Transplant Therapy And Immunosuppressants Drugs Flashcards
(38 cards)
What is the purpose of the immune system?
Name the 3 lines of defense a give examples.
Purpose: protect the body from foreign materials (antigens)
Three lines of defence to protect the body:
- Combo of physical (skin, mucous membranes, hair, cilia) and chemicals (gastric secretions, vaginal secretions, urime, sweats, salive, etc)
- Leukocytes
- Specific immune response (humoral or cellular immunity)
What are immunosuppressants?
What are they used for?
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
What is the mechanism of action of immunosuppressant drugs?
Similar mechanism:
They selectively suppress certain T lymphocyte cell lines which prevents their involvement in the immune response.
What are cyclosporine and tacrolimus are primarly indicated for?
For both prevention of organ rejection and treatment of organ rejection following an organ transplant.
Life long treatment
What are some AE of cyclosporine?
- 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
What are some nursing teachings when a pt is on immunosuppressants?
- 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
What are some nursing implications with cyclosporine?
- 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
What are some uses of mycophenolate mofetil (immunosuppressant) ? And its form available?
Uses:
- prevention of organ rejection in kidney, liver and heart transplant
Forms available:
PO or IV
Should immunosuppressants be used in pregnant women?
Only in urgent situations under close supervision
What are some general food-drug interactions that can occur with the immunosuppressants : cyclosporine, tacrolimus and sirolimus?
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
What are some drug drug interactions that can occur with the immunosuppressants : cyclosporine, tacrolimus and sirolimus?
(Increase/ decrease effect of medication)
Increase their actions:
- fluconazole
- clarithromycin
- allopurinol
- metoclopramide
- amphotericin B
- cimetidine
- grape fruit
Decrease effects of these immunosuppressants:
- carbamazepine
- phenobarbital
- phenytoin
- rifampin
What are some nursing implications with mycophenolate mofetil?
And some specific drug interactions?
- 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
What are some AE of mycophenolate mofetil?
What is the main and most worrisome AE?
- Hypertension
- tachycardia
- peripheral edema
- electrolyte and metabolic disturbances
- dyspnea and cough
Main and most worrisome: bone marrow suppression causing - hematological disturbances (thrombocytopenia, neutropenia, anemia)
What are some AE of tacrolimus?
What are toxicities of tacrolimus?
- agitation
- nausea
- headache
- anxiety
- hallucinations
- dysuria
Neurotoxicity
And nephrotoxicity
High risk of anaphylaxis IV
Myelosuppression (high risk of infection and bleeding)
Post transplant diabetes
What are some nursing important pounts about tacrolimus?
- 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
What are some differences between tacrolimus and sirolimus?
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
What are some assessments needed to be done before administering cyclosporine?
- 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
What are some nursing implementation with immunosuppressants?
- 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
Why can corticosteroids be used for organ rejection?
What implementation needs ti be done for that matter?
- 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.
What are some important pt teaching about corticosteroids?
- 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
What are some examples of corticosteroids that can be given for immune system conditions?
- prednisone
- dexamethasone
- hydrocortisone
Why are some uses for corticosteroids?
Can be given for inflammed joints, lungs and skin (COPD, etc)
What is the class of medicstion often given with immunosuppressants?
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
What are some important lab results to monitor related to blood?
- hgb
- hematocrit
- RBC
- WBC
- platelets
Notify health care if values drop below normal ranges
