine does not prevent postherpetic neuralgia. It can be given to patients who have already had shingles. The vaccine should not be used for the prevention of chickenpox and should not be given to children.
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Adverse Effects
Range from mild and transient to very serious or life threatening
Minor effects
Fever, minor rash, soreness at injection site, itching, adenopathy
Severe effects
Fever higher than 103° F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others
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26. Adverse Effects (cont’d)
Minor reactions
Treated with acetaminophen and rest
Serious or unusual reactions
Serum sickness
Report serious or unusual reactions to the Vaccine Adverse Event Reporting System (VAERS)
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27. Classroom Response Question
After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9° F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate?
Tell the mother there’s nothing to worry about and that these symptoms are normal and will go away
Tell the mother that she should bring her baby in to the office for an examination
Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations.
Complete a Vaccine Adverse Event Reporting System form (VAERS).
Correct answer: C
Rationale: These minor reactions may be treated with acetaminophen and rest. Reactions that are more serious or unusual should be reported with the Vaccine Adverse Event Reporting System (VAERS).
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Nursing Implications
Assess patient’s health history, medication history, allergies, pregnancy status
Assess previous reactions and responses to immunizations
Assess for contraindications, including immunosuppression
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29. Nursing Implications (cont’d)
Before giving any drug, recheck the specific protocols for administration and schedules for administration
Follow manufacturer’s guidelines for drug storage, administration, routes, and site of administration
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30. Nursing Implications (cont’d)
Encourage parents of young children to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any
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31. Nursing Implications (cont’d)
If discomfort occurs at the injection site, apply warm compresses and give acetaminophen
Do not give aspirin to children
Monitor for therapeutic responses and adverse reactions
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32. Illnesses Caused by Possible Bioterrorism Agents
Anthrax
Smallpox
Botulism
Tularemia
Viral hemorrhagic fever
Plague
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33. Possible Bioterrorism Agents
Sarin (nerve gas)
Mustard (blistering agent)
Cyanide (blood agent)
Chlorine (choking agent)
Radioactive elements
Ricin
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34. Classroom Response Question
A patient is admitted to the emergency department with cyanide toxicity. Which antidote drugs does the nurse expect to administer?
atropine
pralidoxime
pyridostigmine
sodium nitrite
Correct answer: D
Rationale: Specific antidote drug therapy for cyanide toxicity includes the chemicals amyl nitrite (by inhalation) and sodium nitrite and sodium thiosulfate (both by injection). Specific antidote drugs for sarin include atropine, pralidoxime, and pyridostigmine.
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35. Classroom Response Question
Which statement regarding possible bioterrorism agents does the nurse identify as being true?
Gentamicin and tetracycline are useful in the treatment of botulism.
Tetracycline and ciprofloxacin are indicated in the treatment of tularemia.
Vaccination for plague is recommended for public defense personnel in the United States.
Antibiotics are useful in the treatment of smallpox.
Correct answer: B
Rationale: Antibiotics are of no benefit in the treatment of botulism. No vaccine currently available in U.S. for the treatment of plague. A vaccine is available for the treatment of small pox and may be effective for up to 3 days after exposure. The antiviral drug cidofovir is possibly effective; however, antibiotics are not effective.
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