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Flashcards in Immunosuppressant Drugs Deck (27):
0

Azathioprine (Imuran)
(Functional Classification)

Immunosuppressant

1

Azathioprine (Imuran)
(Chemical Classification)

Purine Antagonist

2

Azathioprine (Imuran)
(Mechanism of Action)

Produces immunosuppression by inhibiting purine synthesis in cells

3

Azathioprine (Imuran)
(Uses)

Renal transplants to prevent graft rejection, refractory rheumatoid arthritis

4

Azathioprine (Imuran)
(Contraindications)

Pregnancy (D), hypersensitivity, breastfeeding

5

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

6

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

7

Cyclosporine
(Functional Classification)

Immunosuppressant

8

Cyclosporine
(Chemical Classification)

Fungus-derived peptide

9

Cyclosporine
(Mechanism of Action)

Produces immunosuppression by inhibiting lymphocytes (T)

10

Cyclosporine
(Uses)

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

11

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

12

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

13

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

14

Muromonab-CD3
(Functional Classification)

Immunosuppressant

15

Muromonab-CD3
(Chemical Classification

Murine monoclonal antibody

16

Muromonab-CD3
(Mechanism of Action)

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

17

Muromonab-CD3
(Uses)

Acute allograft rejection in renal/cardiac/hepatic transplant patients

18

Muromonab-CD3
(Contraindications)

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

19

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

20

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 -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

Mycophenolate mofetil
(Functional Classification)

Immunosuppressant

22

Mycophenolate mofetil
(Mechanism of Action)

Inhibits inflammatory responses that are mediated by the immune system

23

Mycophenolate mofetil
(Uses)

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

24

Mycophenate mofetil
(Contraindications)

Hypersensitivity to this product or mycophenolic acid
Pregnancy (D)

25

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

26

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