1. Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS CHAPTER Vaccines and Immunoglobulins 14

2. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Multimedia Directory Slide 7Lymphatic System Animation

3. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immune System Rids foreign substances from blood and lymph, combats infectious diseases, maintains tissue fluid balance, absorbs fats

4. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Lymphatic System Vessels: Network of lymphatic vessels beginning in peripheral tissues and ending at connections to the venous system Fluid: Lymph flows through lymphatic vessels

5. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Lymphatic System Lymphoid organs: Lymphoid organs are connected to lymphatic vessels; contain large numbers of lymphocytes –Examples: lymph nodes, spleen, and thymus

6. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 14-1 The lymphatic system includes the tonsils, lymph nodes, spleen, and lymphatic vessels. Within the lymph nodes are the macrophages and lymphocytes.

7. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Lymphatic System Animation Click on the screenshot to view an animation showing the lymphatic system. The animation may take a moment before playing. Back to Directory

8. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Lymphocytes Lymphocytes (white blood cells) respond to: –Invading pathogens, such as bacteria or viruses –Abnormal body cells, such as cancer cells –Foreign proteins, such as toxins released by some bacteria Lymphocytes produce special proteins called antibodies.

9. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Three Classes of Lymphocytes T cells (thymus-dependent): attack foreign cells or body cells infected by viruses B cells (bone marrow–derived): can differentiate into plasma cells, which are responsible for the production and secretion of antibodies

10. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Three Classes of Lymphocytes NK cells (natural killers): attack foreign cells, normal cells infected with viruses, and cancer cells that appear in normal tissue

11. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunity State or condition of being resistant to invading microorganisms Normally acquired either by contracting a disease and then developing immunity to it, or by being vaccinated with proteins from the causative agent

12. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Cell-mediated Immunity T lymphocytes are sensitized by first contact with a specific antigen. T cells and macrophages (immune cells derived from monocytes) destroy antigen. T cells attack antigens directly, rather than produce antibodies.

13. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Cell-mediated Immunity If cell-mediated immunity is lost, as in AIDS, the body is unable to protect itself against many viral, bacterial, and fungal infections.

14. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Humoral Immunity B cells produce circulating antibodies to act against an antigen. B cells form daughter lymphocytes, which develop into plasma cells that produce antibodies and release them into the circulation at the lymph nodes.

15. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Humoral Immunity Some activated B cells turn into memory cells, which continue to produce small amounts of antibody after infection is overcome.

16. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Active Immunity A form of acquired immunity that develops in an individual in response to an immunogen (antigen). May be naturally acquired by exposure to an infectious disease or artificially acquired by receiving active immunizing agents (vaccines). Vaccination is active immunization.

17. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Passive Immunity Effectors of immunity, which are called immunoglobulins or antibodies, are transferred from immune individual to another. Immunoglobulin G (IgG) antibodies transfer from mother to fetus across placental barrier.

18. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Passive Immunity Onset of passive immunity is quicker but of shorter duration than active immunity.

19. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Figure 14-2 Types of immunity.

20. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunizing Agents A vaccine is a preparation of killed microorganisms, living attenuated (reduced virulence) organisms, or living virulent organisms that are administered to produce or artificially increase immunity to a particular disease.

21. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Active Versus Passive Agents Active: usually administered to patients prior to disease exposure to provide long-term, even permanent, protection against the diseases Passive: older than active agents; comprised various antitoxins derived from animals; had problems in efficacy and safety

22. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines Most bacterial vaccines contain killed bacteria or their components. Another type of vaccine contains toxoids (protein toxins that have been modified to reduce their hazardous properties without significantly altering their antigenic properties); oldest of these are diphtheria and tetanus toxoid.

23. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 14-1 Bacterial Vaccines

24. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 14-1 (continued) Bacterial Vaccines

25. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Table 14-2 Inactivated Virus Vaccines

26. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines: Mechanism of Action Exposure to an antigen (a virus or bacterium) in a relatively harmless form sensitizes immune cells. On reexposure, memory of previous challenge triggers an immune response more quickly. As immune processes are stimulated by this agent, active immunity occurs.

27. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines: Use Used against bacterial infections: diphtheria, tetanus, pertussis, pneumonia, tuberculosis, typhoid, cholera, meningitis, plague, and Q fever. Used against viral infections: measles, mumps, rubella (MMR), poliomyelitis, hepatitis A and B, influenza, rabies, and yellow fever.

28. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines: Adverse Effects Common: localized inflammation at injection site, mild fever, headache, malaise, nausea, dizziness Serious: convulsions resulting in brain damage; allergic reactions that could lead to anaphylactic shock

29. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines: Contraindications Avoid in acute febrile illness, pregnancy, lactation, and in those who are known to have developed anaphylactoid reactions with previous vaccines. Interactions: chance increases when multiple vaccines are given simultaneously

30. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Vaccines: Patient Teaching Instruct patients to report severe reaction at injection site. Advise patients to seek immediate medical care for difficult breathing, high fever, convulsions, or extreme fatigue.

31. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Standards for Childhood Immunization Childhood immunization remains one of the most important public health measures. Children should be immunized against 8 infectious diseases, hepatitis A (in areas of high incidence), and human papillomavirus (girls aged 10 to 11).

32. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Routine Immunization Reduces Disease Immunization for diphtheria, tetanus, and pertussis (DTP) has been routinely given in the US since the late 1940s, resulting in dramatic decrease in incidence of these diseases.

33. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Childhood Vaccines Meningitis caused by Hemophilus influenzae type b: (HibTiter, PedvaxHIB) Polio: Salk inactivated vaccine (IPV, IPOL) and Sabin live vaccine (note: the live oral vaccine is no longer used in the United States) Measles, mumps, and rubella: (MMR vaccine)

34. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Childhood Vaccines Hepatitis B infection: (Energix B, Heptava B vaccine) and hepatitis B immunoglobulin Varicella (chickenpox): (Varivax) Hepatitis A: (Havrix, VAQTA) Human papillomavirus (HPV): (Gardasil)

35. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Routine Immunization for Adults Younger than Age 65 Immunization recommended for adults from ages 18 to 65 years is booster (dose given to increase the effectiveness of the original medication) of adult diphtheria and tetanus toxoid every 10 years. New vaccine for shingles (Zostavax) now recommended for adults 60 and older.

36. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Circumstances That Require Adult Booster Immunization Pediatric immunizations should be updated for those: –Who travel internationally –Women of child-bearing age who may become pregnant –With chronic illnesses

37. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Other Adult Immunizations Annual influenza immunization (Fluzone, FluShield): recommended for those at risk for influenza complications Pneumococcal vaccine (Pneumovax 23, Pnu-Immune 23): for people with any major immunosuppression condition, pulmonary or cardiovascular diseases, chronic hepatic or renal disorders, and diabetes mellitus

38. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini International Adult Immunizations International Certificate of Vaccination may be required for: –Yellow fever –Hepatitis A (Havrix, VAQTA) Cholera, typhoid, and plague vaccines may occasionally be suggested

39. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Other Adult Immunizations Hepatitis B vaccine (Energix B, Heptavax B): for health-care workers with exposure to human blood and tissues BCG vaccine: for extremely high-risk individuals –BCG vaccine also used to treat bladder cancer

40. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunization Standards for Adults Older than Age 65 Boosters of diphtheria and tetanus toxoid every 10 years Booster of pneumococcal vaccine (Pneumovax 23, Pnu-Immune 23): those at highest risk for fatal pneumococcal disease every 5 years after initial dose

41. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Influenza and Pneumonia Immunization All individuals 65 and older should receive: –Annual influenza immunization –A single dose of pneumococcal vaccine Individuals who received pneumococcal vaccine prior to age 65 should receive a booster dose if 5 years have passed since first dose.

42. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunoglobulins (Ig) Derived from human plasma containing antibodies that have been formed by the body to specific antigens Two types: one administered intramuscularly and one administered intravenously

43. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunoglobulins: Use Passive prevention or modification of hepatitis A and measles in susceptible persons (HIV positive) Prevention of varicella in immunocompromised patients if varicella-zoster immunoglobulin is not available

44. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunoglobulins: Use Prevention of fetal damage in women exposed to rubella during first trimester of pregnancy

45. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunoglobulins: Adverse Effects Common: local pain and tenderness at injection site Serious: anaphylactic reactions can occur

46. Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini Immunoglobulins: Contraindications IGIM must not be injected intravenously because it can cause serious anaphylactic reactions.