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Immunizations | 마이메르시 MyMerci
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Immunizations

NCLEX Review Guide: Pharmacology - Immune System & Immunizations

Immune System Pharmacology

Immunosuppressants

  • Corticosteroids (Prednisone, Methylprednisolone) suppress inflammation and immune response by inhibiting T-cell activation and cytokine production. Monitor for infection, hyperglycemia, and delayed wound healing.
  • Cyclosporine prevents organ rejection by blocking T-cell activation and is nephrotoxic requiring regular kidney function monitoring. Grapefruit juice increases drug levels and should be avoided.
  • Methotrexate blocks folate metabolism to suppress immune function and requires folic acid supplementation to prevent severe side effects. Monitor CBC and liver function closely.

Clinical Scenario

A post-kidney transplant patient on cyclosporine develops elevated creatinine levels. The nurse should immediately notify the provider as this indicates potential nephrotoxicity requiring dose adjustment or alternative therapy.

Key Points

  • All immunosuppressants increase infection risk - monitor for fever, unusual symptoms
  • Never stop corticosteroids abruptly - taper gradually to prevent adrenal crisis
  • Live vaccines are contraindicated in immunocompromised patients

Immunostimulants

  • Interferons (Interferon alfa, beta) enhance immune response against viral infections and certain cancers by stimulating T-cell and macrophage activity. Common side effects include flu-like symptoms and depression.
  • Colony Stimulating Factors (Filgrastim, Pegfilgrastim) stimulate white blood cell production in patients with chemotherapy-induced neutropenia. Monitor absolute neutrophil count and watch for bone pain.
Important Alert: Monitor for signs of infection even when WBC counts improve, as newly produced cells may not be fully functional initially.

Immunizations

Live vs. Inactivated Vaccines

Live VaccinesInactivated Vaccines
MMR, Varicella, Rotavirus, FluMistDTaP, IPV, Hepatitis A/B, Influenza injection
Contraindicated in immunocompromisedSafe for immunocompromised patients
Single dose often provides immunityMultiple doses usually required
Can cause mild form of diseaseCannot cause the disease

Memory Aid

"LIVE vaccines are LIVELY" - MMR, Varicella, Rotavirus, FluMist (nasal). These are the main live vaccines to remember!

Pediatric Immunization Schedule

  1. Birth: Hepatitis B (first dose within 24 hours)
  2. 2 months: DTaP, IPV, Hib, PCV13, Rotavirus
  3. 6 months: Influenza vaccine (annually thereafter)
  4. 12-15 months: MMR, Varicella, Hib, PCV13
  5. 4-6 years: DTaP, IPV, MMR, Varicella boosters

Clinical Scenario

A 13-month-old child is due for MMR vaccine but has a mild cold with low-grade fever (100.2°F). The nurse should proceed with vaccination as mild illness is not a contraindication, but defer if fever is >101°F or child appears seriously ill.

Adult Immunizations

  • Tdap should be given once as an adult, then Td boosters every 10 years. Pregnant women receive Tdap during each pregnancy (27-36 weeks) to protect newborns.
  • Pneumococcal vaccines are recommended for adults >65 years and high-risk individuals. PCV13 followed by PPSV23 provides optimal protection.
  • Shingles vaccine (Shingrix) is recommended for adults >50 years in two doses, even if they've had shingles before or received the older Zostavax vaccine.

Commonly Confused Points

ConceptKey DifferenceNCLEX Tip
Immunosuppression vs. ImmunodeficiencySuppression is therapeutic/intentional; Deficiency is pathologicalContext clues - transplant = suppression
Active vs. Passive ImmunityActive = body makes antibodies; Passive = receives antibodiesVaccines = active; Immunoglobulins = passive
DTaP vs. Tdap vs. TdCapital letters = higher antigen contentDTaP for children, Tdap for adolescents/adults, Td for boosters
Common Pitfall: Don't confuse hepatitis A and B vaccines - Hep A is food/water-borne, Hep B is blood-borne and given at birth!

Study Tips & Memory Aids

Contraindications Memory Aid

"LIVE vaccines need LIVE immune systems" - Never give live vaccines to immunocompromised patients, pregnant women, or severely ill individuals.

Vaccine Storage

"Keep it COOL but don't FREEZE" - Most vaccines stored at 35-46°F. Freezing destroys many vaccines except varicella and zoster.

Quick Check Questions

  • □ Can you name the 4 main live vaccines?
  • □ What's the difference between DTaP and Tdap?
  • □ When is the first hepatitis B vaccine given?
  • □ Which patients cannot receive live vaccines?
  • □ What are signs of immunosuppressant toxicity?

Remember: You're building the foundation to protect and heal others. Every vaccine you administer and every immunosuppressant you monitor safely makes a difference in someone's life. You've got this, future nurse! 💪

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