McKenna's Pharmacology for Nursing, 2e

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P A R T 3  Drugs acting on the immune system

TABLE 18.2

DRUGS IN FOCUS Immune sera

Drug name

Dosage/route

Usual indications

Immune sera Anti Rh(D) immunoglobulin (WinRho SDF)

28 weeks gestation: 1500 IU IM or IV. Sensitising event in pregnancy: <34 weeks gestation: 1500 IU every 12 weeks. >34 weeks 600 IU IM or IV. Following birth or abortion: 600 IU. Must be administered within 72 hours of sensitising event 10–15 mg/kg/day × 14 days, then alternate days for 14 days to total 21 doses in 28 days Prophylaxis: 25,000 U/kg IV days –4, –2 and day of surgery. Treatment: 50,000 U/kg IV repeated in 4–5 days, then every 10–14 days as needed 400 IU deep IM. Babies born to hepatitis B positive mothers: 100 IU IM at birth

Prevention of sensitisation to the Rh factor

antithymocyte globulin (Atgam)

Treatment of renal transplant acute rejection in conjunction with immunosuppression Attenuation of primary cytomegalovirus disease after renal transplantation

cytomegalovirus immunoglobulin (CMV Immuno-globulin-VF) hepatitis B immunoglobulin (Hepatitis B Immunoglobulin-VF) immunoglobulin, normal (Intragam P, Octagam and others) rabies immunoglobulin (Imogam Rabies) tetanus immunoglobulin (generic) zoster immunoglobulin (Zoster Immunoglobulin-VF) Antitoxins and antivenins black snake antivenom (generic) box jellyfish antivenom (generic) brown snake antivenom (generic) death adder antivenom (generic) funnel-web spider antivenom (generic)

Postexposure prophylaxis against hepatitis B

Dose varies with indication and preparation; always check manufacturer’s instructions

Prophylaxis after exposure to hepatitis A, measles, varicella or rubella; bone marrow and other transplants; Kawasaki’s disease; chronic lymphocytic leukaemia; treatment of people with immunoglobulin deficiency Protection against rabies in non-immunised people exposed to rabies Passive immunisation against tetanus at time of injury Passive immunisation against varicella zoster in immunosuppressed people exposed to disease Systemic envenoming following bite from king brown or mulga snake Systemic envenoming or extreme pain following box jellyfish sting, not responding to routine analgesia Systemic envenoming following bite from snake of genus Pseudonaja Systemic envenoming following bite from death adder Systemic envenoming following bite from funnel-web spider Systemic envenoming following snakebite, where the snake has not been identified. Contains antibodies to king brown, tiger, brown snakes, death adder and taipan. Not used in Victoria or Tasmania Systemic envenoming following bite from redback spider Systemic envenoming following bite from a sea snake

20 International Units/kg IM

250–500 IU deep IMI

<10 kg: 125 IU, 10.1–20 kg: 250 IU, 20.1–30 kg: 375 IU, 30.1–40 kg: 500 IU, >40 kg: 600 IU by deep IMI within 96 hours of exposure

18,000 U by slow IV infusion diluted in Hartmann’s solution 20,000 U by slow IV infusion diluted with IV solution 1000 U by slow IV infusion diluted in Hartmann’s solution 6000 U by slow IV infusion diluted in Hartmann’s solution 2 vials diluted by slow IV injection, simultaneously given with adrenaline. Dose repeated in 15 minutes if required 40,000 U by slow IV infusion diluted in Hartmann’s solution

polyvalent snake antivenom (generic)

redback spider antivenom (generic)

1 vial IM, or IV diluted in Hartmann’s solution. May be repeated in 2 hours 1000 U by slow IV infusion diluted with Hartmann’s solution or normal saline

sea snake antivenom (generic)