| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Azathioprine (Imuran)—PO, IV 3–5 mg/kg/day initially; maintenance: 1–3 mg/kg/day | Prevent renal transplant rejection Ulcerative colitis Rheumatoid arthritis | Antagonizes purine metabolism/inhibition of DNA/RNA synthesis | Hypersensitivity; additive myelosuppression with anti-neoplastics; hepatotoxicity, leukopenia |
| NURSING IMPLICATIONS: Assess for infection; monitor I&O and daily weight | |||
| Cyclosporine (Sandimmune)—PO 5–10 mg/kg several hours before surgery; daily for 2 wk; reduce dosage by 2.5 mg/kg/wk to 5–10 mg/kg/day; IV 5–6 mg/kg several hours before surgery; switch to PO form as soon as possible | Prevent organ rejection Ulcerative colitis; Rheumatoid arthritis | Inhibits interleukin-2, which is necessary for initiation of T-cell activity | Hypersensitivity; caution with alcohol, renal impairment |
| NURSING IMPLICATIONS: Monitor: I&O, daily weight, blood pressure; take as directed (time of day and with food); observe for nephrotoxicity, gingival hyperplasia; avoid self-administration of OTC drugs | |||
| Muromonab-CD 3 (Orthoclone OKT3)—IV 5 mg/day, 10–14 days | Renal, liver, or cardiac transplant rejection | Immunosuppression of T-cell function | Tremor; dyspnea, shortness of breath, wheezing; chest pain; diarrhea, nausea, vomiting; chills, fever |
| NURSING IMPLICATIONS: Draw solution into filter; give IV push over <1 min; do not give as IV infusion; do not mix with other medications | |||
| Mycophenolate (CellCept)—PO 1 gm twice daily | Prevent renal transplant rejection | Inhibits purine synthesis; suppresses T and B lymphocytes | Diarrhea; vomiting; leukopenia; sepsis |
| NURSING IMPLICATIONS: Give initial dose within 72 hr of transplant surgery; give on empty stomach 1 hr before or 2 hr after meals; do not open, crush, or chew capsules; do not give with magnesium or aluminum antacids | |||
| Tacrolimus—PO 0.075–0.15 mg/kg q12h; IV 0.05–0.1 mg/kg/day | Prevent rejection of liver transplant | Inhibits T-lymphocyte activation | Headache, insomnia, tremor; ascites; hypertension; peripheral edema; abdominal pain; rash; hyperglycemia, anemia |
| NURSING IMPLICATIONS: Give 6 hr after transplant surgery; oral therapy is preferred because of anaphylaxis with IV; therapy is lifelong | |||