DRUGS USED FOR DE-ADDICTION

❑Addiction is a chronic, relapsing brain disease that leads to

medical, mental, and social complications.
❑Deaddiction refers to a method of addressing and overcoming
addiction to drugs, alcohol, or other substances. It is also
referred to as addiction treatment or substance abuse treatment.
❑Drugs used for addiction can be broadly categorized into
stimulants, sedatives, inhalants, hallucinogens, alcohol,
solvents, opioids and cocaine.
Stimulants Drugs
❑Include drugs like nicotine and amphetamine which can lead
to mood swings, excessive speech and manifestations of
anxiety.
Sedatives
❑Include alcohol and tranquilizers which can lead to poor
concentration, slowing of the CNS, motor incoordination and
deterioration of psychomotor performance.
Inhalants

❑These are solvent, paint thinners and aerosol sprays whichm could lead to hallucinations,
impaired judgement, severe headache, slurred speech and rashes around nose and mouth.

Hallucinogens

❑Include LSD and cannabis which can lead to mood swings, impaired judgement and altered
perception to space and time.

Alcohol

❑Apart from acting as depressants it lowers inhibition, slows the CNS as well as reaction time.
Solvents like fuels, paints and glue can lead to hallucination and altered perception.
Treatment for De-addiction
Substance use disorders are preventable and treatable and
treatment in order to be successful needs to be individualized
and should include medication, behavioral interventions and
peer support.
Purpose of Treatment
❑To reduce the major symptoms of the illness.
❑ To teach, counsel, and motivate the person.
❑To monitor their symptoms and manage threat of relapse.
❑To improve functioning both socially and physically.
Treatment
It needs to be individualized hence needs of patient should
be known and matching treatment setting, interventions,
and services to particular problems and needs is critical for
the success in returning to productive functioning in the
family, workplace, and society.
 Duration of Treatment
It cannot be predetermined and good outcome is contingent on
adequate length of treatment. Less than 90 days’ participation of
the person has limited or no effectiveness.
Methadone maintenance is required minimum for 12 months or
more for opioid de-addiction. Medication detoxification is must
for associated withdrawal symptoms and is generally the first
step to treatment but not suitable for long-term abstinence
 DRUGS USED FOR DEADDICTION

Substance-induced disorders include intoxication, withdrawal,

and substance-induced mental disorders such as psychotic

disorders, bipolar disorder, depressive disorder, anxiety disorder,

obsessive-compulsive disorder, sleep disorders, sexual

dysfunction, delirium, and neurocognitive disorders.

 OPIOID DRUGS

Opioids are the semisynthetic chemical derivatives of morphine

(such as heroin) and others are fully synthetic (such as pethidine

and methadone). Prolonged opioid use results in tolerance and

lowering of pain threshold, therefore apparently mild pain may

be perceived as more severe.

Naloxone
Naloxone has been the only antidote to opioids for over 50
years, and the drug has been readily available as a parenteral
formula.
Indications
❑ Opioid toxicity
❑To reverse respiratory depression from opioid use.
❑Accidental or intentional overdose and acute or chronic
toxicity.
Mechanism of Action
Naloxone is a pure, competitive opioid antagonist with a high
affinity for the mu-opioid receptor, allowing for reversal of the
effects of opioids
Route and Dosage
Naloxone administration is usually via intravenous, but if no IV
access is available, it can also be administered via an IO line,
subcutaneously (SQ), IM, or via the intranasal (IN) route.
❑Initial dose, usually 0.04 mg to 0.1 mg IV.
❑Larger initial doses, such as 1 mg to 2 mg IV or 2 mg
intranasal, IM, or SQ.
Contraindications
No absolute contraindications.
Adverse Effects
❑Anxiety
❑ Aggression
❑ Nausea, vomiting
❑ Diarrhea
❑Abdominal pain, and Rhinorrhea.
Naltrexone
It is an opioid antagonist used to treat alcohol use disorder and
opioid dependence.
Indications
❑Alcohol use disorder
❑Opioid use disorder
Naltrexone
It is an opioid antagonist used to treat alcohol use disorder and
opioid dependence.
Indications
❑Alcohol use disorder
❑Opioid use disorder
 Mechanism of Action
❑Block the mu-opioid receptor.
❑Blocks the effect of opioids and
prevents opioid intoxication and
physiologic dependence on opioid
users.
❑Naltrexone also modifies the
hypothalamic-pituitaryadrenal axis
to suppress ethanol consumption.
Contraindications

❑Failure to pass a naloxone challenge test or positive urine

screen for opioids.

