Immunoglobulins: Nursing pharmacology

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IMMUNOGLOBULINS
DRUG NAME
immune globulin IV (BayGam, Flebogamma, Gammagard), immune globulin SC (BayGam, Cutaquig, Cuvitru, Hizentra), immune globulin IM (BayGam, Gammastan), hepatitis B immune globulin (HBIG), tetanus immunoglobulin (TIG), botulism immune globulin (BIG), Rh(D) immune globulin (RhoGAM, WinRho)
CLASS
Immunoglobulins
MECHANISM OF ACTION
  • Increase antibody levels in individuals with immunodeficiency
  • Help fight off infectious diseases
  • Prevent the immune system from attacking the body’s own healthy cells
INDICATIONS
  • Replacement therapy for immunodeficiency
  • Prophylaxis of infectious diseases
  • Treatment of inflammatory or autoimmune disorders (e.g., Kawasaki disease, idiopathic thrombocytic purpura, Guillain-Barré syndrome, etc.)
  • Prevention of Rh sensitization in pregnant Rh-negative clients
ROUTE(S) OF ADMINISTRATION
  • IV, SC, IM
SIDE EFFECTS
  • Headache
  • Local injection site reactions
  • Flu-like symptoms: fatigue, fever, chills, myalgias, arthralgias, nausea and vomiting
  • Transfusion-associated cardiovascular overload (TACO)
  • Delayed side effects: thrombotic events, skin reactions, renal impairment, hemolysis, neutropenia
  • Rh(D) immune globulin: intravascular hemolysis (boxed warning)
  • IVIG, SCIG, IMIG: thrombosis, renal impairment, acute renal failure (boxed warning)
CONTRAINDICATIONS AND CAUTIONS
  • Coagulation disorders
  • Selective IgA deficiency
NURSING CONSIDERATIONS: IMMUNOGLOBULINS
ASSESSMENT AND MONITORING
Assessment
  • Current symptoms
  • Weight
  • Vital signs, lung sounds
  • Cardiovascular status
  • Hydration status
  • Laboratory test results: CBC, ESR, renal and hepatic function, clotting studies; Coombs test for Rh antibodies
  • Diagnostic test results: echocardiogram

Interventions
  • Patient IV
  • Epinephrine readily available
  • During administration
    • Hydrate with IV fluids
    • Premedicate with antihistamine and acetaminophen
    • Confirm correct dosage
    • Start infusion at lower rate, then gradually increase

Monitoring
  • Vital signs
  • Intake and output
  • Side effects
    • Local insertion site reactions
    • Notify healthcare provider
      • Hypersensitivity reaction: stop infusion; administer epinephrine if needed
      • Circulatory overload: stop infusion
  • Delayed reactions
  • Therapeutic response: resolution of infection, absence of symptoms
CLIENT EDUCATION
  • Purpose of medication: treat infection and resolve symptoms
  • Administered IV over 2–24 hours
  • Symptoms should resolve three days
    • If not, second dose may be needed
  • Side effects (immediate)
    • Headaches, flu-like symptoms, fluid overload
  • Notify healthcare provider
    • Thrombosis
      • Lower extremity swelling, tenderness; chest pain, shortness of breath; coughing up blood; severe headache
    • Renal damage
      • Decreased urine output, blood in urine, unusual weight gain, severe abdominal pain
    • Hemolysis
      • Fatigue, dark urine, or yellowing of the skin or eyes

Transcript

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Human immunoglobulin therapy contains a mixture of immunoglobulins, also called antibodies, derived from the plasma of healthy donors.

Immunoglobulin therapy is used in a variety of health conditions, including treatment of immune deficiencies, prophylaxis of infectious diseases, and management of various inflammatory or autoimmune diseases, such as Kawasaki disease, idiopathic thrombocytopenic purpura, and Guillain-Barré syndrome.

Immunoglobulin products primarily contain IgG antibodies, as well as small amounts of IgM and IgA antibodies.

There are three routes of immunoglobulin administration: intravenous, more commonly known as IVIG, subcutaneous, or SCIG, and intramuscularly, or IMIG.

Other examples of commonly used immunoglobulins include the hepatitis B immune globulin, or HBIG, which is administered to clients after exposure to the hepatitis B virus; the tetanus immunoglobulin, or TIG, which is used primarily for prophylaxis of tetanus infection in clients with traumatic, puncture, or contaminated wounds; and the botulism immune globulin, or BIG, which is used to treat infant botulism caused by toxin type A or B.

Additionally, a specific immunoglobulin called RhO (D) immune globulin, or RhoGAM, is given to Rh-negative clients during pregnancy in order to prevent Rh immunization against their Rh-positive fetus.

Once administered, immunoglobulins act just like natural antibodies; so they recognize a specific antigen, bind to it so that the immune system can eliminate it, as well as modulating the immune response.

This can be helpful to fight off infections, as well as to prevent the immune system from attacking the body’s own cells in autoimmune disorders.

One thing to keep in mind is that immunoglobulins offer passive immunity, which is temporary and only lasts for as long as the antibodies persist, usually a few weeks to months.

Sources

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  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Adverse Effects of Immunoglobulin Therapy" Frontiers in Immunology (2018)
  6. "Gold Standard Drug Database" Elsevier
  7. " Outline Download Cite Share Favorites Permissions I.V. ROUNDS Administering immune globulin" Journals (March 2006)
  8. "The Nurse's Role in Administration of Intravenous Immunoglobulin Therapy" Home Healthcare Nurse (2009)
  9. "Kawasaki Disease: Summary of the American Heart Association Guidelines" American Family Physician (2006)
  10. "Kawasaki Disease" Centers for Disease Control and Prevention (2020)
  11. "Intravenous Immunoglobulin (IVIG)" Childrens Hospital of Philadelphia (2020)
  12. "Maternal Child Nursing Care in Canada" Mosby Canada (2016)