Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 45 Immunosuppressant Drugs

2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Immune System (cont’d)  Participates in anaphylactic reactions  Responsible for rejection of kidney, liver, and heart transplants

4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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

6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Immunosuppressants (cont’d)  Corticosteroids  cyclosporine (Sandimmune)  azathioprine (Imuran)  muromonab-CD3 (Orthoclone)  daclizumab (Zenapax)  sirolimus (Rapamune)  basiliximab (Simulect)  glatiramer acetate (Copaxone)  tacrolimus (Prograf)

8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Immunosuppressants (cont’d)  Muromonab-CD3 is the only drug indicated for reversal of organ rejection once rejection of a transplanted organ has started

10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Immunosuppressants (cont’d)  azathioprine (Imuran)  Used as an adjunct medication to prevent rejection of kidney transplants  Also used in the treatment of rheumatoid arthritis

11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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  tacrolimus (Prograf)  Used only for the prevention of liver transplant rejection  Others uses are unlabeled uses

12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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)

13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Immunosuppressants (cont’d)  Adverse effects vary according to drugs and may be devastating  All immunosuppressed patients have a heightened susceptibility to opportunistic infections

14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Follow guidelines for parenteral administration carefully  Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation

20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Monitor for adverse effects and signs of drug toxicity