❑Opioid dependence or current use of opioid analgesics,

including partial agonists.

Route and Dosage

Oral dosage: Available as an oral tablet (50 mg), and the usual

dose for alcohol treatment is 50 to 100 mg.

Dosing should start at 25 mg orally.

Injection dosage: Available in a depot injection (380 mg), IM.

Contraindications

Same as naloxone

Adverse Effects

Gastrointestinal irritation such as diarrhea, abdominal cramps.

Methadone

It is a drug that is used to control and treat opioid use disorder as

well as an analgesic in chronic pain. It is a long-acting synthetic

opioid agonist drug.

Indications

Detoxification and treatment of opioid use disorder.

Mechanism of Action

Methadone is a synthetic opioid and full agonist at the μ-opioid

receptor and induces other opioid receptors, act to modulate various

neurochemical activities involved in analgesia, euphoria, and sedation.

Activation of the μ-receptors by methadone activates the same

pathways.
Contraindications

CNS depression and respiratory compromise; hence it should be used with extreme caution

in patients with CNS related pathologies such as trauma, increased intracranial pressure,

dementia, delirium, etc.

Drug Interactions

Methadone should not be used in conjunction with medications or substances with similar

depressant effects such as other opioids, benzodiazepines, alcohol, antipsychotics, etc.

unless necessary.
Dosage and Route

General: Oral dosing starts at 30 to 40 mg/day and is titrated upwards by 10 to 20

mg/week to an optimal of 80 to 150 mg/day. Long-term treatment is optimal if it lasts

for at least 14 months.

Pregnancy: Continue maintenance treatment in women who are pregnant and have

opioid use disorder. Consider treating with buprenorphine instead due to less

sedation on the neonate.

Adverse Effect

➢Diaphoresis/flushing

➢Pruritis

➢Nausea

➢ Dry mouth

➢Constipation

➢ Sedation
Toxicity

Overdose of methadone can cause severe respiratory depression and

can lead to demise. Signs of overdose include extreme lethargy,

somnolence, stupor, coma, miosis, bradycardia, hypotension,

respiratory sedation, and cardiac arrest.

Buprenorphine

It a synthetic opioid, treats pain and opioid use syndrome. It is a synthetic

variant of thebaine, an alkaloid molecule found in poppy flowers.

Indications

Pain and opioid addiction.

Mechanism of Action

Buprenorphine is a partial agonist at the mu receptor that partially activates opiate

receptors.

Route and Dosage

❑Oral, Parenteral (subdermal or subcutaneous implant and intravenous (IV) or

intramuscular (IM) injections).

❑Initial dose is 2 to 4 mg.

❑Maximum of 24 mg in one day. Most patients respond to doses between 8 to 12

mg per day.
Toxicity

Respiratory depression and/or hypotension

Confusion, dizziness, pinpoint pupils, hallucinations, hypotension, respiratory

depression, seizures, or coma.

Contraindication

Hypersensitivity reaction

Adverse Effects

Buprenorphine exerts some anticholinergic (depression, hypotension, QT

prolongation, and lower seizure threshold).
ALCOHOL DEADDICTION

Treatment of alcoholism can be divided into three stages. Initially, the person has
to be medically stabilized. Next, he or she must undergo a detoxification process,
followed by long-term abstinence and rehabilitation.

Alcohol Detoxification

This stage involves stopping alcohol consumption. This is very difficult for an
alcohol-dependent person, requires extreme discipline, and usually requires
extensive support.
ALCOHOL DEADDICTION

Treatment of alcoholism can be divided into three stages. Initially, the person has
to be medically stabilized. Next, he or she must undergo a detoxification process,
followed by long-term abstinence and rehabilitation.

Alcohol Detoxification

This stage involves stopping alcohol consumption. This is very difficult for an
alcohol-dependent person, requires extreme discipline, and usually requires
extensive support.
Drug of Choice

Benzodiazepines.

