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Collab Therapies 2 > Transplant Therapy And Immunosuppressants Drugs > Flashcards

Transplant Therapy And Immunosuppressants Drugs Flashcards

1
Q

What is the purpose of the immune system?

Name the 3 lines of defense a give examples.

A

Purpose: protect the body from foreign materials (antigens)

Three lines of defence to protect the body:

  1. Combo of physical (skin, mucous membranes, hair, cilia) and chemicals (gastric secretions, vaginal secretions, urime, sweats, salive, etc)
  2. Leukocytes
  3. Specific immune response (humoral or cellular immunity)
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2
Q

What are immunosuppressants?

What are they used for?

A

Drugs that decrease or prevent an immune response, and suppresses the immune system.

Used for many disorders including:
- rheumatoid arthritis
- crohns disease
- multiple sclerosis
- systemic lupus reythematosus
- myasthenia gravis
-psoriasis 
- to prevent organ rejection after a transplant
and more
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3
Q

What is the mechanism of action of immunosuppressant drugs?

A

Similar mechanism:

They selectively suppress certain T lymphocyte cell lines which prevents their involvement in the immune response.

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4
Q

What are cyclosporine and tacrolimus are primarly indicated for?

A

For both prevention of organ rejection and treatment of organ rejection following an organ transplant.

Life long treatment

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5
Q

What are some AE of cyclosporine?

A
  • neurotoxicity
  • myelosuppression (risk of infection and bleeding)
  • hepatotoxicity
  • nephrotoxicity
  • post transplant diabetes
  • gingival hyperplasia: overgrowth of gum tissue around the teeth
  • hirsutism: condition in which women grow excessive dark or coarse hair in a men like pattern (chest, face and back)
  • tremor
  • vomiting
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6
Q

What are some nursing teachings when a pt is on immunosuppressants?

A
  • avoid grapefruit
  • avoid St. John wort

Medication causes:
Increased risk of infection and injury (thrombocytopenia, neutropenia, anemia, etc

So:

  • avoid big crowds,
  • avoid fresh fruits
  • avoid raw meats
  • avoid live vaccines
  • avoid using razors
  • report any signs of infection
  • dont take with aspirin, or ibuprofen (increase risk of bleed)

Before administration:

  • check platelets and WBC counts
  • monitor for bleeding

Others:

  • life long medication
  • dont double dose
  • take everyday at same time
  • monitor drug levels closely
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7
Q

What are some nursing implications with cyclosporine?

A
  • PO: take with meals to decrease GI upset
  • if IV: infuse slowly over 2 to 6hrs and assess closely for allergic reactions (up to 30min after infusion)
  • can be taken with orange juice or milk
  • avoid breast feeding
  • maintain good oral hygiene
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8
Q

What are some uses of mycophenolate mofetil (immunosuppressant) ? And its form available?

A

Uses:
- prevention of organ rejection in kidney, liver and heart transplant

Forms available:
PO or IV

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9
Q

Should immunosuppressants be used in pregnant women?

A

Only in urgent situations under close supervision

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10
Q

What are some general food-drug interactions that can occur with the immunosuppressants : cyclosporine, tacrolimus and sirolimus?

A

All three:
- avoid grapefruit juice and grape fruit
- meals high in fat or carbs can decrease absorption

Cyclosporine:

  • foods high in potassium (ex: banana, tomatoes) can increase cyclosporine nephrotoxicity
  • st john wort : decrease therapeutic levels and cause organ rejection

Sirolimus:
- meals with high fat content: xan increase sirolimus levels

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11
Q

What are some drug drug interactions that can occur with the immunosuppressants : cyclosporine, tacrolimus and sirolimus?

(Increase/ decrease effect of medication)

A

Increase their actions:

  • fluconazole
  • clarithromycin
  • allopurinol
  • metoclopramide
  • amphotericin B
  • cimetidine
  • grape fruit

Decrease effects of these immunosuppressants:

  • carbamazepine
  • phenobarbital
  • phenytoin
  • rifampin
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12
Q

What are some nursing implications with mycophenolate mofetil?
And some specific drug interactions?

A
  • take on an empty stomach: 2hrs after meals or 1hr before
    Taken 2 times per day q12hrs bc very hard in stomach

Interactions:
Antacids, iron : decrease absorption
Oral contraceptives: decrease its effectiveness
Avoid grapefruit
No live vaccines

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13
Q

What are some AE of mycophenolate mofetil?
What is the main and most worrisome AE?

