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49 Cards in this Set
- Front
- Back
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The purpose of the _____ is to distinguish self from nonself and to protect the body from foreign material (antigens), including cancer. |
immune system |
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WBC are pit bulls Immunosuppression meds are leashes and hold back pit bulls. If you stop taking them, the leashes break |
immune system |
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Participates in anaphylactic reactions Responsible for rejection of kidney, liver, and heart transplants |
immune system |
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immune system Can also sometimes attack itself, causing 2
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“autoimmune diseases” or immune-mediated diseases |
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Drugs that decrease or prevent an immune response, thus suppressing the immune system
Used to prevent or treat rejection of transplanted organs |
Immunosuppressants |
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All Immunosuppressants suppress certain T-lymphoyte cell lines, thus preventing their involvement in the immune response Results in a pharmacologically ____
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immunocompromised state |
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Administering patients Immunosuppressants is like inducing ___ on an individual. It knocks their T cells down (like hiv) and allow opportunistic infections |
aids |
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Immunosuppressants Classes Major classes used to prevent organ rejection 3 |
Glucocorticoids Calcineurin inhibitors Antimetabolites
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Protein that blocks the body’s immune response (inflammation) |
Calcineurin inhibitors |
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Drugs 6 |
cyclosporine (Sandimmune) azathioprine (Imuran) muromonab-CD3 (Orthoclone) basiliximab (Simulect) glatiramer acetate (Copaxone) mycophenolate mofetil (CellCept) sirolimus (Rapamune) tacrolimus (Prograf)
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Indications vary from drug to drug Primarily indicated for the prevention of organ rejection Also used with immunological disorders |
Immunosuppressants |
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__2__are indicated for both prevention of rejection and treatment of organ rejection |
Muromonab-CD3 & mycophenolate (Cellcept) |
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____ is an immunosuppressant drug that is indicated for the prevention of organ rejection as well as the treatment of other immunologic disorders, such as various forms of arthritis, psoriasis, and irritable bowel disease. |
: Cyclosporine (Sandimmune, Neoral, Gengraf) |
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Prophylaxis of organ rejection concurrently with other immunosuppressant drugs, such as cyclosporine and corticosteroids Also used in the treatment of rheumatoid arthritis |
azathioprine (Imuran)
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Interacts with gout meds |
azathioprine (Imuran) |
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2 Monoclonal antibodies Used to prevent rejection of transplanted kidneys Generally used as part of a multidrug immunosuppressive regimen that includes cyclosporine and corticosteroids Have a tendency to cause the allergy-like reaction known as cytokine release syndrome (cytokines cause inflammation) *Not FDA approved
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basiliximab (Simulect) and daclizumab (Zenapax)
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Blocks metabolism of purines, inhibiting the synthesis of T-cell DNA, RNA, and proteins and thereby blocking immune response |
azathioprine (Imuran) |
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Suppresses T-cell activity by blocking the binding of the cytokine mediator IL-2 to a specific receptor
Prevention of organ rejection in kidney transplantation |
basiliximab (Simulect) and daclizumab (Zenapax) |
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Prevention of organ rejection Not interchangeable with its modified Gengraf or Neoral May be used for other autoimmune disorders various forms of arthritis, psoriasis, and irritable bowel disease. 50% of patients have moderate ____ with the use of this drug. |
cyclosporine (Sandimmune)
hypertension |
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NO ___!! With any Immunosuppressants! It increases Toxicity |
Grapefruit |
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This must be mixed in a Glass container |
cyclosporine (Sandimmune) |
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Check for gingival hyperplasia Problems
Must check for for thrush, bleeding
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cyclosporine (Sandimmune) |
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Inhibits activation of T cells by blocking the production and release of the cytokine mediator IL-2 Prevention of organ rejection in kidney, liver, and heart transplantation; treatment of rheumatoid arthritis and psoriasis. Unlabeled uses* include prevention of rejection in pancreas, bone marrow, and heart/lung transplantation. |
cyclosporine (Sandimmune) |
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___ should not be mixed in a Styrofoam container because the medication has been found to adhere to the inside wall of the cup or container. |
Cyclosporine |
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Works by blocking T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with multiple sclerosis
Mixes with sugar – manitol which allows it to be injected Helps regrow myelin sheaths
