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Immunosuppressants increase the risk for
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When to use immunosuppressants
- Autoimmune diseases
- Transplants
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Calcineurin Inhibitors
most effective class of immunosupressants
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Cyclosporin (Sandimmune)
Therapeutic uses
Prevent transplant rejection
to a lesser extent autoimmune diseases
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What class is Cyclosproin (Sandimmune)
Calcineurin Inhibitor
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What is the action of Cyclosporin (Sandimmune)
Calcineurin is needed for Interleukin 2 production (IL2)
IL2 is needed for B and T cell proliferation
Therefore, Cyclosporin suppresses B and T cell production, which are used in immunity
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What are the major side effects of Cyclosporin (Sandimmune)
Nephrotoxicity and infection
There is also a low risk for Lymphoma
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What does Cyclosporin not cause
bone marrow suppression, so there is not a change in the number of RBCs
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When are levels for Cyclosporin (Sandimmune) drawn
At the trough
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What is the route for Cyclosporin (Sandimmune)
PO - can be as a pill or as a terrible tasting drink
IV - there is a high risk for anaphylaxis
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What other considerations are there for Cyclosporin
Sandimmune can not come in contact with plastic
Keep it out of the light
Grapefruit juice can increase levels
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What are the drug-drug interactions of Cyclosporin (Sandimmune)
Anti-seizure medications can lower levels
NSAIDs can increase a risk for kidney failure
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What class is Tacrolimus (Prograf)
Calcineurin Inhibitor
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When is Tacrolimus (Prograf) used?
ONLY for organ rejection
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Why is Tacrolimus (Prograf) used?
It is a more effective medication for host rejection than Cyclosporin (Sandimmune), although it has a much higher incidence of side effects
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What are the major side effects of Tacrolimus (Prograf)
- Nephrotoxicity
- Infections
- Malignancy
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If you have a patient who has recently been prescribed Cyclosporin (Sandimmune) while taking Dilantin. Why should you question this?
Cyclosporin cannot be taken with anti-seizure medications. It will lower the therapeutic levels of Cyclosporin
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Cytotoxic Drugs
Kill T and B cells undergoing proliferation to prevent immunity
However, they are nonspecific and will kill ALL cells undergoing proliferation
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Cytotoxic Drugs side effects
- Bone marrow depression
- GI disturbances
- hair loss
- fertility problems
- neutropenia
- thrombocytopenia
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Who gets cytotoxic drugs
People who have been unresponsive to safer immunosupressants
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Methotrexate (Rheumatrex) or Trexall is taken with what
Combined with Cyclosporine (Sandimmune)
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Methotrexate (Rhematrex) is a class of what?
Cytotoxic drug
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What is the action of Methotrexate (Rheumatrex)
Suppresses T and B cell production by interfering with Folate metabolism
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What is the primary use for Methotrexate (Rheumatrex)
Cancer
Can also be used for arthritis and other autoimmune disorders, but in small doses
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How are all monoclonal antibodies given?
IV, but can have a risk for anaphylax
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What class of Drug is Prednisone (Cortisone)
Glucocorticoid
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What are the actions of Prednisone (Cortisone)
1.) Suppresses lymphocyte proliferation
2.) Sequesters extracellular lymphocytes
3.) Reduces the responsiveness of T lmphocytes
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How is Cortisone given?
In large doses, .5-2 mg/kg
500-1500 mg for acute episodes
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What are the side effects of Glucocorticoids
- Risk for infection
- Endothelial loss
- Fluid and electrolyte disturbances
- Fat redistribution
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What are other side effects of Glucocorticoids
- Osteoporosis
- Muscle weakness/loss
- Hyperglycemia
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What is endothelial loss?
Thin skin and fragile veins
Seen with glucocorticoid use
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When is RhoGAM given
28 weeks gestation and 72 hours after delivery
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Who gets RhoGAM?
An Rh- mother with an Rh+ fetus
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