muromonab-cd3

s/e

• only agent indicated for reversal of organ rejection once rejection of a transplanted organ has started
• s/e: chills, fever, tremors, difficulty breathing, wheezing, pulmonary edema, chest pain, vomiting, nausea, diarrhea

cyclosporine

s/e

-primary agent used in prevention of: kidney, liver, heart, bone marrow transplant rejection

-may be used for other autoimmune disorders

-has profound interaction w grapefruit juice-->increased bioavailability of drug from 20-200%

-s/e: moderate HTN, neurotoxicity, hepatotoxicity, hypersensitivity, gingival hyperplasia, hirsutism

tacrolimus

s/e

• used for prevention of liver and kidney transplant rejection
• s/e: leukopenia, thrombocytopenia, hepatotoxicity (common)

-only immunosuppresant agent used for tx of MS

-used to reduce frequency of MS relapses (excacerbations)

side effects

1. hepatotoxicity
2. nephrotoxicity
3. dyspnea
4. chest pain
5. hypertension
6. leukopenia

cyclosprine INTERACTIONS

1. increase actions: diltiazem, nicardipine, verapamil, maxeran, cimetidine, ketoxonaxole
2. decrease actions: carbzemapine, phenobarbital, phenytoin, and rifampin

Nursing Assessment

1. renal: BUN, Cr, urine output
2. liver: liver function test, jaundice ascities
3. CVS vx, baseline ECG
4. CNS: baseline function (motor, sensory, past hx of seizures)
5. resp. assessment: dyspnea, SOB, wheezing, pulmonary edema
6. baseline vx signs: temp
7. baseline lab studies: hgb, Hct, WBC, platelets

Contraindications

1. drug allergies
2. liver failure
3. renal failure
4. hypertension
5. WBC count: if below 3.0 x 10 to the 9th/L, may be d/c
6. concurrent radiation therapy
7. only to be used in emergency situations during pregnancy

Nursing Implications

1. taken with food to minimize GI upset
2. oral forms used to decrease infection as with parenteral injections
3. oral antifungal agents are usually given w these agents to treat oral candidias that may occur
4. observe oral cavity often for white patches on tongue, mucous membranes, and oral pharynx
5. lifelong therapy w immunosuppresants indicated w organ transplantation

Nursing Implications 2

basiliximab, daclizumab, sirolimus, & mycophenolate, mofetil

prophylaxis

Lab Results

1. Hgb
2. Cr
3. Urea
4. Urine C&S
5. Urine R&M

INDICATIONS

1. primarily indicated for prevention of organ rejection

2. immunological diseases: rheumatoid arthritis & M.S