A
  • Hypertension
  • tachycardia
  • peripheral edema
  • electrolyte and metabolic disturbances
  • dyspnea and cough

Main and most worrisome: bone marrow suppression causing - hematological disturbances (thrombocytopenia, neutropenia, anemia)

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14
Q

What are some AE of tacrolimus?
What are toxicities of tacrolimus?

A
  • agitation
  • nausea
  • headache
  • anxiety
  • hallucinations
  • dysuria

Neurotoxicity
And nephrotoxicity
High risk of anaphylaxis IV
Myelosuppression (high risk of infection and bleeding)
Post transplant diabetes

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15
Q

What are some nursing important pounts about tacrolimus?

A
  • cannot be administered with cyclosporine
  • shouldnt be taken grape fruit
  • high fat or high carbs food can decrease absorption
  • monitor kidney function tests due to risk of nephrotoxicity (electrolytes, BUN, creatinine)
  • preferred PO bc high risk of anaphylaxis with IV
  • when iv: assess closely for first 30min for signs of anaphylaxis
  • higher risk of infection
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16
Q

What are some differences between tacrolimus and sirolimus?

A

Very similar drug

  • sirolimus: only available PO but tacrolimus available PO and IV
  • sirolimus levels increased when taken with high fat meals
  • sirolimus can be given with cyclosporine
17
Q

What are some assessments needed to be done before administering cyclosporine?

A
  • assess function of all organ (especially cardiovascular, CNS, liver and kidney disease due to toxicities)
  • CBC, hgb, hct,
  • baseline oral assessment due to risk of gingival hyperplasia
  • assess and document baseline BP due to risk of hypertension
18
Q

What are some nursing implementation with immunosuppressants?

A
  • oral immunosuppressants need to be taken with food to minimize GI upset except tacrolimus PO and mycophenolate mofetil
  • oral forms are preferred from injections due to risk of infection and injury
  • monitoring for anaphylactic or allergic reaction (especially with tacrolimus IV and cyclosporine)
  • pre medications may be needed to prevent allergic reactions (like antihistamines or anti-inflammatory)
  • no grapefruit
  • no St. John wort
  • no NSAIDs
  • adequate protection in the su
  • adequate protection for high risk of infection and bleeding
19
Q

Why can corticosteroids be used for organ rejection?

What implementation needs ti be done for that matter?

A
  • can be taken due to immunosuppressant properties and for their antiinflammatory properties.

If for organ rejection: taken for life long so can cause a decrease in bone density—> because of that pt should be taking calcium and vitamin D supplements

  • also take with food to decrease GI upset and decreade the risk for GI ulcers.
20
Q

What are some important pt teaching about corticosteroids?

A
  • helps body respond to inflammation and stresss
  • need to be taken with food
  • cant be stopped abruptly
  • can cause sepsis
  • causes an increase in blood sugar so may need insulin injections and need to monitor CBGM even if not diabetic
  • can affect vision
21
Q

What are some examples of corticosteroids that can be given for immune system conditions?

A
  • prednisone
  • dexamethasone
  • hydrocortisone
22
Q

Why are some uses for corticosteroids?

A

Can be given for inflammed joints, lungs and skin (COPD, etc)

23
Q

What is the class of medicstion often given with immunosuppressants?

A

Oral antifungals are often given with immunosuppressants to treat oral candidiasis that occurs due to immunosuppression and fungal overgrowth

Ex: Nystatin often given for oral candida with immunosuppressants and chemo drugs

24
Q

What are some important lab results to monitor related to blood?

A
  • hgb
  • hematocrit
  • RBC
  • WBC
  • platelets

Notify health care if values drop below normal ranges

25
Q

What are immunosuppressants used for?

Prototypes:
Cyclosporine, tacrolimus and mycophenolate mofetil

A

Used for organ transplants

And tacrolimus and cyclosporine also used for autoimmune diseases

26
Q

What are major toxicities associated with cyclosporine treatment?

And what are some other AE?

A
  • high risk for infection
  • high risk of bleeding due to myelosuppression
  • neurotoxicity
  • hepatotoxicity
  • nephrotoxicity

Can also cause:
- Gingival hyperplasia
- post transplant diabetes
- tremor
- n& v

27
Q

What are patient teaching associated with cyclosporine?

A
  • high risk for infection so avoid big crowds, no live vaccines, no buffets, no raw foods, well cooked meat only,
  • high risk of bleeding so avoid razors uses, no contact sports, adequate protection in activities
  • adequate protection in the sun bc increase risk for skin cancer
  • avoid grapefruit juice
  • avoid St. John’s wort
  • avoid NSAIDs
  • foods high in potassium can increase nephrotoxicity (bananas, tomatoes)
28
Q

How should cyclosporine be taken?

