Chapter 45, Immunosuppressant drugs

Question 1

why should patient taking cyclosporine avoid consumption of grapefruit or grapefruit juice?

Answer 1

because of the potential for an increase in the blood concentration of cyclosporine.

Question 2

what are some clinical uses for immunosuppressants?

Answer 2

suppression of immune-mediated disorders
malignancies
improvement of short-term and long-term allograft survival.

Question 3

what should patient who are receiving cyclosporine and are to undergo transplant surgery know?

Answer 3

several days before surgery they may be told to take the cyclosporine with corticosteroids and oral antifungal as prophylaxis for candida infections.

Question 4

True/false

Patient taking cyclosporine can mix the medication with milk or meals to minimize GI upset.

Answer 4

True

Question 5

white patches on the tongue, mucous membranes, and/or oral pharynx of a patient taking immunosuppressants may indicate?

Answer 5

oral candidiasis

Question 6

signs of cytokine release syndrome results in

Answer 6

fever, dyspnea, and general malaise

Question 7

Generally with most organ transplants, mild nephrotoxicity may occur within?

Answer 7

2 to 3 months,

Question 8

severe toxicity for most organ transplants occurs?

Answer 8

closer to the time of the actual transplantation.

Question 9

What should the nurse do when a patient taking Daclizumab leukocyte count drops below 3000 cells/mm3?

Answer 9

discontinue the drug after the prescriber is contacted.

Question 10

Female patients taking immunosuppressants should be educated about the use of what?

Answer 10

Contraception during the Tx and for up to 12 weeks after therapy ends.

Question 11

SxS such as fever, sore throat, chills, joint pain, or fatigue in a patient taking immunosuppressant may indicate?

Answer 11

infection and requires immediate medical attention

Question 12

what is the indication/uses of cyclosporine?

Answer 12

prevention of organ rejection in kidney, liver, heart transplantation.
Tx of rheumatoid arthritis and psoriasis.
unlabeled uses: rejection prevention in pancreas, bone marrow, and heart/lung transplantation.

Question 13

Cyclosporine MOA

Answer 13

inhibits activation of T cells by blocking the production and release of the cytokine mediator IL-2

Question 14

What the indications for azathioprine (Imuran)

Answer 14

organ rejection prevention in kidney transplantation

Tx of rheumatoid arthritis

Question 15

Azathioprine (Imuran) MOA

Answer 15

blocks metabolism of purines, inhibiting the synthesis of T-cell DNA, RNA and proteins and thereby blocking immune response.

Question 16

Uses of basiliximab (simulect)

Answer 16

organ rejection prevention in kidney transplantation.

Question 17

MOA basiliximab (simulect)

Answer 17

suppresses T-cell activity by blocking cytokine mediator.

Question 18

Daclizumab (Zenapax) uses?

Answer 18

organ rejection prevention in kidney transplantation

Question 19

what are the indications for glatiramer acetate

Answer 19

reduction of relapse frequency in patients with RRMS

Question 20

muromonab-CD3 (Orthoclone OKT3) indications

Answer 20

Tx of acute organ rejection in kidney, liver, and heart transplantation

Question 21

indications for sirolimus (Rapamune)

Answer 21

organ rejection prevention in kidney transplantation

Question 22

Mycophenolate mofetil (CellCept)

Answer 22

organ rejection prevention in kidney, liver and heart transplantation.

Question 23

Tacrolimus (Prograf) indications

Answer 23

organ rejection prevention in liver, kidney or heart transplantation.
unlabeled uses: rejection prevention in born marrow, pancreas, pancreatic islet cell, and small intestine transplantation, Tx of autoimmune disease and severe psoriasis.

Question 24

The term used for transplanted tissues or organs?

Answer 24

Grafts

Question 25

Humoral immunity is mediated by?

Answer 25

B lymphocytes

Question 26

immunity mediated by T lymphocytes is called?

Answer 26

Cellular immunity

Question 27

Which of the immunosuppressant drugs is indicated for Tx of organ rejection once rejection of the transplanted organ has begun?

Answer 27

muromonab-CD3

Question 28

Which of the immunosuppressant is currently the only one for the Tx of multiple sclerosis (MS)?

Answer 28

Glatiramer acetate

it for the reduction of the frequency of relapses (exacerbations) of RRMS - relasing-remitting multiple sclerosis.

Question 29

contraindications for immunosuppressants

Answer 29

drug allergy
renal or hepatic failure
hypertension
concurrent radiation therapy

Question 30

Adverse Effects for cyclosporine

Answer 30

hypertension
neurotoxicity, tremors
hepatotoxicity with cholestasis and hyperbilirubinemia 
nephrotoxicity 
hypersensitivity 
gingival hyperplasia
hirsutism

Question 31

azathioprine adverse effects

Answer 31

leukopenia, thrombocytopenia

hepatotoxicity

Question 32

Adverse effects when using muromonab-CD3

Answer 32

chest pain
pyrexia (fever), chills, tremors
N/V, diarrhea
dyspnea, wheezing, pulmonary edema
flulike symptoms, fluid retention

Question 33

Adverse Effects tacrolimus

Answer 33

agitation
anxiety, confusion, hallucinations
neuropathy
Albuminuria, dysuria, acute renal failure, renal tubular necrosis

Question 34

Adverse effects for antibody immunosuppressants: basiliximab, daclizumab and muromonab-CD3

Answer 34

cytokine release syndrome : fever, dyspnea, tachycardia, sweeting, chills, headache, N/V, diarrhea, muscle and joint pain and general malaise

Question 35

drug interactions with immunosuppressant

Answer 35

vaccines
grapefruit
echinacea
St. John’s wort

Question 36

Which of the immunosuppressant drugs is contraindicated in patients with a hypersensitivity to murine produces and those who are experiencing fluid overload?