Treatment for Alcoholism

Vitamin supplements (most importantly thiamine).

Disulfiram

Disulfiram is one of three medications used to treat alcoholism. It is a second-line

choice (acamprosate and naltrexone are first-line therapies).

Indications

Alcohol dependence.
Mechanism of Action

It interferes with alcohol metabolism, resulting in a metabolite that makes the

person very uncomfortable and nauseated when consuming alcohol.

Disulfiram inhibits aldehyde dehydrogenase (ALDH1A1) irreversibly by

competing with nicotinamide adenine dinucleotide (NAD) at the cysteine residue
in the enzyme’s active site.
ALDH1A1 is a liver enzyme that converts acetaldehyde to acetate via
the primary oxidative pathway of alcohol metabolism. Alcohol
consumption increases serum acetaldehyde at therapeutic doses of
disulfiram, causing diaphoresis, palpitations, face flushing, nausea,
vertigo, hypotension, and tachycardia
Contraindications

❑Coronary artery disease or heart failure.

❑Psychosis as it may worsen the patient's psychosis.

❑Patients receiving metronidazole, paraldehyde, alcohol, or alcohol-

containing preparations (sauces, cough mixtures, vinegar).
Drug Interactions

Amitriptyline, imipramine, phenytoin, chlordiazepoxide, diazepam,

omeprazole, and acetaminophen.

Slow elimination of disulfiram may give rise to the disulfiram-alcohol

reaction up to fourteen days after the discontinuation. Disulfiram-alcohol
reactions have been reported in patients exposed to environmental chemical
compounds containing alcohol.
Toxicity

Overdose require supportive care via supplemental oxygen, cardiac

monitoring, and intravenous fluids may be necessary.

Role of Nurse

❑Monitor for signs and symptoms of hepatitis, including fatigue,

weakness, anorexia, nausea, vomiting, jaundice, malaise, and dark urine.

❑Complete blood count and serum chemistries should also require routine
monitoring.
Acamprosate

Acamprosate (a kam' proe sate) is N-acetylhomotaurine, a synthetic amino acid

analogue similar to gamma aminobutyric acid (GABA) and taurine that has been

shown to decrease alcohol craving

Indication

❑It is used as an alcohol deterrent in management of alcohol dependence and

abuse.

❑Maintenance of alcohol abstinence.

Dose and Route

❑Delayed release tablets of 333 mg generically and under the brand name
Campral.

❑The maintenance dose is 666 mg three times daily.

Mechanism of Action

Acamprosate appears to function as a neurotransmitter which acts as a GABA

agonist and partial glutamate (N-methyl-D-aspartate [NMDA]) antagonist, but its

precise mechanism of action in decreasing alcohol craving is unknown.

Side Effects

❑Fatigue, anorexia, diarrhea, flatulence, nausea, headache, dizziness,

insomnia, paresthesia, itching and sweating.

❑Rare but potentially serious adverse events include suicidal ideation and
behavior and hypersensitivity reactions.
 TOBACCO DEADDICTION

There are over 4000 chemicals in tobacco smoke, many of which are
poisonous, and 43 that have been proven to be carcinogens. These
chemicals include nicotine, tar and carbon monoxide.

Nicotine is the short-acting psychoactive drug in tobacco that causes

addiction among smokers. The strength of addiction is said to be as
powerful or more so than that of heroin.
Bupropion

It is an antidepressant medication that is now also used in smoking cessation.

Indication

Smoking cessation

Mechanism of Action

Bupropion acts to a lesser degree on nicotinic and serotonin receptors.

Route and Dose

❑Immediate-release tablets are available in 75 mg and 100 mg strength.

❑ Extended-release forms of 12-hour hydrochloride salts formulations are available in 100

mg, 150 mg, and 200 mg tablets.

Adverse Side Effects

➢Headache

➢Flushing

➢Tachycardia

➢Hypertension
 ROLE OF NURSE

Monitor activities,
perform medication
reconciliation before
drug administration
Bupropion is
pregnancy class C
and requires caution

Observe for adverse

side effects.
 Varenicline

Varenicline is the first drug of choice for smoking cessation because it has
demonstrated a significant effect in preventing both short-term and long-term
relapse. Due to its partial agonist properties, varenicline has also been

shown to have a lower risk of withdrawal symptoms than other drugs.

