Ch 45 Immunosuppressants

Question 1

What is the function of immunosuppressant drugs?

Answer 1

Their function is to suppress selectively T lymphocytes to prevent their involvement in the Immune Response (cellular immunity).

Question 2

What is the result of T lymphocytes suppression?

Answer 2

An immunocompromised state similar to that in a cancer patient whose bone marrow and immune cells have been destroyed –> therefore decreases the chances of organ transplant rejection.

Question 3

What are the 3 most common adverse effects of Azathiopine?

Answer 3

• leukopenia
• thrombocytopenia
• hepatoxicity

Question 3

What is the indication for Azathiopine?

Answer 3

Organ rejection prevention = kidneys

Question 4

What is the indication of Cyclosporine?

Answer 4

Organ rejection prevention =

• kidney
• liver
• ❤
• pancreas
• bone marrow
• ❤/ lung transplants

Question 5

What are the 5 most common adverse effects of Cyclosporine?

Answer 5

• moderate hypertension
• neurotoxicity
• hepatotoxicity
• nephrotoxicity
• hypersensitivity

Question 5

What is the indication of Muromonab-CD3?

Answer 5

Treatment of acute organ rejection in kidney, liver and ❤ transplants.

• Only drug to treat acute rejection when in progress.

Question 5

What are the most common adverse effects of Muromonab-CD3?

Answer 5

• chest pain
• pyrexia, tremors
• vomiting, diarrhea
• dyspnea, pulmonary edema
• fluid retention

Question 6

What is the role of immunosuppressant drugs in the treatment of autoimmune diseases?

Answer 6

It is to avoid the body to “attack” itself.

Question 7

What is the role of immunosuppressant drugs in the treatment of organ transplant recipients?

Answer 7

To suppress the immune system so it doesn’t recognize the transplanted organ as a dangerous foreign organ.

Question 8

When assessing a patient prior to giving immunosuppressant drugs, what should the nurse focus on?

Answer 8

• preexisting diseases affecting the immune status (diabetes, cancer, hypertension)
• urinary function
• presence of jaundice, edema
• ❤ disease or dysrhythmias
• respiratory status
• GI function
• BUN
• ALP, AST, ALT

Question 9

What assessments are required prior to giving Azathiopine?

Answer 9

• WBCs + platelet count
• S x S of infection
• bleeding tendencies = due to potential drug related leukopenia + thrombocytopenia

Question 10

What assessments are required prior to giving Cyclosporine?

Answer 10

• cardiovascular + CNS
• hepatic and/or renal disease
• oral assessment (gingival hyperplasia)
• K+ level
• uric acid

Question 11

What assessments are required prior to giving Muromonab-CD3?

Answer 11

• weight baseline (because of potent fluid retention + edema)
• vital signs (potent fever)
• chest x-rays (clear lungs = no fluid)

Question 12

How should oral immunosuppressant drugs be taken?

Answer 12

With food to minimize GI upset.

Question 13

What other medication should be administered when on “oral” immunosuppressants?

Answer 13

An oral antifungal to treat potential oral candidiasis.

• Monitor potential drug interactions

Question 14

What are some criteria to follow when administering oral solutions of Cyclosporine?

Answer 14

• should not be refrigerated
• measured in calibrated device
• may be mixed w/ chocolate milk, OJ at room Temp.
• do NOT serve in styrofoam containers (use glass)

Question 15

What are some criteria to follow when administering Cyclosporine intravenously?

Answer 15

• dilute medication w/ normal saline or 5% dextrose water
• monitor closely the first 30 min for S x S of allergic reaction (flushing, urticaria, wheezing, dyspnea, and rash)
• assess BUN, AST, ALT
• assess oral hygiene to prevent gum problems

Question 16

What situations should the patient avoid when on immunosuppressants?

Answer 16

Risk of exposure to infection =

–> Avoid malls, crowds, movie theaters

Question 17

What S x S should the patient report to the prescriber immediately?

Answer 17

• fever
• sore throat
• chills
• fatigue
• May be signs of infection

Question 18

What teaching tip should be reminded to female patients on immunosuppressant drugs?

Answer 18

The need to use some form of contraception during treatment and for up to 12 weeks after therapy ends.

Question 19

What food and type of sports should be avoided while on immunosuppressant treatment?

Answer 19

• Grapefruit + grapefruit juice

- outdoor sports because photosensitivity

Question 20

What is the preferred route of administration when using immunosuppressants?

Answer 20

Oral route because of the risk of infection when choosing the intravenous route.