1. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 46 Immunizing Drugs and Biochemical Terrorism

2. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Immunity  Immune response  Antigens  Antibodies  Active immunization  Passive immunization

3. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Immunizing Biologicals  Biological antimicrobial agents  Also called biologicals  Antitoxins  Antisera  Toxoids  Vaccines  Used to prevent, treat, or cure infectious diseases

4. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Toxoids  Antigenic (foreign) preparations of bacterial exotoxins  Detoxified with chemicals or heat  Weakened or “attenuated”  Cannot revert back to a toxic form

5. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Toxoids (cont’d)  Stimulate one’s immune system to produce a specific antibody  Artificial active immune response  These antibodies protect against future exposures

6. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Vaccines  Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms  The weakened form prevents the person from contracting the disease

7. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

8. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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  The immunizations do not cause a full-blown infection

9. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Active Immunizing Drugs  BCG vaccine (tuberculosis)  Diphtheria, tetanus, and pertussis toxoids, several forms  Haemophilus influenzae type b conjugate vaccine  Hepatitis A and B virus vaccines

10. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Active Immunizing Drugs (cont’d)  Measles, mumps, and rubella virus vaccine, live—several forms  Pneumococcal bacterial vaccines  Poliovirus vaccine, several forms  Rabies virus vaccine

11. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Active Immunizing Drugs (cont’d)  Smallpox virus vaccine  Tetanus toxoid  Varicella virus vaccine (chickenpox)  Yellow fever virus vaccine  Many others

12. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Passive Immunization  Serum or concentrated immune globulins 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 to active immunization, but works faster

13. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Passive Immunization (cont’d)  Naturally acquired passive immunity  From mother to fetus through the placenta  From mother to infant through breast milk  Artificially acquired passive immunity  Acquired from an external source, such as injection of antibodies or immunoglobulins

14. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Passive Immunization Drugs  Antitoxins  Immunoglobulins  Snake and spider antivenins (antivenom)

15. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Passive Immunizing Drugs  Antivenins  Pit viper, coral snake  Black widow spider  Hepatitis B immune globulin  Immunoglobulin, various forms  Rabies immunoglobulin (human)

16. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Examples of Passive Immunizing Drugs (cont’d)  Rh 0 (D) immune globulin (RhoGAM)  Tetanus immunoglobulin  Varicella zoster immunoglobulin (chickenpox/shingles)

17. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications  Active immunization  Prevents infection caused by bacterial toxins or viruses  Provides long-lasting or permanent immunity  “Herd immunity”

18. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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)

19. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

20. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

21. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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)

22. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess patient’s health history, medication history, allergies, pregnancy status  Assess previous reactions and responses to immunizations  Assess for contraindications, including immunosuppression

23. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

24. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) Parents of young children should be encouraged to keep a journal of the child’s immunization status, with dates of immunizations and reactions, if any

25. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

26. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Illnesses Caused by Possible Bioterrorism Agents  Anthrax  Smallpox  Botulism  Tularemia  Viral hemorrhagic fever  Plague

27. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Possible Chemical Terrorism Agents  Sarin (nerve gas)  Mustard (blistering agent)  Cyanide (blood agent)  Chlorine (choking agent)  Radioactive elements  Ricin