Pharm ch 48 - Immunosuppressant Drugs

Immunosuppressants results in?

a pharmacologically immunocompromised state

A male patient who received a kidney transplant 6 months ago is taking cyclosporine. The patient tells the nurse that he has started to take several herbal preparations. Which does not pose a possible problem for the patient? A. St. John's wort B. Ginkgo C. Cat's claw D. Echinacea

B. The potential for interactions between immunosuppressant drugs and herbal preparations should not be overlooked. For example, the enzyme-inducing properties of St. John's wort have been demonstrated to reduce the therapeutic levels of cyclosporine and cause organ rejection. The immunostimulant properties of cat's claw and echinacea may be similarly undesirable in transplant recipients, because they have effects that are opposite those of the immunosuppressants.

What should you encourage patients taking immunosuppressants to reduce the risk of infection?

-Avoid crowds. -Avoid people with colds or other infections.

basiliximab (Simulect) and daclizumab (Zenapax)

-Monoclonal antibodies. -Used to prevent rejection of transplanted kidneys. -Generally used as part of a multidrug immunosuppressive regimen that includes cyclosporine and corticosteroids.

cyclosporine (Sandimmune)

-Prevention of organ rejection. -May be used for other autoimmune disorders.

azathioprine (Imuran)

-Prophylaxis of organ rejection concurrently with other immunosuppressant drugs, such as cyclosporine and corticosteroids. -Also used in the treatment of rheumatoid arthritis.

What should you monitor for throughout the therapy?

-WBC counts. -if the count drops below normal range, contact the prescriber.

When monitoring patients on immunosuppressants therapy, the nurse must keep in mind that the major risk factor for patients taking these drugs is which condition? A. Severe hypotension with potential renal failure. B. Increased susceptibility to opprortunistic infections. C. Decreased platelet aggregation. D. Increased bleeding tendencies.

B. Increased susceptibility to opprortunistic infections.

Which potential problem is of most concern for the patient receiving immunosuppressant drugs? A. Orthostatic hypotension B. Increased susceptibility to infections C. Neurotoxicity D. Peripheral edema

B. Neurotoxicity and edema may be a problem with some immunosuppressants (not orthostatic hypotension), but a heightened susceptibility to opportunistic infections is a major risk factor in immunosuppressed patients.

Oral immunosuppressants should be taken with?

food, to minimize GI upset.

azathioprine (Imuran): Mechanism of Action

Blocks metabolism of purines, inhibiting the synthesis of T cell DNA, RNA, and proteins and thereby blocking immune response.

The nurse is discussing drug therapy with cyclosporine (Sandimmune). Which food product inhibits metabolism enzymes and possibly increases the activity of cyclosporine? A. Dairy products. B. Orange juice. C. Grapefruit juice D. Red wines

C. Grapefruit juice

The nurse should question the prescriber regarding use of cyclosporine for the treatment of which disease? A. Arthritis B. Psoriasis C. Irritable bowel disease D. Multiple sclerosis

D. Cyclosporine (Sandimmune, Neoral, Gengraf) is an immunosuppressant drug that is indicated for the prevention of organ rejection as well as the treatment of other immunologic disorders, such as various forms of arthritis, psoriasis, and irritable bowel disease.

The purpose of the immune system is to

Distinguish self from nonself and to protect the body from foreign material (antigens), including cancer.

fingolimod (Gilenya)

-Failed as an antirejection drug. -Approved in 2010 for multiple sclerosis. -Only oral drug for relapsing forms of multiple sclerosis.

Immunosuppressants: Indications

-For the prevention of organ rejection. -Muromonab-CD3, mycophenolate, and tacrolimus are indicated for both prevention of rejection and treatment of organ rejection.

Major classes used to prevent organ rejection:

-Glucocorticoids. -Calcineurin inhibitors. -Antimetabolites.

basiliximab (Selulect): Indications

-Prevention of organ rejection in kidney transplantation.

azathioprine (Imuran): Indications

-Prevention of organ rejection in kidney transplantation. -Treatment of rheumatoid arthritis.

muromonab-CD3 (Orthoclone OKT3)

-Reversal and prevention of graft rejection. -Monoclonal antibody.

tacrolimus (Prograf)

-Used for the prevention of liver transplant rejection. -Others uses are unlabeled uses.

A patient will be taking cyclosporine (Sandimmune) after transplant surgery. Which of these are potential adverse effects of cyclosporine therapy? A. Hypertension. B. Fever. C. Nephrotoxicity. D. Fluid retention. E. Hypotension. F. Post-transplant diabetes mellitus.

