Immunizing Agents

Action:  Administration of an antigen to induce antibody formation (active artifical) or serum from immune people (passive artifical) 

Examples: 

Active Artificial - Vaccines, Toxoids 

Passive Artificial - Immune globlune products; rabies shot 

Use: To protect immune system from foreign attacks/cell injury 

Adverse Effects: pain at injection site / Fever / malaise / muscle ache / anaphylaxis 

Contraindications: during febrile illness / immunosuppressant treatment / immunodeficiency states (luekemia, lymphoma) / hematological cancers / pregnancy

Nursing Implications:  

• observe patient for 30 minutes
• check CDC for recommendations
• Refrigerate
• Maintain records
• avoid pregnancy w/ rubella & vericella for 3 months 
• tylenol for discomfort 
• educate 

Immunosuppressants 

"-limus" 

Action:  Interfere w/ production or function of immune cells, inhibits T lymphocytes 

Drug: 

• cyclosporine (Sandimmune) 

Use: prevention of organ rejection / arthritis 

Adverse Effects: tremors / headaches / oral candida / seizures / hypertension / nephrotoxicity / many drug interactions 

Contraindications: None given 

Nursing Implications:  

• need contraceptive use during Tx & 12 weeks after therapy ends 
• Take drug at same time every day 
• Take w/ meals 
• Use same solution consistently 
• Specific instructions to mix 

Tumor Necrosis Factor - α Blocking Agent 

"-mab", "-cept"

Action:  Neutralizes the activity of tumor necrosis factor - alpha 

Drug: 

• infliximab (Remicade) 

Use: rheumatoid arthritis / Chrohn's disease 

Adverse Effects: headache / dizziness / fatigue / anxiety / fever / rash 

Contraindications: None given 

Nursing Implications:  

• Aminister immediately after reconstituion 
• do not breastfeed 
• watch for blood in stools 
• monitor for TB 
• May be premedicated w/ acetaminophen or diphenhydramine 

Antineoplastic Agents 

Action:  Interfere w/ cell replication, w/ supply of nutrients, genetics in the nucleus 

Characteristics:

• cell cycle specific vs. non-cell cycle specific 
• specific percentage of kills 
• drug resistance
• harmful to rapidly dividing healthy cells
  

Only given by certified chemotherapy nurses

Given via central line 

Adverse Effects: GI / hair loss / mucositis / anemia / bleeding / neutropenia / thrombocytopenia 

Nursing Implications:  

• chemotherapy precautions from patients actively receiving chemo agents (in place up to 48 hours since last dose of therapy) 
• common side effects (listed above) 
• teach nutrition 

Antimetabolites

Action:  specific to a cell cycle --> enter cancer cells & deprive the cell of substances needed for formation of DNA 

Drug: 

• methotrexate (Rheumatrex)
• fluorouracil (5-FU)

Use: effective against rapidly growing tumors 

Adverse Effects: bone marrow suppression / mucositis / GI ulcerations / alopecia 

Nursing Implications:  

For Methotrexate:

• Avoid alcohol
• Avoid aspirin 
• avoid sunlight 
• Excreted by kidneys 

Plant Alkaloids

• originate from vinca genus plant
• are cell cycle specific 

Action:  stop mitosis

Drug: 

• vincristine (Oncovin) 

Use: Hodgkin's Lymphoma / Acute Lymphoblastic Leukemia (ALL)

Adverse Effects: severe tissue damage w/ inflitrate (extraversation) / peripheral nerve toxicity / alopecia / mucositis (stomatitis - in mouth) 

Contraindications: hepatic impairment 

Nursing Implications:  

• prepare patient for side effects
• start anti-emetics (anti-vomiting) before & maintain them on a schedule 
• Eat 
• alopecia solutions
• Urge use of soft tooth brush, rinsing, drinking fluids, & using systemic analgesics to combat mucositis 
• Watch for bleeding 

Alkylating Agents

• developed from mustard gas agents

Action:  Interfere w/ cell division and structure of DNA during ALL phases of cell cycle

Drug: 

• cyclophoshamide (Cytoxan)
• cisplatin (Platinol) 

Use: wide spectrum of malignancies / hematological & solid cancers (Platinol) 

Adverse Effects: cystitis (Cytoxan) / N/V, nephrotoxicity, ototoxicity (Platinol) 

Contraindications: None given 

Nursing Implications:  

For Cytoxan:

• take on empty stomach
• increase fluids 

Anti-Tumor Antibiotics 

Action:  Bind to DNA and block DNA & RNA transcription 

Drug: 

• doxorubicin (Adriamycin) 

Use: leukemia, breast, lung, & ovary cancer

Adverse Effects: bone marrow depression / GI / cardiotoxicity / tissue necrosis w/ IV infiltrate / alopecia 

(hepatic impairment increases these effects) 

Contraindications: None given 

Nursing Implications:  

Interferons 

Action:  Inhibits viral replication by reprogramming virus - prevents rapid growth of malignant cells 

Drug: 

• interferon alfa 2a (Roferon-A)
• interferon alfa 2b (Intron-A)

Use: hairy cell leukemia, Kaposi's sarcoma, chronic hepatitis 

Adverse Effects: flu-like symptoms / depression / suicide 

Nursing Implications:  

• read label 
• refrigerate
• do not shake 
• photosensitive 

Hematopoietic Drugs

Drug: 

• epoetin alfa (Epogen), subcut, IV

Use: to prevent anemia / renal failure / cancer / HIV 

Adverse Effects: Possible GI symptoms

Nursing Implications:  

• check blood counts 
• check blood pressure 

Colony Stimulating Agents

Action: Promotes the proliferation, differentiation, and activation of the cells that make granulocytes 

Drug: 

• filgrastim (G-CSF) (Neupogen)  

Use: prevent infection , stimulate arteriole growth 

Adverse Effects: bone pain / redness at injection 

Nursing Implications:  

• administer 24 hours after chemotherapy 
• advise patient to avoid infections 

Interleukins

Action:  activates cellular immunity, inhibits tumor growth, prevents rapid growth of malignant cells 

Drug: 

• aldesleukin (Proleukin) 

Use: renal cancer , melanoma, HIV, Kaposi sarcoma