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glatiramer acetate (Copaxone) |
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(contraindicated with manitol allergy) |
glatiramer acetate (Copaxone) |
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Injectables Reversal and prevention of graft rejection Monoclonal antibody Corticosteriods minimize adverse reactions Monitor of fluid overload Monitor for chest pain, fever, chills, tremors, N/V/D after organ transplant
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muromonab-CD3 (Orthoclone OKT3) |
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-_____ cause a flu like state
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nabs |
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Indicated for the prevention of organ rejection as well as the treatment of organ rejection FDA black box warning for increased risk of congenital malformations and spontaneous abortions when used during pregnancy Common side effects include hypertension, hypotension, peripheral edema, tachycardia, pain, headache, hyperglycemia * (will lead to diabetes), hyperlipidemia, electrolyte disturbances, and others
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mycophenolate (CellCept)
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There is a black box warning on this med (do not get pregnant after transplant) |
mycophenolate (CellCept) |
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Adverse effects vary according to drugs and may be devastating All immunosuppressed patients have a heightened susceptibility to opportunistic infections |
Nursing Implications |
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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 |
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Inhibits T-cell activation, possibly by binding to an intracellular protein known as FKBP-12
Prevention of organ rejection in liver, kidney, and heart transplantation. Unlabeled uses† include prevention of rejection in bone marrow, pancreas, pancreatic islet cell, and small intestine transplantation; treatment of autoimmune diseases; and severe psoriasis. |
tacrolimus (Prograf) |
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Inhibits T-cell activation by binding to an intracellular protein known as FKBP-12 that subsequently prevents cellular proliferation
Prevention of organ rejection in kidney transplantation |
sirolimus (Rapamune) |
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Assess for contraindications, drug allergies, and drug interactions Monitor WBC counts throughout therapy; if the count drops below normal range, contact the prescriber |
Nursing Implications |
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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 |
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_____ is a major risk factor in immunosuppressed patients. |
a heightened susceptibility to opportunistic infections |
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Check blood sugar a few times a day and keep it in diary All these patients keep a diary |
Nursing Implications |
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Treats RRMS, relapsing-remitting multiple sclerosis |
glatiramer acetate (Copaxone) |
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Works by blocking T-cell autoimmune activity against myelin protein, which reduces the frequency of the neuromuscular exacerbations associated with multiple sclerosis |
glatiramer acetate (Copaxone) |
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______are usually given with these drugs to treat oral candidiasis that may occur Assess the oral cavity often for white patches on the tongue, mucous membranes, and oral pharynx (can go all the way down to their stomach) This is prevented by nistatin
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Nursing Implications
Oral antifungal drugs |
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Mix oral ____ solution in a glass container Do not use Styrofoam containers because the drug adheres to the inside wall of the container |
cyclosporine |
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Follow guidelines for parenteral administration carefully Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation Monitor for therapeutic responses Monitor for adverse effects and signs of drug toxicity |
Nursing Implications |
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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
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Nursing Implications |
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-____ – gout medication, can increase level of toxicity with cyclosporine.
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Allopurinol |
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Don’t let people bring____ to your room on these drugs. |
fresh flower |
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Agitation, anxiety, confusion, hallucinations, neuropathy Albuminuria, dysuria, acute renal failure, renal tubular necrosis
Posttransplant diabetes mellitus |
Tacrolimus adverse effects |
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Sirolimus and tacrolimus are structurally related and act through similar mechanisms. Sirolimus is classified as an ____, whereas tacrolimus is classified as a _____. Sirolimus is available only for oral use, whereas tacrolimus is available in both oral and injectable forms. |
mTOR kinase inhibitor
calcineurin inhibitor |
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____originally was approved for the treatment of advanced renal cell carcinoma and recently has been approved for the prevention of rejection in kidney transplant. It is an analogue of sirolimus. |
Everolimus (Certican) |