Mechanism

Acts as a partial nicotine receptor agonist similar to cytisine. Varenicline

substantially lowers the stimulation of the mesolimbic dopamine system
associated with nicotine addiction due to its partial agonism.

Indication

Varenicline is used as a smoking cessation aid to help people stop smoking in

conjunction with education and counseling.
Contraindications

❑ Severe psychiatric symptoms, including suicidal ideation.

❑ Hypersensitivity reactions

Dose and Route

❑Starting Week: 0.5 mg orally once daily on days 1 to 3 and is increased to 0.5
mg twice daily on days 4 through 7. It should start one week before the target
quit date.

❑Continuing Weeks: 1 mg twice daily after day 8 for 11 weeks.

DRUGS USED IN CPR AND EMERGENCY
 HYDROCORTISONE

Hydrocortisone is a naturally occurring corticosteroid which has glucocorticoid

and significant mineralocorticoid activity). It is used in emergency conditions
(anaphylactic Shock, allergic conditions, Status asthmaticus, angioedema

of larynx and Acute renal insufficiency) as It works on the immune system to

help relieve swelling, redness, itching, and allergic reactions.
 DEXAMETHASONE

It is long acting glucocorticoid and used to treat anaphylactic Shock,

severe allergic and inflammatory reactions as emergency condition. It
suppresses the migration of neutrophils which decrease proliferation
of lymphocyte colony and inflammation . Dose is 0.5-5 mg/day oral.
 INTRAVENOUS FLUIDS AND ELECTROLYTE REPLACEMENT

Fluid and electrolyte therapy is given to patients to maintain normal fluid and
electrolyte balance in body to maintain normal functioning of all body systems.
Intravenous fluids have different osmolarity which are used in day to day
practice.
Isotonic Fluid

This fluid has same osmolality to extracellular fluid (ECF). Both extracellular
and intracellular fluid (ICF) have same osmolality so there will be no movement
of water between ECF and ICF.

Hypotonic

This fluid has less osmolality as compared to plasma. E.g., normal saline 0.45%
and 0.33% sodium chloride. It is used in patients with hyponatremia and other
hyperosmolar conditions.
Hypertonic

This fluid has higher osmolality (375 mEq/L and greater) as compared to
plasma. E.g., 3% sodium chloride, 5% sodium chloride, 25% and 50% dextrose
solution.
 COLLOIDS

Colloids have large proteins and are used as plasma expanders in case of burns,
trauma, tissue damage and hypovolemic shock. e.g., albumin, dextran, hydroxyl
ethyl starch (HES) and fresh frozen plasma, blood products (cryoprecipitates
and platelets) and blood product synthetics (gelafusin or gelafundin).
 IV FLUIDS AND ELECTROLYTE REPLACEMENT

Intravenous (IV) administration is administration of fluids and medicine

directly into a vein which is the quickest way to deliver fluids and medicine to
the body. It is also known as IV therapy, IV drip, or simply IV. Typically have
no serious consequences. IV route is used for fluid/ electrolyte administration
where the normal blood volume

is 4.5-5 L and IV fluids do not replace blood or carry O2. They introduce
medications which has immediate drug absorption and effects.
✓Care should be taken to maintain sterile conditionswhen preparing and using
the site.

✓ If severe edema, burns, or lacerations: Choose another site. Too much

swelling at a site can prevent the fluid from entering the body.

✓The chosen site must be constantly monitored for signs of infections,

swelling, or other problems that create additional medical issues. When the
needle is removed, the site is usually covered with a bandage to help prevent
infection.
 Adverse Effects with IV Administration

✓Phlebitis/Thrombophlebitis

✓ Cellulitis

✓Necrosis (due to extravasation)

✓Septicemia

✓Pulmonary edema- caused by rapid infusion.

✓Pulmonary embolism - Increased risk present inpatients having lower extremity

thrombosis.
 Method of Administrating IV Drugs

There are three main methods of intravenous drug administration.

