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CHAPTER 46 Immunizing Drugs and Biochemical Terrorism 1/7/20161Winter 2013
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IMMUNITY Immune response … Antigens … Antibodies Active immunization Passive immunization 1/7/20162Winter 2013
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IMMUNIZING BIOLOGICALS Biological antimicrobial agents … Also called biologicals … Used to prevent, treat, or cure infectious diseases Antitoxins Antisera Toxoids and vaccines (immunizing biologicals) 1/7/20163Winter 2013
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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 1/7/20164Winter 2013
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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 1/7/20165Winter 2013
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VACCINES Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms The weakened form prevents the person from contracting the disease 1/7/20166Winter 2013
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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 1/7/20167Winter 2013
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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 Do not cause a full-blown infection 1/7/20168Winter 2013
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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 1/7/20169Winter 2013
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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 1/7/201610Winter 2013
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ACTIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D) Smallpox virus vaccine Tetanus toxoid Varicella virus vaccine (chickenpox) Yellow fever virus vaccine Many others 1/7/201611Winter 2013
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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 with active immunization, but works faster 1/7/201612Winter 2013
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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 1/7/201613Winter 2013
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PASSIVE IMMUNIZING DRUGS Antitoxins Immunoglobulins Snake and spider antivenins (antivenom) 1/7/201614Winter 2013
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PASSIVE IMMUNIZING DRUGS: EXAMPLES Antivenins … Pit viper, coral snake … Black widow spider Hepatitis B immune globulin Immunoglobulin, various forms Rabies immunoglobulin (human) 1/7/201615Winter 2013
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PASSIVE IMMUNIZING DRUGS: EXAMPLES (CONT’D) Rh o (D) immune globulin (RhoGAM) Tetanus immunoglobulin 1/7/201616Winter 2013
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INDICATIONS Active immunization … Prevents infection caused by bacterial toxins or viruses … Provides long-lasting or permanent immunity … “Herd immunity” 1/7/201617Winter 2013
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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) 1/7/201618Winter 2013
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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 1/7/201619Winter 2013
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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 1/7/201620Winter 2013
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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) 1/7/201621Winter 2013
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NURSING IMPLICATIONS Assess previous reactions and responses to immunizations Assess for contraindications, including immunosuppression 1/7/201622Winter 2013
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NURSING IMPLICATIONS (CONT’D) Before giving any drug, recheck the specific protocols for administration and schedules for administration 1/7/201623Winter 2013
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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 1/7/201624Winter 2013
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ILLNESSES CAUSED BY POSSIBLE BIOTERRORISM AGENTS Anthrax Smallpox Botulism Tularemia Viral hemorrhagic fever Plague 1/7/201625Winter 2013
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POSSIBLE BIOTERRORISM AGENTS Sarin (nerve gas) Mustard (blistering agent) Cyanide (blood agent) Chlorine (choking agent) Radioactive elements Ricin 1/7/201626Winter 2013
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