Section 4: Immunosuppressive Therapy

NUR 433: Adult Health II; MCUSON; Mrs. Cooper

The goal is to prevent _____ while keeping enough immunity to fight infection

rejection

Too little _____ invites rejection; too much invites infection and cancer

immunosuppression

the _____ phase’s purpose is strong suppression at surgery. some examples include Basiliximab, antithymocyte globulin

induction

the _____ phase’s purpose is lifelong prevention. some examples include Triple therapy: calcineurin inhibitor + mycophenolate + corticosteroid; doses taper over time

maintenance

the _____ phase’s purpose is to treat acute rejection. some examples include Pulse IV methylprednisolone, antibody therapy

rescue

_____ drugs works because each blocks a different step, so lower doses of several drugs suppress rejection with fewer side effects

combining

what drug class includes tacrolimus and cyclosporine

calcineurin inhibitors

where does calcineurin inhibitors blocks ___-___ production

IL-2

some key nursing points for calcineurin inhibitors include Trough levels; nephrotoxicity, tremor, hypertension, hyperglycemia, high K+; no _____; many CYP3A4 interactions

grapefruit

what drug class includes mycophenolate and azathioprine

antiproliferatives

antiproliferatives block ___ and ___ cell proliferation

T-; B-

key nursing points for antiproliferatives include Diarrhea, leukopenia; mycophenolate is teratogenic: _____ required

contraception

what drug class includes prednisone and methylprednisone

corticosteroids

corticosteroids block _____ activation and inflammation

macrophage

key nursing points for corticosteroids include _____, bone loss, infection, mood changes, delayed healing

hyperglycemia

what drug class includes sirolimus and everolimus

mTOR inhibitors

mTOR inhibitors block ___-cell activation

T

key nursing points for mTOR inhibitors include _____ and delayed wound healing

hyperlipidemia

what drug class includes basiliximab

IL-2 receptor antagonist

IL-2 receptor antagonists blocks the ___-___ receptor

IL-2

key nursing points for IL-2 receptor antagonists include Induction and _____ reactions

infusion

what drug class includes antithymocyte globulin

polyclonal antibody

polyclonal antibody depletes ___ cells

T

key nursing points for polyclonal antibody includes _____ (acetaminophen, diphenhydramine, IV methylprednisolone); infuse slowly; fever, chills, hypotension, leukopenia

premedicate

a priority for immunosuppressive therapy includes draw tacrolimus troughs right before the _____ dose, and give doses on schedule. A missed dose can trigger rejection. Check every new order for interactions: azole antifungals and macrolides raise tacrolimus levels; some anticonvulsants and rifampin lower them

morning