❖Bolus

❖ Short infusion

❖ Continuous infusion.
 DRUGS USED FOR THE TREATMENT OF POISONING
✓Leading causes of pharmaceutical death or poisoning
✓ Analgesics
✓Tricyclic antidepressants
✓Sedative/hypnotics
✓Stimulants and street drugs
✓ Cardiovascular drugs
✓Alcohols
✓Insecticides and pesticides
Mechanisms of Toxicity

✓ Interfere with O2 transport or tissue utilization of oxygen - (example cyanide, CO).

✓ CNS - (example - cocaine, sedatives).

✓ANS - (example organophosphates).

✓Lungs - (example paraquat).

✓Cardiovascular system (example TCA, Ca++ channel blockers).

✓ Direct local damage (example acids, bases).

✓Delayed effects on liver or kidneys (example acetaminophen, metals).

 Decontamination Methods for Poisoning

Aim is to prevent absorption and minimize exposure. Many “standard” practices

now virtually extinct.

❑ Forced emesis, forced lavage, charcoal “anytime”.

❑ Removal of contaminated clothing, substances on skin or in eyes.

 Decontamination Methods for Toxins
✓Gastric Lavage
✓ Used far less now than in the past.
✓“Stomach pumped,” Large tube inserted into stomach, suctioned, and lavaged.
✓ Risk of perforation, aspiration.
Whole Bowel Irrigation
✓Cleanses gut of intoxicants.
✓Polyethylene glycol (PEG) solutions at 2 liters/hour.
✓ Effective for body substances poorly absorbed by charcoal (e.g., Iron, Lithium).
Activated Charcoal

✓Activated charcoal is a standard therapy for gut decontamination after self-

poisoning.

✓Works by substances being adsorbed to the surface which is size dependent.

✓Window of opportunity around one hour post ingestion.

Ipecac Antidotes

Ipecac is commonly made from alcohol extraction of the plants Cephaelis

acuminata and Cephaelis ipecacuanha. The extract is commonly mixed with
glycerin, sugar (syrup), and methylparaben. The active ingredients are plant
alkaloids, cephaeline, and methyl-cephaeline (emetine).
Dose

✓15-30 mL with one full glass of water.

Mechanism of Action

✓Ipecac irritates the stomach lining and chemically stimulates the CRTZ
(chemoreceptor trigger zone) in the medulla oblongata of the central nervous
system to induce near-immediate vomiting.
Drug Interactions

Since syrup of ipecac induces vomiting, it can delay the administration of PO

medications, such as activated charcoal.

Contraindications

✓Patients who are unable to protect their airway or in whom medical personnel
cannot adequately maintain an airway.

✓After the ingestion of caustic substances, such as acids or bases

 ORGANOPHOSPHATE COMPOUND (OPC) POISONING

Drugs tend to increase the levels of acetylcholine (ACh) and potentiate the
effect. Drugs that can lead to OPC poisoning are Irreversible Choline Esterase
Inhibitors (Dyflos, Echothiphate, Parathion, Malathion, Diazinon and
Carbamates like carbaryl and propoxur).
 Treatment of OPC Poisoning

•Terminate further exposure

✓Fresh air, wash skin and mucous membrane with water, gastric lavage.

•Maintain airway

•Supportive measures

✓Maintain blood pressure, hydration, diazepam (in case of seizures).

Specific antidotes

✓Atropine– 2 mg IV every 10 minutes–till pupil dilates (Max-200 mg/d)

Reverses muscarinic (but not Nicotinic peripheral muscle paralysis) followed
by a maintenabcedose for 1-2 week.

✓Cholinesterase Reactivators—Restore Neuromuscular junction.

➢Oximes pralidoximeis ineffective with Carbamate choline esterase poisoning.

DRUGS USED FOR COMMON POISONING
 ANTIDOTES
Definition: An antidote or counter dose is a substance which can counteract a
form of poisoning.
• Very limited number and range of antidotes are available for pharmaceuticals
and chemicals.
• “Coma Cocktail”
❑Glucose
❑Thiamine
❑Naloxone
Common Antidotes
 Anti-Snake Venom

The poisonous snakes belong to three families based on the poison secreted
into:

1. Elapidae which secrete neurotoxin

2. Viperidae which secrete vasculotoxin

3. Hydrophidae which secrete Myotoxin.

Indications for Anti-snake Venom Include

❑Spontaneous systemic Bleeding, WBCT > 20 minutes, thrombocytopenia

(platelet count less than 1 lac); patient coming with chock, paralysis, acute
renal failure, Rhabdomyolysis, Hyperkalaemia.

