NURS 330 Chp. 45

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CHAPTER 45 Immunosuppressant Drugs

Immune System: 

Immune System Defends the body against invading pathogens, foreign antigens, and its own cells that become cancerous Can also sometimes attack itself, causing “autoimmune diseases” or immune-mediated diseases

Immune System (cont’d): 

Immune System (cont’d) Participates in anaphylactic reactions Responsible for rejection of kidney, liver, and heart transplants

Immunosuppressants: 

Immunosuppressants Drugs that decrease or prevent an immune response, thus suppressing the immune system Used to prevent or treat rejection of transplanted organs

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) All suppress certain T-lymphocyte cell lines, thus preventing their involvement in the immune response Results in a pharmacologically immunocompromised state Mechanisms of action vary according to drug

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) Corticosteroids cyclosporine (Sandimmune) azathioprine (Imuran) muromonab-CD3 (Orthoclone) daclizumab (Zenapax) sirolimus (Rapamune) basiliximab (Simulect) glatiramer acetate (Copaxone) tacrolimus (Prograf)

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) Indications vary from drug to drug Primarily indicated for the prevention of organ rejection Some also used for immunologic diseases such as rheumatoid arthritis and multiple sclerosis

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) Muromonab-CD3 is the only drug indicated for reversal of organ rejection once rejection of a transplanted organ has started

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) azathioprine (Imuran) Used as an adjunct medication to prevent rejection of kidney transplants Also used in the treatment of rheumatoid arthritis Requires the assessment of WBC and platelet counts with notation of any signs and symptoms of infection as well as any bleeding tendencies due to the potential for drug-related leukopenia and thrombocytopenia.

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) cyclosporine (Sandimmune) Primary drug used for the prevention of kidney, liver, heart, and bone marrow transplant rejection May be used for other autoimmune disorders (RA, psoriasis) Specific assessment of the functional levels of all organs, as well as assessment for any underlying cardivascular, CNS, hepatic, and/or renal disease. A baseline oral assessment is needed, because gingival hyperplasia is a know adverse effect. Measurement of serum potassium and uric acid levels tacrolimus (Prograf) Used only for the prevention of liver transplant rejection Others uses are unlabeled uses R equires obtaining history with attention to medication use and renal functioning through monitoring of BUN, serum creatinine and serum electrolyte levels. Requires very close assessment for the first 30 minutes with the first dose of the medication for anaphylaxis

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) glatiramer acetate (Copaxome) The only immunosuppressant drug used for the treatment of multiple sclerosis (MS) Used to reduce the frequency of MS relapses (exacerbations) in relapsing-remitting multiple sclerosis (RRMS) Contraindicated in patients allergic to sugar mannitol

Immunosuppressants (cont’d): 

Immunosuppressants (cont’d) Adverse effects vary according to drugs and may be devastating All immunosuppressed patients have a heightened susceptibility to opportunistic infections

Nursing Implications: 

Nursing Implications Perform a thorough assessment before administering these drugs Renal, liver, and cardiovascular function studies CNS baseline function Respiratory assessment Baseline vital signs Baseline laboratory studies, including hemoglobin, hematocrit, WBC, and platelet counts

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Assess for contraindications, drug allergies, and drug interactions Monitor WBC counts throughout therapy; if the count drops below 3000/mm 3 , discontinue the drug, but only after contacting the physician

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Oral immunosuppressants should be taken with food to minimize GI upset Oral forms are used when possible to decrease the risk of infection that may occur with parenteral injections Note that there are several possible drug interactions Grapefruit juice also interacts with some of these drugs

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Oral antifungal drugs are usually given with these drugs to treat oral candidiasis that may occur Observe the oral cavity often for white patches on the tongue, mucous membranes, and oral pharynx

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Mix oral cyclosporine solution in a glass container Do not use Styrofoam containers because the drug adheres to the inside wall of the container

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Follow guidelines for parenteral administration carefully Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection Avoiding crowds Avoiding people with colds or other infections Inform patients to immediately report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection

Nursing Implications (cont’d): 

Nursing Implications (cont’d) Monitor for therapeutic responses Monitor for adverse effects and signs of drug toxicity