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Immunosuppressants increase the risk for
When to use immunosuppressants
- Autoimmune diseases
most effective class of immunosupressants
Prevent transplant rejection
to a lesser extent autoimmune diseases
What class is Cyclosproin (Sandimmune)
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
What are the major side effects of Cyclosporin (Sandimmune)
Nephrotoxicity and infection
There is also a low risk for Lymphoma
What does Cyclosporin not cause
bone marrow suppression, so there is not a change in the number of RBCs
When are levels for Cyclosporin (Sandimmune) drawn
At the trough
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
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
What are the drug-drug interactions of Cyclosporin (Sandimmune)
Anti-seizure medications can lower levels
NSAIDs can increase a risk for kidney failure
What class is Tacrolimus (Prograf)
When is Tacrolimus (Prograf) used?
ONLY for organ rejection
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
What are the major side effects of Tacrolimus (Prograf)
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
Kill T and B cells undergoing proliferation to prevent immunity
However, they are nonspecific and will kill ALL cells undergoing proliferation
Cytotoxic Drugs side effects
- Bone marrow depression
- GI disturbances
- hair loss
- fertility problems
Who gets cytotoxic drugs
People who have been unresponsive to safer immunosupressants
Methotrexate (Rheumatrex) or Trexall is taken with what
Combined with Cyclosporine (Sandimmune)
Methotrexate (Rhematrex) is a class of what?
What is the action of Methotrexate (Rheumatrex)
Suppresses T and B cell production by interfering with Folate metabolism
What is the primary use for Methotrexate (Rheumatrex)
Can also be used for arthritis and other autoimmune disorders, but in small doses
How are all monoclonal antibodies given?
IV, but can have a risk for anaphylax
What class of Drug is Prednisone (Cortisone)
What are the actions of Prednisone (Cortisone)
1.) Suppresses lymphocyte proliferation
2.) Sequesters extracellular lymphocytes
3.) Reduces the responsiveness of T lmphocytes
How is Cortisone given?
In large doses, .5-2 mg/kg
500-1500 mg for acute episodes
What are the side effects of Glucocorticoids
- Risk for infection
- Endothelial loss
- Fluid and electrolyte disturbances
- Fat redistribution
What are other side effects of Glucocorticoids
- Muscle weakness/loss
What is endothelial loss?
Thin skin and fragile veins
Seen with glucocorticoid use
When is RhoGAM given
28 weeks gestation and 72 hours after delivery
Who gets RhoGAM?
An Rh- mother with an Rh+ fetus
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