❑Local swelling involving > ½ of bitten limb with rapid extension of swelling.
 VITAMINS AND MINERALS SUPPLEMENTATION VITAMINS

Vitamins are organic substances needed in minuscule amounts for various roles
in the regulation of the body processes.

Vitamins are categorized based on their solubility as Water soluble vitamins and
Lipid (Fat) soluble vitamins.
Water soluble vitamins B and C are adsorbed in the intestinal cells and
delivered directly to the blood stream. The kidneys filter out excesses of most
water soluble vitamins and excrete them in urine.

Fat soluble vitamins are adsorbed with fat, micelles carry fat-soluble vitamins
and dietary fat. Chylomicrons containing fat-soluble vitamins are transported
via the lymph to the bloodstream and eventually to the liver.
Vitamin B1 (Thiamine)

Rich sources of thiamine are cereals, pulses, nuts, green vegetables, yeast, egg
meat. The biological active form of Thiamine is TPP (Thiamine
pyrophosphate). Thiamine functions as a co-enzyme in carbohydrate
metabolism and has some role in neuromuscular transmission.
Deficiency

Thiamine has early manifestations and advances deficiency. Early

manifestations: Anorexia, muscle cramps, paresthesia, and irritability. The
advanced deficiency can lead to beriberi (Wet beriberi (CVS) and dry beriberi

(Nervous System). This is prevalent in parts of the world that rely on

unfortified, milled rice as staple diet.
Vitamin B3 (Niacin)

Also know as pellagra preventing factor, forms of niacin are nicotinic acid, or
nicotinamide. Rich source of niacin includes liver, fish, meat, cereal husk, nuts,
and pulses. It can be synthesized from amino acid tryptophan (1 mg from 60
mg).
Deficiency of Niacin

It occurs in those with maize as major food, and alcoholics. The deficiency
symptom is pellagra with cardinal manifestation of DDD (Diarrhea, Dermatitis
(In Sun Exposed Areas), Dementia. It also leads to anemias, glossitis, salivation
and nausea and vomiting.
Vitamin B5 (Pantothenic Acid)

Pantothenic Acid is a component of CoA, e.g., Succinyl CoA, Acetyl CoA, and
of fatty acid synthetase. Rich sources of pantothenic acid include liver, mutton,
egg yolk and vegetables. It plays a physiological role in fat, carbohydrate,
steroid, and porphyrin metabolism with the daily requirement of 4-7 mg.
Vitamin B7 (Biotin)

Rich Source of biotin include egg yolk, liver, nuts and intestinal bacteria. Avidin
(protein in egg white), binds with biotin and prevents its absorption. Biotin has
a physiological role as it acts as a co-enzyme in various carboxylation reactions
in carbohydrate and fat metabolism.
Vitamin B12 (Cyanocobalamin and Hydroxocobalamin)

It is synthesized in nature only by microorganisms and plants and animals

acquire it from them. Vitamin B12 is essential for cell replication;
hematopoiesis and myelin synthesis. Dietary source for Vitamin B12 are meat,
eggs, milk, and seafood.
Deficiency occurs when internal reserve (6-10 years) is depleted and lack of
intrinsic factor required for absorption. Deficiency can occur due to pernicious

anemia, chronic gastritis, malabsorption or increased demand. Manifestations of

deficiency are megaloblastic anemia, glossitis and subacute combined
degeneration of spinal cord. Supplementation is done by using
cyanocobalamin which is water soluble, and its excess is excreted in urine. It

can be used as tablets (not suitable for pernicious anemia) or injection.

Vitamin A

Precursor is beta carotene which can be either consumed in the diet or

biosynthesized from beta-carotene. There are three active forms of vitamin A,
used by our body, and are named retinoids. These include: Retinol, Retinal and

Retinoic Acid. Vitamin A is stored in the liver in the form of retinyl esters.
Retinol binding protein carries vitamin A in the blood stream.
Deficiency

It lead to night blindness, skin lession, and immunity deficiency. Excessive

levels lead to death, liver damage, bone fractures, skin disorders and birth
defects.
Vitamin D

It is a fat soluble vitamin and it differs from other fat soluble vitamins because it is
synthesized in the body. It is beneficial for bone health and its deficiency makes the person
highly susceptible to bone fractures.

