Immunosuppressant Drugs Flashcards
Azathioprine (Imuran)
Chemical Classification
Purine Antagonist
Azathioprine (Imuran)
Mechanism of Action
Produces immunosuppression by inhibiting purine synthesis in cells
Azathioprine (Imuran)
Uses
Renal transplants to prevent graft rejection, refractory rheumatoid arthritis
Azathioprine (Imuran)
Contraindications
Pregnancy (D), hypersensitivity, breastfeeding
Azathioprine (Imuran)
Side Effects
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
Azathioprine (Imuran)
Nursing Considerations
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
Cyclosporine
Functional Classification
Immunosuppressant
Cyclosporine
Chemical Classification
Fungus-derived peptide
Cyclosporine
Mechanism of Action
Produces immunosuppression by inhibiting lymphocytes (T)
Cyclosporine
Uses
Organ transplants( liver, kidney, heart) to prevent rejection, rheumatoid arthritis, psoriasis
Cyclosporine
Contraindications
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
Cyclosporine
Side Effects
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
Cyclosporine
Nursing Considerations
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
Muromonab-CD3
Functional Classification
Immunosuppressant
Muromonab-CD3
(Chemical Classification
Murine monoclonal antibody
Muromonab-CD3
Mechanism of Action
Recognizes and reacts with T3 antigens on T lymphocytes; leads to cytokines release, blocks T-cell function
Muromonab-CD3
Uses
Acute allograft rejection in renal/cardiac/hepatic transplant patients
Muromonab-CD3
Contraindications
CHF, uncontrolled hypertension, hypersensitivity to murine origin, breastfeeding, pregnancy (C)
Fluid overload, seizures
Muromonab-CD3
Side Effects
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
Muromonab-CD3
Nursing Considerations
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
Mycophenolate mofetil
Functional Classification
Immunosuppressant
Mycophenolate mofetil (Mechanism of Action)
Inhibits inflammatory responses that are mediated by the immune system
Mycophenolate mofetil
Uses
Prophylaxis for organ rejection in allogenic cardiac, hepatic, renal transplants
Mycophenate mofetil
Contraindications
Hypersensitivity to this product or mycophenolic acid
Pregnancy (D)
Mycophenolate mofetil
Side Effects
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
Mycophenolate mofetil
Nursing Considerations
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
Azathioprine (Imuran)
Functional Classification
Immunosuppressant
