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NCLEX > Immunosuppressant Drugs > Flashcards

Immunosuppressant Drugs Flashcards

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0
Q

Azathioprine (Imuran)

Chemical Classification

A

Purine Antagonist

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1
Q

Azathioprine (Imuran)

Functional Classification

A

Immunosuppressant

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2
Q

Azathioprine (Imuran)

Mechanism of Action

A

Produces immunosuppression by inhibiting purine synthesis in cells

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3
Q

Azathioprine (Imuran)

Uses

A

Renal transplants to prevent graft rejection, refractory rheumatoid arthritis

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4
Q

Azathioprine (Imuran)

Contraindications

A

Pregnancy (D), hypersensitivity, breastfeeding

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5
Q

Azathioprine (Imuran)

Side Effects

A

GI: Nausea, Vomiting, stomatitis, esophagitis, PANCREATITIS, HEPATOTOXICITY, JAUNDICE
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, ANEMIA, PANCYTOPENIA, BLEEDING
INTEG: rash, alopecia
MISC: SERUM SICKNESS, Raynaud’s symptoms, secondary malignancy, infection
MS: arthralgia, muscle wasting

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6
Q

Azathioprine (Imuran)

Nursing Considerations

A

ASSESS:

  • FOR INFECTION: increased temp, WBC; sputum, urine
  • I&O, weight daily, report decreasing urine output; toxicity may occur
  • Bone marrow suppression: severe leukopenia, pancytopenia, thrombocytopenia; Hgb, WBC, platelets during treatment monthly; if leukocytes are <100,000/mm3, product should be discontinued
  • HEPATOTOXICITY: IF DARK URINE, JAUNDICE, ITCHING, LIGHT-COLORED STOOLS, INCREASED LFTs, PRODUCT SHOULD BE DISCONTINUED; HEPATIC STUDIES: ALK PHOS, AST, ALT, BILIRUBIN
  • ARTHRITIS: pain, ROM, swelling, mobility before, during treatment
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7
Q

Cyclosporine

Functional Classification

A

Immunosuppressant

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8
Q

Cyclosporine

Chemical Classification

A

Fungus-derived peptide

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9
Q

Cyclosporine

Mechanism of Action

A

Produces immunosuppression by inhibiting lymphocytes (T)

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10
Q

Cyclosporine

Uses

A

Organ transplants( liver, kidney, heart) to prevent rejection, rheumatoid arthritis, psoriasis

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11
Q

Cyclosporine

Contraindications

A

Breastfeeding, hypersensitivity to polyxyethylated castor oil (inj only); psoriasis or RA in renal disease (Neoral/Gengraf); Gengraf/Neoral used with PUVA/UVB, methotrexate, coal tar; ocular infections
Uncontrolled, malignant hypertension; radiation in psoriasis, neoplastic disease, sunlight (UV) exposure, renal disease/failure

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12
Q

Cyclosporine

Side Effects

A

CNS: Tremors, Headache, SEIZURES, CONFUSION
GI: nausea, vomiting, diarrhea, Oral Candida, Gum Hyperplasia, HEPATOTOXICITY, pancreatitis
GU: ALBUMINURIA, HEMATURIA, PROTEINURIA, RENAL FAILURE
INTEG: rash, acne, Hirsutism, pruritus
META: hyperkalemia, hypomagnesemia, hyperlipidemia, hyperuricemia
MISC: Infection, Hypertension

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13
Q

Cyclosporine

Nursing Considerations

A

ASSESS:

  • Renal studies: BUN, creatinine at least monthly during treatment, 3 mo after treatment
  • Product blood level during treatment 12 hr after dose, toxic >400ng/ml
  • Hepatic studies: alk phos, AST, ALT, bilirubin; hepatotoxicity: dark urine, jaundice, itching, light-colored stools; product should be discontinued
  • Serum lipids, magnesium, potassium, cycloSPORINE blood concentrations
  • ENCEPHALOPATHY: impaired cognition, seizures, visual changes including blindness, loss of motor function, movement disorders and psychiatric changes; dosage reduction or discontinuation may be needed in severe cases
  • NEPHROTOXICITY: 6wk after surgery, acute tubular necrosis, CyA trough level >200ng/ml, gradual rise in creatinine (0.15mg/dl/day), creatinine plateau <40mmHg
  • Signs/symptoms of encephalopathy, lymphoma
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14
Q