Deficiency: The disease is characterized by growth failure, bone deformity, enlarged joints,
muscular hypotonia etc.

The milestone of development such as walking and teething are delayed. Tetany and
convulsions occur due to hypocalcaemia. Later features are the development of bone
deformity i.e. curved legs (bow legs), knock knees, deformed pelvis, and pigeon chest.
Vitamin E (α-tocopherol)

Vitamin E play anti-oxidant role, in preventing attack of peroxides on

unsaturated fatty acids. It is adsorbed along with fat in the small intenstine as it
gets incorporated into chylomicrons, enters the bloodstream via the lymph
system. 90% of body’s vitamin E is stored in adipocytes, 10% in cell
membranes, liver ships it to other tissues.
Deficiency
It leads to liver atrophy, red blood cell hemolysis, in cases of malabsorption such
as cystic fibrosis anemia, and in premature infants: anemia.
It is to be given either by oral/parenteral route.
Adverse Effects
It seen with Iron are gastrointestinal irritation, nausea, constipation, black stools,
and tooth staining with liquid supplements.
Toxicity
It can occur and lead to erosion of stomach lining (causing pain, bleeding, and
vomiting), acidosis, hypotension, cardiovascular collapse. They are treated with
desferrioxamine.
 VACCINES
➢Vaccines are attenuated, live or killed suspensions of microorganisms that
stimulate active immunity.
➢Vaccination is the process of artificially stimulating active immunity. It
exposes the body to weakened or less toxic proteins associated with specific
disease-causing organisms.
➢Goal to cause an immune response without having the patient.
➢Goal of vaccination is to cause an immune response without having the full
course of a disease in the person.
 Principles of Vaccination

Vaccination provides protection from infectious diseases and is very specific to

a single organism. It could be active immunity or passive immunity.

❑Active Immunity: Protection produced by the person’s own immune system,

which is usually life-long.

❑Passive Immunity: Protection transferred from another person or animal,

this is a temporary protection that wanes with time.
Live Attenuated Vaccines

These are attenuated (weakened) form of the “wild” virus or bacterium and they
must replicate to be effective. The immune response generated is similar to
natural infection and is usually effective with single dose. There are severe

reactions possible, it tends to have interference from circulating antibody and is

fragile so must be stored and handled carefully.
Inactivated Vaccines

These cannot replicate and are not as effective as live vaccines. They have less
interference from circulating antibody than live vaccines and require 3-5 doses
for adequate response. The immune response is mostly humoral and antibody
titer may diminish with time.
Vaccine Adverse Reactions

It could be local, systemic and allergic.

❑Local reactions include pain, swelling, redness at site of injection (common

with inactivated vaccines), which is usually mild and self-limited.

❑Systemic effects include fever, malaise, headache, nonspecific, may be

unrelated to vaccine.

❑ Allergic reactions due to vaccine or vaccine component is rare and the risk
can be minimized by screening.
Universal Immunization Schedule
IMMUNE SERA

Definition

Sera contains antibodies to specific bacteria or viruses. The three main media
that can be used for the administration of the requisite antibodies into the human

Beings.

Administration of requisite antibodies for artificial passive immunity

Hyperimmune Sera of Human or Animal Origin

❑The serum of either animals or humans (subject to the purposeful active

artificial immunization) containing the immunoglobulins for the specific
antigens is used parentally to eliminate that infection from the individual.

❑They are used in emergency and give transient protection. The hyperimmune
sera of animal origin can cause hypersensitivity and immune elimination in
human beings. Thus, the hyperimmune sera of human origin are preferred
over the hyperimmune sera of animal origins.
Convalescent Sera

The serum of any patient recovering from a disease contains large number of
antibodies against that antigen at a particular point of time. This serum,
containing the specific antibodies, can be used for the treatment of another
individual suffering from the same disease.
Pooled Human Gamma Globulin

This is the serum that is prepared by mixing the sera from different persons
collected from several healthy donors and which contains many
immunoglobulins against many pathogens usually found in a particular
geographical area.
ANTICANCER DRUGS

Cancer is a loss in the normal control mechanisms that govern cell survival,
proliferation, and differentiation. Tumour stem cells reside within a tumour
mass and retain the ability to undergo repeated cycles of proliferation and
migrate to distant sites in the body
 DEFINITIONS

Chemotherapy

It can be defined as a specific chemical treatment intended to heal a disorder or

an infectious disease that involves either the elimination of the proliferating
malignant cells or the elimination of the infectious pathogens like bacteria,

viruses from within the diseased host‘s body.