Answer 36

muromonab-CD3

Question 37

When a change is made from Neoral or Gengraf to Sandimmune, the starting dose should be?

Answer 37

1:1 mg

Question 38

Cyclosporine may sometimes be administered with grapefruit juice intentionally to achieve therapeutic blood levels True or False?

Answer 38

True

Question 39

what are some assessment requirements for Azathioprine

Answer 39

assessment of WBC and platelet counts with notation of any SxS of infection.
bleeding tendencies due to the potential for drug related leukopenia and thrombocytopenia.

Question 40

what should the nurse assess for with a patient taking cyclosporine

Answer 40

functional level of all organs.
physiologic impact of organ transplant process
baseline oral assessments because of gingival hyperplasia
measurement of serum K and uric acid levels.

Question 41

What baseline assessment should be made for a patient taking Daclizumab

Answer 41

V/s specific attention to BP and PR
any immunecompromising disorders or infectious disease processes
H&H, WBC and platelet counts

Question 42

assessment for patients taking Muromonab-CD3

Answer 42

baseline weight,V/S

X-ray within 24 hours of beginning the drug to be sure that lung fields are clear and without fluid.

Question 43

Assessment for Tacrolimus

Answer 43

medication use
renal functioning; monitoring of BUN, serum creatinine and electrolyte levels
close assessment for the first 30 minutes for anaphylactic reactions.
Ensure that resuscitative equipments are accessible and functioning.
Have appropriate doses of epinephrine and O2

Question 44

How should the oral liquid dosage forms of cyclosporine be administered?

Answer 44

using a calibrated liquid measuring devic

Question 45

Guild lines for the use of cyclosporine oral solutions

Answer 45

should not be refrigerated
may be mixed in a glass container with chocolate mike, milk or OJ served at room temp.
patient must drink solution immediately after mixing.
styrofoam containers or cups should be avoided.
oral hygiene should be performed frequently to prevent gum problems.

Question 46

Administration of cyclosporine intravenously

Answer 46

diluted with NS or 5% dextrose in water.
infused using infusion pump
monitor patient closely during infusion for allergic reactions - facial flushing, urticaria, wheezing, dyspnea, and rash.
serum drug levels should be closely monitored

Question 47

intravenously administered muromonab CD-3

Answer 47

infused over 1 minute
medication must be withdrawn from the ampule through a low protein-binding 0.22 micron filter, filter must be detached and a new sterile needle applied after the medication is withdrawn

Question 48

Oral tacrolimus

Answer 48

given 8 to 12 hours after the discontinuation of the intravenous drug.
should be given on an empty stomach and put in a glass container.
Drug should not be put in styrofoam containers.
patient should consume no grapefruit with 2 hours of taking drug.
CBC, liver enzyme levels and serum K levels need to be monitored for the duration of therapy.

Question 49

How should the nurse administer an oral dose of cyclosporine?

Answer 49

should not use a styrofoam cup when mixing the medication.
may be mixed with milk, chocolate milk or orange juice.
should be mixed in a glass container and served immediately at room temperature.

Question 50

what important measure will be taken to prevent toxicity when taking cyclosporine?

Answer 50

monitoring serum levels closely because cyclosporine has a narrow therapeutic index.
monitor BUN, LDH, AST and ALT.

Question 51

what teaching should the nurse give to a patient who is taking oral cyclosporine and wants to relax by a pool and go shopping?

Answer 51

The nurse should advise the patient to avoid exposure to the sun and to wear sunscreen and protective clothing when outdoors.
The importance of avoiding situations that pose an increased risk of exposure to infections such as being in crowds, malls, movie theaters.

Question 52

A patient who is taking cyclosporine calls the nursing office to ask about eating grapefruit. what is nurse’s best answer?

Answer 52

grapefruit can increase the activity of cyclosporine.
grapefruit or grapefruit juice need not avoid entirely, but patient have to maintain a steady consumption. For example, patient can eat a half grapefruit each morning, as long as she does not vary the amount she eats from day to day.
notify physician if the grapefruit consumption levels change. This may require either an increase or decrease in dosage.

Question 53

The nurse is explaining the purpose of cyclosporine to a patient who wants to know how it keeps the immune system from attacking the new organ. what is the nurse’s best answer?

Answer 53

cyclosporine is a very potent immunosuppressant.
when the body receives a new transplanted, the body treats it as a foreign cells and attacks it.
cyclosporine works by inhibiting the activation of T-lymphocyte cell involvement in the immune response and stop it from attacking the newly transplanted organ.

Question 54

The nurse knows that, the most appropriate premedication for a patient who is about to receive muromonab-CD3 as part of post transplant drug.

Answer 54

muromonab-CD3 can cause cytokine release syndrome (fever, dyspnea and general malaise)
patients should be given corticosteroid to prevent this syndrome from occurring.

Question 55

why should injections be avoided as much as possible for patients who are going to have lung transplant.

Answer 55

to prevent the risk for infections associated with parenteral injections and subsequent injury to intact skin, which is the first line of defense.
medications should be given orally if possible.