Muromonab-CD3

Functional Classification

A

Immunosuppressant

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15
Q

Muromonab-CD3

(Chemical Classification

A

Murine monoclonal antibody

16
Q

Muromonab-CD3

Mechanism of Action

A

Recognizes and reacts with T3 antigens on T lymphocytes; leads to cytokines release, blocks T-cell function

17
Q

Muromonab-CD3

Uses

A

Acute allograft rejection in renal/cardiac/hepatic transplant patients

18
Q

Muromonab-CD3

Contraindications

A

CHF, uncontrolled hypertension, hypersensitivity to murine origin, breastfeeding, pregnancy (C)
Fluid overload, seizures

19
Q

Muromonab-CD3

Side Effects

A

CNS: Pyrexia, Chills, Tremors, ASEPTIC MENINGITIS, Fever, headache, ENCEPHALOPATHY, seizures
CV: Chest, Pain, sinus tachycardia, hypertension, angina
EENT: vision impairment, irreversible, blindness
GI: Vomiting, Nausea, Diarrhea
MISC: INFECTION, CYTOKINE RELEASE SYNDROME, ANAPHYLAXIS, malaise, SECONDARY MALIGNANCY
MS: myalgia, arthralgia
RESP: Dyspnea, Wheezing, PULMONARY EDEMA

20
Q

Muromonab-CD3

Nursing Considerations

A

ASSESS:

  • CYTOKINE RELEASE SYNDROME (CRS): nausea, vomiting, chills, fever, joint pain, weakness, dizziness, diarrhea, tremors, abdominal pain; usually occur within 30-48hr, may last 6hr; treat with antihistamines, acetaminophen
  • HYPERSENSITIVITY, ANAPHYLAXIS: dyspnea, bronchospasm, urticaria, tachycardia, angioedema; emergency equipment must be available
  • Blood Studies: Hgb, WBC, platelets during treatment monthly; if leukocytes are </=25 cells/mm3
  • Hepatic studies: alk phos, AST, ALT, bilirubin
  • HEPATOTOXICITY: dark urine, jaundice, itching, light-colored stools; product should be discontinued
  • Infection: sore throat, fever, chills, temp; notify prescriber immediately
  • ASEPTIC MENINGITIS: fever, headache, photophobia
  • FLUID OVERLOAD: increased weight, I&O, edema, crackles, BP
21
Q

Mycophenolate mofetil

Functional Classification

A

Immunosuppressant

22
Q 
Mycophenolate mofetil 
(Mechanism of Action)
A

Inhibits inflammatory responses that are mediated by the immune system

23
Q

Mycophenolate mofetil

Uses

A

Prophylaxis for organ rejection in allogenic cardiac, hepatic, renal transplants

24
Q

Mycophenate mofetil

Contraindications

A

Hypersensitivity to this product or mycophenolic acid

Pregnancy (D)

25
Q

Mycophenolate mofetil

Side Effects

A

CNS: Tremor, Dizziness, Insomnia, Headache, Fever, anxiety, pain, PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
CV: Hypertension, Chest Pain, hypotension
GI: Diarrhea, Constipation, Nausea, Vomiting, stomatitis, GI BLEEDING, abdominal pain, anorexia, dyspepsia
GU: UTI, Hematuria, RENAL TUBULAR NECROSIS, POLYOMAVIRUS-ASSOCIATED NEPHROPATHY
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, ANEMIA, PANCYTOPENIA, PURE RED CELL APLASIA
INTEG: Rash
META: Peripheral Edema, Hypercholesterolemia, Hypophosphatemia, Edema, Hyperkalemia, Hypokalemia, Hyperglycemia, hypocalcemia, hypomagnesemia
MS: arthralgia, muscle wasting, back pain, weakness
RESP: Dyspnea, Respiratory Infection, Increased Cough, Pharyngitis, Bronchitis, Pneumonia
SYST: LYMPHOMA, Nonmelanoma Skin Carcinoma, SEPSIS

26
Q

Mycophenolate mofetil

Nursing Considerations

A

ASSESS:

  • PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, may be fatal; ataxia, confusion, apathy, hemiparesis, visual problems, weakness; side effects should be reported to FDA
  • Blood studies: CBC during treatment monthly
  • Hepatic studies: alk phos, AST, ALT, bilirubin
  • Renal studies: BUN, CCr, electrolytes
  • Pregnancy test within 1wk prior to initiation of treatment; confirm negative pregnancy test

NCLEX (40 decks)

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