A
  • Take with foods, orange juice or milk to decrease GI upset
  • take same time every day
  • don’t double dose
  • don’t skip dose
  • take as prescribed
  • life long medication tx
29
Q

What are some assessments needing to be done before starting immunosuppressants therapy?

A
  • allergies
  • medical history
  • contraindications
  • possible interactions
  • blood tests (CBC, hct, hgb, platelets, WBC, RBC, neutrophils)
  • kidney and liver function tests
  • diet
30
Q

What is the top risk for tacrolimus administration IV and what are the assessments or monitoring needing to be done?

A

High risk of anaphylaxis reaction

  • assess closely for first 30min for signs of anaphylaxis (hives, itching, flushing, hypotension, weak and rapid pulse, n&v, dizziness, wheezing, SOB)
31
Q

What are some toxicities of tacrolimus therapy?
And how do they present?

A
  • nephrotoxicity (swelling around the eyes, ankles and feet, proteinuria (foamy urine), weight gain bc of fluid retention, fatigue, loss of appetite, abnormal kidney results)
  • neurotoxicity (confusion, headaches, migraines, sleep disorders, balançe and hearing problems, anxiety, depression, impaired control of limbs or organs)
  • anaphylaxis (wheezing, SOB, flushing, itching, hives, edema, fever, chills)
  • myelosuppression: low WBCs, low RBCs, low platelets (increased risk of bleeding), low neutrophils
  • high risk for infection (fever, chills, sweating, increased WBCs, pus formation, fatigue)
32
Q

How should tacrolimus be taken PO?

A
  • can be taken with food but not high fat or high carbs
  • don’t administer with cyclosporine
  • high fat foods or high in carbs can decrease medication absorption
  • may need nystatin for oral candida
33
Q

How should mycophenolate mofetil be taken PO?

A

Usually taken twice daily q12hrs on empty stomach (2hrs after or 1hr before)
Usually given twice a day bc is very hard on stomach but food decreases it’s absorption
IMPORTANT TO BE TAKEN WITHOUT FOOD

34
Q

What are some nursing considerations related to mycophenolate mofetil?

A
  • avoid pregnancy
  • decrease effet of contraceptives so need to switch to other form of protection other than PO
  • avoid antacids and iron within 2 hr of this medication(decrease absorption)
  • TAKE ON EMPTY STOMACH VERY IMPORTANT
  • not to be used with concurrent radiotherapy
  • decreased effect with rifampin
  • can cause congenital malformations
35
Q

What are important considerations regarding immunosuppressants?
And some specifics to the meds (cyclosporine, tacrolimus, and mycophenolate mofetil)

A
  • avoid grapefruit
  • cyclosporine and tacrolimus should not be given together
  • cyclosporine: take with food or milk
  • tacrolimus can be taken with food but not higher fat foods or high in carbs
  • mycophenolate mofetik: take without food
  • protective mesures for myelosupprestion and bleeding risk
  • mycophenolate mofetil decrease effectiveness of oral contraceptives
  • Mycophenolate mofetil: decrease absorption with antacids and iron
  • may need oral antifungals (nystatin) to tx possible AE of oral candidiasis (thrush)
  • monitor lab results (Hgb, Hct, RBC, WBC and platelet)
  • life long tx
  • report fever, sore throat, joint pain or fatigue
36
Q

Identify the 2 immunosuppressants that cannot be prescribed together.

  1. Mycophenolate mofetil (salcate)
  2. Cyclosporine
  3. Tacrolimus
  4. Prednisone

A. 1 and 3
B. 1 and 4
C. 2 and 3
D. 2 and 4

A

C

37
Q

Patient XY will be going home on the following meds:
- prednisone
- tacrolimus PO
- mycophenolate mofetik
The nurse has started discharge teaching regarding the meds.

Identify the statement that indicates the pt requires further teaching regarding mycophenolate mofetil.

A) I can take the medication with food and fluids like orange juice and chocolate milk
B) I should order my groceries and supplies online to avoid going out into the shops
C) if I Forget to take my medication in the morning I can take it as soon as I remember as long as it’s not within two hours of the evening dose
D) I will need to take my medication for the rest of my life

A

A)

The medication should be taken on an empty stomach all the time to avoid subtherapeutic effect

38
Q

The drug mycophenolate mofetil (cellcept) has a black box warning because of which potential AE?

A) hypertension
B) suicidal idéations
C) abnormal heart rhythms
D) congenital malformations

A

D

Collab Therapies 2 (28 decks)

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