Corticosteroids immunosuppressive activity

Pneumococcal Vaccine, Polyvalent (Pneumovox-23) [Vaccine/ Inactive Bacteria] Uses Immunization against pneumococcal Infxns in pts at high risk (eg, all = 65 y of age) Action Active immunization Dose 0.5 mL EM. Caution [C, ] Contra Do not vaccinate during immunosuppressive thCTapy Disp Inj SE Fever, inj site Rxn, hemolytic anemia, thromboc5rtopenia, anaphylaxis Interactions Effects W/ corticosteroids, immunosuppressants EMS None OD ... 

Hepatitis A (Inactivated) Hepatitis B (Recombinant) Vaccine (Twinrix) [Vaccine/lnactivated] Uses Active immunization against Hep A/B Action Active immunity Dose 1 mT, IM at 0, 1, 6 mo Caution [C, +] Contra Component sensitivity Disp Single-dose vials, syringes SE Fever, fatigue, pain at site, HA Interactions X- Immune response w/ corticosteroids, immunosuppressants EMS None OD Unlikely... 

Hepatitis B Vaccine (Engerix-B, Recombivax HB) [Vaccine/ Inactivated] Uses Prevent Hep B Action Active immunization recombinant DNA Dose Adults. 3 EM doses 1 mL each 1st 2 doses 1 mo apart the 3rd 6 mo after the 1st Peds. 0.5 mL EM adult schedule Caution [C, +] 1 effect w/ immunosuppressives Contra Yeast allergy Disp Engerix-B Inj 20mcg/mL peds inj 10 mcg/0.5 mL Recombivax HB Inj 10 40 mcg/mL peds inj 5 mcg/0.5 mL SE Fever, inj site pain Interactions i Immune response W/ corticosteroids, immunosuppressants EMS None OD Unlikely... 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

In addition to these anti-inflammatory and immunosuppressive activities of pain control, oral corticosteroids have several other properties that make them useful as multipurpose adjuvant analgesics, especially in patients with pain associated with chronic disease or cancer. The mechanisms of these effects are less well worked out but corticosteroids also stimulate the erythroid cells of bone marrow and prolong the survival time of erythrocytes and platelets. They promote gluconeogenesis and protein catabolism. They reduce chemotherapy-induced nausea and vomiting, and alleviate dyspnea, effusion... 

Infliximab is used for moderate to severe active Crohn s disease in patients failing immunosuppressive therapy, in those who are corticosteroid dependent, and for treatment of fistulizing disease. A single, 5 mg/kg infusion is effective when given every day for 8 weeks. Additional doses at 2 and 6 weeks following the initial dose results in higher response rates. Adalimumab is effective in 54% of patients with moderate to severe Crohn s disease who have lost response to infliximab. The typical dosage is 160 mg subcutaneously initially, followed by 80 mg subcutaneously at week 2, with subsequent doses of 40 mg subcutaneously every other week thereafter. 

Corticosteroids synthesized by the adrenal gland are mineralocorticoids and GC. Min-eralocorticoids regulate fluid and electrolyte balance by affecting ion transport in the kidney. Cortisol, the primary circulating GC in most species (including humans), has many activities, including resistance to stress, regulation of intermediary metabolism, and immunosuppressive and anti-inflammatory effects. GC synthesis and secretion is... 

Several types of immunosuppression have also been tried. Azathioprine alone was found to have no effect on PBC [82], but additional benificial effects were found in combination with ursodeoxychohc add and corticosteroids [78]. Cyclosporin showed some success, espe-dally in corticosteroid-resistant autoimmune hepatitis [83], but its use is generally considerably hmited by severe side-effects. Corticosteroids were effective in the management of several types of autoimmune chronic active hepatitis [84,85] and in the management of acute al-cohohc hepatitis [86]. Their use, however, has to be brief hi order to minimize side-effects. In the treatment of PBC, corticosteroids alone were found to be toxic and had only limited efficacy [77]. 

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

Betamethasone Synthetic corticosteroid, displays glucocorticoid activity, lacks mineralocorticoid activity Use mainly as anti-inflammatory and immunosuppressive effect... 

Glucocorticoids inhibit acquired or cell-mediated immunity. Their effects are mediated via inhibition of genes that code for various cytokines. The cytokines inhibited by glucocorticoids include IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8 and IFN-y. IL-2 inhibition by corticosteroids is the most crucial effect in immunosuppression, which results in the inhibition of T-cell proliferation and activation of cytolytic T cells. Glucocorticoids also slightly affect humoral immunity by inhibiting B-cell clonal expansion and antibody synthesis, and these effects are mediated via their ability to inhibit B cells ability to express IL-2 and IL-2 receptors. 

The anti-inflammatory effects of corticosteroids reduce CME, vitreous inflammation, and retinal vasculitis. Use of corticosteroids is especially important if the macular area is threatened. Because they are immunosuppressive, they should never be used without concurrent antimicrobial agents. Oral prednisone 40 to 60 mg is given daily for 2 to 6 weeks depending on clinical response. Topical corticosteroids are used for the secondary anterior chamber reaction but have no impact on retinal inflammation, and periocular injections should be used cautiously, if at all, because of their intense anti-inflammatory activity. 

Immunosuppressive drugs can be divided into five basic categories. Corticosteroids such as methylprednisolone and prednisone are a part of virtually all immunosuppressive drug regimens. Corticosteroids block the production of IL-1 and have potent anti-inflammatory effects. Calcineurin inhibitors such as cyclosporine and tacrolimus are also used in a majority of immunosuppressive drug regimens. Calcineurin inhibitors inhibit the production and secretion of IL-2. IL-2 is involved with T-lymphocyte activation and proliferation. Antiproliferative agents such as azathioprine, mycophenolate mofetil, and sirolimus block T-lymphocyte... 

The immunologic basis of IBD is supported by a number of observations. First is the pathology of the lesions. With Crohn s disease, the bowel waU is infiltrated with lymphocytes, plasma cells, mast cells, macrophages, and neutrophils. Similar infiltration has been observed in the mucosal layer of the colon in patients with ulcerative cohtis. Inflammation in IBDs is maintained by an influx of leukocytes from the vascular system into sites of active disease. This influx is promoted by expression of adhesion molecules (such as alpha-4 in-tegrins) on the surface of endothefial cells in the microvasculature in the area of inflammation. Second, many of the systemic manifestations of IBD have an immunologic etiology (e.g., arthritis or uveitis). Finally, IBD is responsive to immunosuppressive drugs (e.g., corticosteroids and azathioprine). 

Immunosuppressive agents, alone or in combination, are commonly used to alter the immune processes that are responsible for the glomerulonephritides. Corticosteroids, in addition to their immunosuppressive effecL also possess anti-inflammatory activities. They reduce the production and/or release of many substances that mediate the inflammatory process, such as prostaglandins, leukotrienes, platelet-activating factors, tumor necrosis factors (TNFs), and interleukin-1 (IL-1). Movement of leukocytes and macrophages to the site of inflammation is also inhibited. The immunosuppressive effects of corticosteroids are mediated through the inhibition of the release... 

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