A. Hypertension. C. Nephrotoxicity. F. Post-transplant diabetes mellitus.

Immunosuppressants

-Drugs that decrease or prevent an immune response, thus suppressing the immune system. -Used to prevent or treat rejection of transplanted organs. -All suppress certain T-lymphocyte cell lines, thus preventing their involvement in the immune response.

mycophenolate (CellCept)

-FDA black box warning for increased risk of congenital malformations and spontaneous abortions when used during pregnancy.

Immunosuppressant Nursing Implications with antifungals.

-Oral antifungal drugs are usually given with these drugs to treat oral candidiasis that may occur. -Assess the oral cavity often for white patches on the tongue, mucous membranes, and oral pharynx.

Immune System

-Participates in anaphylactic reactions. -Responsible for rejection of kidney, liver, and heart transplants. -Can also sometimes attack itself, causing "autoimmune diseases" or immune-mediated diseases.

What should you assess before starting immunosuppressant therapies?

-Renal, liver, and cardiovascular function studies. -CNS baseline function. -Respiratory assessment. -Baseline vital signs. -Baseline laboratory studies, including hemoglobin, hematocrit, WBC, and platelet counts.

What should you mix oral cyclosporine in?

-a glass container. -Do not use Styrofoam containers because the drug adheres to the inside wall of the container.

Two types of immunity:

-humoral immunity, which is mediated by B lymphocytes. -cellular immunity, which is mediated by T lymphocytes.

The nurse providing teaching for patients taking immunosuppressnts will include which information?(Select all that apply) A. The mouth and tongue should be inspected carefully for white patches. B. Allergic reactions to these drugs are rare. C. Patients should avoid crowds to minimize the risk of infection. D. Patients should report any fever, sore throat, chills, or joint pain. E. Patients should take oral forms with food to avoid GI upset.

A. The mouth and tongue should be inspected carefully for white patches. C. Patients should avoid crowds to minimize the risk of infection. D. Patients should report any fever, sore throat, chills, or joint pain. E. Patients should take oral forms with food to avoid GI upset.

When teaching patients who are taking oral doses of immunosuppressants, how will the nurse instruct the patient to take the medication? A. With food to minimize GI upset. B. On an empy stomach to increase absorption rate. C. Only when adverse effects are tolerable. D. Mixed with water only.

A. With food to minimize GI upset.

Which drugs are indicated for the treatment of multiple sclerosis? (Select all that apply) A. glatiramer (Copaxone) B. azathioprine (Imuran) C. basiliximab (Simulect) D. daclizumab (Zenapax) E. fingolimod (Gilenya)

A. glatiramer (Copaxone) E. fingolimod (Gilenya)

A patient who had a kidney transplant is receiving cyclosporine PO in maintenance doses. What action would decrease the potency of this drug? A. Taking it with orange juice B. Taking it with milk C. Using a Styrofoam container to administer the drug D. Mixing it with chocolate milk

C. Cyclosporine should not be mixed in a Styrofoam container because the medication has been found to adhere to the inside wall of the cup or container.

A patient is experiencing rejection of a transplantd organ. The nurse expects which drug to be given to manage this? A. azathioprine (Imurant). B. cyclosporine (Sandimmune) C. muromonab-CD3 (Orthoclone OKT3) D. glatiramer (Copaxone)

C. muromonab-CD3 (Orthoclone OKT3)

basiliximab (Selulect): Mechanism of Action

Supresses T-cell activity by blocking the binding of the cytokine mediator IL-2 to a specific receptor.

What should you inform patients on immunosuppressants for organ transplants?

That the therapy is lifelong.

glatiramer acetate (Copaxone)

Works by blocking T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with multiple sclerosis.

Immunosuppressants examples

cyclosporine (Sandimmune), azathioprine (Imuran), muromonab-CD3 (Orthoclone), daclizumab (Zenapax), sirolimus (Rapamune), basiliximab (Simulect), glatiramer acetate (Copaxone), tacrolimus (Prograf), mycophenolate mofetil (CellCept)

basiliximab (Simulect) and daclizumab (Zenapax) Have a tendency to cause the allergy-like reaction known as?

cytokine release syndrome

fingolimod (Gilenya): Adverse Effects

headache, hepatotoxicity, flulike symptoms, back pain, AV block, bradycardia, hypertension, and macular edema, may occur

mycophenolate (CellCept): Adverse Effects

hypertension, hypotension, peripheral edema, tachycardia, pain, headache, hyperglycemia, hyperlipidemia, electrolyte disturbances, and others

mycophenolate (CellCept): Indications

prevention of organ rejection as well as the treatment of organ rejection.

When are oral forms used?

when possible, to decrease the risk of infection that may occur with parenteral injections.