Chapter 45, Immunosuppressant drugs Flashcards
why should patient taking cyclosporine avoid consumption of grapefruit or grapefruit juice?
because of the potential for an increase in the blood concentration of cyclosporine.
what are some clinical uses for immunosuppressants?
suppression of immune-mediated disorders
malignancies
improvement of short-term and long-term allograft survival.
what should patient who are receiving cyclosporine and are to undergo transplant surgery know?
several days before surgery they may be told to take the cyclosporine with corticosteroids and oral antifungal as prophylaxis for candida infections.
True/false
Patient taking cyclosporine can mix the medication with milk or meals to minimize GI upset.
True
white patches on the tongue, mucous membranes, and/or oral pharynx of a patient taking immunosuppressants may indicate?
oral candidiasis
signs of cytokine release syndrome results in
fever, dyspnea, and general malaise
Generally with most organ transplants, mild nephrotoxicity may occur within?
2 to 3 months,
severe toxicity for most organ transplants occurs?
closer to the time of the actual transplantation.
What should the nurse do when a patient taking Daclizumab leukocyte count drops below 3000 cells/mm3?
discontinue the drug after the prescriber is contacted.
Female patients taking immunosuppressants should be educated about the use of what?
Contraception during the Tx and for up to 12 weeks after therapy ends.
SxS such as fever, sore throat, chills, joint pain, or fatigue in a patient taking immunosuppressant may indicate?
infection and requires immediate medical attention
what is the indication/uses of cyclosporine?
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.
Cyclosporine MOA
inhibits activation of T cells by blocking the production and release of the cytokine mediator IL-2
What the indications for azathioprine (Imuran)
organ rejection prevention in kidney transplantation
Tx of rheumatoid arthritis
Azathioprine (Imuran) MOA
blocks metabolism of purines, inhibiting the synthesis of T-cell DNA, RNA and proteins and thereby blocking immune response.
Uses of basiliximab (simulect)
organ rejection prevention in kidney transplantation.
MOA basiliximab (simulect)
suppresses T-cell activity by blocking cytokine mediator.
Daclizumab (Zenapax) uses?
organ rejection prevention in kidney transplantation
what are the indications for glatiramer acetate
reduction of relapse frequency in patients with RRMS
muromonab-CD3 (Orthoclone OKT3) indications
Tx of acute organ rejection in kidney, liver, and heart transplantation
indications for sirolimus (Rapamune)
organ rejection prevention in kidney transplantation
Mycophenolate mofetil (CellCept)
organ rejection prevention in kidney, liver and heart transplantation.
Tacrolimus (Prograf) indications
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.
The term used for transplanted tissues or organs?
Grafts
Humoral immunity is mediated by?
B lymphocytes
immunity mediated by T lymphocytes is called?
Cellular immunity
Which of the immunosuppressant drugs is indicated for Tx of organ rejection once rejection of the transplanted organ has begun?
muromonab-CD3
Which of the immunosuppressant is currently the only one for the Tx of multiple sclerosis (MS)?
Glatiramer acetate
it for the reduction of the frequency of relapses (exacerbations) of RRMS - relasing-remitting multiple sclerosis.
contraindications for immunosuppressants
drug allergy
renal or hepatic failure
hypertension
concurrent radiation therapy
Adverse Effects for cyclosporine
hypertension neurotoxicity, tremors hepatotoxicity with cholestasis and hyperbilirubinemia nephrotoxicity hypersensitivity gingival hyperplasia hirsutism
azathioprine adverse effects
leukopenia, thrombocytopenia
hepatotoxicity
Adverse effects when using muromonab-CD3
chest pain pyrexia (fever), chills, tremors N/V, diarrhea dyspnea, wheezing, pulmonary edema flulike symptoms, fluid retention
Adverse Effects tacrolimus
agitation
anxiety, confusion, hallucinations
neuropathy
Albuminuria, dysuria, acute renal failure, renal tubular necrosis
Adverse effects for antibody immunosuppressants: basiliximab, daclizumab and muromonab-CD3
cytokine release syndrome : fever, dyspnea, tachycardia, sweeting, chills, headache, N/V, diarrhea, muscle and joint pain and general malaise
drug interactions with immunosuppressant
vaccines
grapefruit
echinacea
St. John’s wort
Which of the immunosuppressant drugs is contraindicated in patients with a hypersensitivity to murine produces and those who are experiencing fluid overload?
muromonab-CD3
When a change is made from Neoral or Gengraf to Sandimmune, the starting dose should be?
1:1 mg
Cyclosporine may sometimes be administered with grapefruit juice intentionally to achieve therapeutic blood levels True or False?
True
what are some assessment requirements for Azathioprine
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.
what should the nurse assess for with a patient taking cyclosporine
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.
What baseline assessment should be made for a patient taking Daclizumab
V/s specific attention to BP and PR
any immunecompromising disorders or infectious disease processes
H&H, WBC and platelet counts
assessment for patients taking Muromonab-CD3
baseline weight,V/S
X-ray within 24 hours of beginning the drug to be sure that lung fields are clear and without fluid.
Assessment for Tacrolimus
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
How should the oral liquid dosage forms of cyclosporine be administered?
using a calibrated liquid measuring devic
Guild lines for the use of cyclosporine oral solutions
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.
Administration of cyclosporine intravenously
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
intravenously administered muromonab CD-3
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
Oral tacrolimus
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.
How should the nurse administer an oral dose of cyclosporine?
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.
what important measure will be taken to prevent toxicity when taking cyclosporine?
monitoring serum levels closely because cyclosporine has a narrow therapeutic index.
monitor BUN, LDH, AST and ALT.
what teaching should the nurse give to a patient who is taking oral cyclosporine and wants to relax by a pool and go shopping?
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.
A patient who is taking cyclosporine calls the nursing office to ask about eating grapefruit. what is nurse’s best answer?
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.
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?
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.
The nurse knows that, the most appropriate premedication for a patient who is about to receive muromonab-CD3 as part of post transplant drug.
muromonab-CD3 can cause cytokine release syndrome (fever, dyspnea and general malaise)
patients should be given corticosteroid to prevent this syndrome from occurring.
why should injections be avoided as much as possible for patients who are going to have lung transplant.
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.