Classification

Cytotoxic Drugs

❑Alkylating agents: Cyclophosphamide (2-3 mg/kg/ day oral), Thio-TEPA

❑Antimetabolite: Methotrexate (1 mg/kg/day), 5-Fluorouracil

❑Vinca Alkaloids: Vincristine, Vinblastine

❑Taxanes: Paclitaxel, Docetaxel

❑Antibiotics: Dactinomycin, Doxorubicin

❑Miscellaneous: Cisplatin, Hydroxyurea

Hormones and their Antagonists

Prednisolone, Estrogens, Antiestrogens, Antiandrogens, GnRH, Progestin.

Alkylating Agents

Alkylating agents are a class of antineoplastic or anticancer drugs which act by

inhibiting the transcription of DNA into RNA and thereby stopping the protein
synthesis.
Antimetabolites
An antimetabolite is a substance that prevents the utilisation of a metabolite.
Such substances are frequently structurally similar to the metabolite that they
interfere with, such as antifolates that interfere with the use of folic acid; thus,
competitive inhibition can occur, and the presence of antimetabolites can have
toxic effects on cells, such as halting cell growth and division; thus, these
compounds are used as cancer chemotherapy.
General Toxicity of Cytotoxic Drugs
Profound effect on rapidly growing cells, dose dependent toxicity.

❑Bone marrow depression causes: Granulocytopenia, agranulocytosis,

thrombocytopenia, aplastic anemia.

❑Lymphoreticular tissues: Lymphocytopenia.

❑GIT symptoms: Stomatitis, diarrhea, hemorrhages, nausea and vomiting.

❑Skin: Alopecia, dermatitis present.

Nursing Responsibilities

❑Always obtain renal function test, liver function test and complete blood
count and potassium level prior to start of therapy and regularly.

❑Antiemetic therapy should be administered 30 minutes one hour prior to start

of chemotherapeutic drug administration.

❑Administer antacids before oral dose to prevent GI upset.

❑ Advise the patient to maintain oral hygiene with soft brush to prevent
stomatitis.
 Immunosuppression is a decrease in the
immune system's ability to respond
effectively to foreign antigens, especially
surface antigens on cancer cells.
IMMUNOSUPPRE
Immunosuppression can occur as a result of
SSANTS
the death of immune effector cells or the
obstruction of intracellular pathways
required for antigen detection or other
aspects of the immune response.
Classification

❑Specific T-cell inhibitor: Cyclosporine, Tacrolimus

❑Cytotoxic drugs: Azathioprine, Cyclophosphamide, Methotrexate

❑Glucocorticoids: Prednisolone

❑Antibodies: Muromonoab CD3, Antithymocyte globulin (ATG), rho(D)

immunoglobulin.
 Nursing Responsibilities

❖Always obtain renal function test, liver function test and complete blood
count and potassium level prior to start of therapy and regularly.

❖Always prevent infection in patients by hand hygiene and patients should

wear mask while going to crowed places.

❖Advise the patient to monitor signs of infection- sore throat, fever) and
inform the physician immediately.

❖Women in child bearing age should avoid pregnancy and breast feeding.
 IMMUNOSTIMULANTS

Immunostimulants are those compounds which could be chemicals, drugs,

stressor that can elevate the non-specific defense mechanisms by increasing
phagocytic activity, leucocytic activity, macrophage and neutrophil migration or
specific immune response. These are used during infections, immunodeficiency
and cancer.
 LEVAMISOLE

This is an anthelminthic drug which tends to restores depressed immune

function of B and T Cells, monocytes, and macrophages. It’s used as adjuvant to
5-FU (5-Florouracil) in colon cancer, being associated with agranulocytosis. It
was removed from market in 2005.