Immunosuppressant Drugs

Question 1

Describe the Mechanism of Action of Immunosupressants.

Answer 1

Immunosuppressants work by suppressing T-lymphocytes, preventing their involvement in the immune response.

Question 2

What is the primary indication of the immunosuppressant class of drugs?

Answer 2

Prevention of organ rejection

Question 3

What are the contraindications to the use of Immunosuppressants?

Answer 3

1) Renal Failure
2) Hepatic Failure
3) Hypertension
4) Radiation Therapy

Question 4

What are some of the Interactions caused by Tx with Immunosuppressants?

Answer 4

1) ⬇ Effectiveness of vaccines
2) Grapefruit juice may increase the bioavailability of cyclosporine by 20% to 200%.
3) St. John’s Wort ⬇ effectiveness of cyclosporine
4) ⬇ effectiveness with concurrent use of Cat’s Claw and Echinacea

Question 5

What are the 3 drugs from the Immunosuppressant class we should focus on?

Answer 5

1) Azothioprine (Imuran)
2) Cyclosporine
3) Muromonab-CD3

Question 6

What are the common adverse effects of cyclosporine?

Answer 6

1) Hypertension
2) Tremors
3) Hepatotoxicity
4) Nephrotoxicity
5) Gingival Hyperplasia
6) Hirsutism

Question 7

What are the common adverse effects of Azothioprine (Imuran)?

Answer 7

1) Leukopenia
2) Thrombocytopenia
3) Hepatotoxicity

Question 8

What are the common adverse effects of Muromonab-CD3?

Answer 8

1) Chest Pain
2) Fever, chills and tremors
3) Vomiting, nausea, and diarrhea
4) Dyspnea, wheezing and pulmonary edema
5) Flu-like symptoms and fluid retention

Question 9

Besides organ rejection, what is the other indication of the drug Muromonab-CD3?

Answer 9

1) The reversal of graft rejection

Question 10

What is important for the nurse to assess when giving Azathioprine drugs?

Answer 10

1) Requires assessment of WBC and platelet counts with notation of any SxS of infection because and any bleeding tendencies because of the potential for drug related leukopenia and thrombocytopenia.

Question 11

What is important for the nurse to assess when giving Cyclosporine drugs?

Answer 11

1) Functional level of all organs
2) Cardiovascular, CNS, hepatic and renal disease
3) Oral assessment (because of gingival hyperplasia)
4) Potassium and Uric levels

Question 12

What is important for the nurse to assess when giving Muromonab-CD3 drugs?

Answer 12

1) Baseline weight
2) Baseline vitals
3) X-ray within 24 hours of beginning the drug to be sure that lung fields are clear and without fluid.

Question 13

(T/F) Oral immunosuppressants should be taken with food to minimize GI upset?

Answer 13

True

Question 14

What are the 5 rules patients should adhere to when taking oral forms of Cyclosporine?

Answer 14

1) Do not use the different formulations of Cyclosporines interchangeably.
2) Do not refrigerate oral forms of Cyclosporines
3) Use a calibrated device to administer oral liquid forms
4) Do not use styrofoam cups
5) Oral solutions may be mixed w/milk, or OJ and served at room temperature (must be served immediately).

Question 15

It is important to monitor which lab values during IV therapy of Cyclosporine in order to detect possible renal and hepatic impairment?

Answer 15

1) BUN
2) Lactate dehydrogenase
3) AST
4) ALT

Question 16

How is a dose of IV Muromonab-CD3 prepared and administered?

Answer 16

1) The medication must be withdrawn from the ampule through a low-protein binding 0.22 micron filter, and the filter must be detached and a new sterile needle applied.
2) IV dose is administered over 1 minute

Question 17

What should the nurse teach the patient regarding Immunosuppressant drugs?

Answer 17

1) Avoid crowds because they increase the risk for infections
2) Report any fever, sore throat, chills, joint pain, or fatigue (may indicate infection).
3) Female PTs should use contraceptives
4) Drugs should be taken at the same time everyday

Question 18

The immunosuppressant drug Muromonab-CD3 is contraindicated in patients with what?

Answer 18

1) Patients with hypersensitivity to murine products

2) Patients with fluid volume overload

Question 19

(T/F) Cyclosporine may sometimes be administered with grapefruit juice intentionally to achieve therapeutic blood levels?

Answer 19

True