Ch 45 Immunosuppressants Flashcards
What is the function of immunosuppressant drugs?
Their function is to suppress selectively T lymphocytes to prevent their involvement in the Immune Response (cellular immunity).
What is the result of T lymphocytes suppression?
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.
What are the 3 most common adverse effects of Azathiopine?
- leukopenia
- thrombocytopenia
- hepatoxicity
What is the indication for Azathiopine?
Organ rejection prevention = kidneys
What is the indication of Cyclosporine?
Organ rejection prevention =
- kidney
- liver
- ❤
- pancreas
- bone marrow
- ❤/ lung transplants
What are the 5 most common adverse effects of Cyclosporine?
- moderate hypertension
- neurotoxicity
- hepatotoxicity
- nephrotoxicity
- hypersensitivity
What is the indication of Muromonab-CD3?
Treatment of acute organ rejection in kidney, liver and ❤ transplants.
- Only drug to treat acute rejection when in progress.
What are the most common adverse effects of Muromonab-CD3?
- chest pain
- pyrexia, tremors
- vomiting, diarrhea
- dyspnea, pulmonary edema
- fluid retention
What is the role of immunosuppressant drugs in the treatment of autoimmune diseases?
It is to avoid the body to “attack” itself.
What is the role of immunosuppressant drugs in the treatment of organ transplant recipients?
To suppress the immune system so it doesn’t recognize the transplanted organ as a dangerous foreign organ.
When assessing a patient prior to giving immunosuppressant drugs, what should the nurse focus on?
- 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
What assessments are required prior to giving Azathiopine?
- WBCs + platelet count
- S x S of infection
- bleeding tendencies = due to potential drug related leukopenia + thrombocytopenia
What assessments are required prior to giving Cyclosporine?
- cardiovascular + CNS
- hepatic and/or renal disease
- oral assessment (gingival hyperplasia)
- K+ level
- uric acid
What assessments are required prior to giving Muromonab-CD3?
- weight baseline (because of potent fluid retention + edema)
- vital signs (potent fever)
- chest x-rays (clear lungs = no fluid)
How should oral immunosuppressant drugs be taken?
With food to minimize GI upset.
What other medication should be administered when on “oral” immunosuppressants?
An oral antifungal to treat potential oral candidiasis.
- Monitor potential drug interactions
What are some criteria to follow when administering oral solutions of Cyclosporine?
- 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)
What are some criteria to follow when administering Cyclosporine intravenously?
- 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
What situations should the patient avoid when on immunosuppressants?
Risk of exposure to infection =
–> Avoid malls, crowds, movie theaters
What S x S should the patient report to the prescriber immediately?
- fever
- sore throat
- chills
- fatigue
- May be signs of infection
What teaching tip should be reminded to female patients on immunosuppressant drugs?
The need to use some form of contraception during treatment and for up to 12 weeks after therapy ends.
What food and type of sports should be avoided while on immunosuppressant treatment?
- Grapefruit + grapefruit juice
- outdoor sports because photosensitivity
What is the preferred route of administration when using immunosuppressants?
Oral route because of the risk of infection when choosing the intravenous route.
