Pharmacologic Profile

General Use

Azathioprine, basiliximab, cyclosporine, everolimus, mycophenolate, sirolimus, and tacrolimus are used with corticosteroids in the prevention of transplantation rejection reactions. Muromonab-CD3 is used to manage rejection reactions not controlled by other agents. Azathioprine, cyclosporine, cyclophosphamide, and methotrexate are used in the management of selected autoimmune diseases (nephrotic syndrome of childhood and severe rheumatoid arthritis).

General Action and Information

Inhibit cell-mediated immune responses by different mechanisms. In addition to azathioprine and cyclosporine, which are used primarily for their immunomodulating properties, cyclophosphamide and methotrexate are used to suppress the immune responses in certain disease states (nephrotic syndrome of childhood and severe rheumatoid arthritis). Muromonab-CD3 is a recombinant immunoglobulin antibody that alters T-cell function. Basiliximab is a monoclonal antibody.

Contraindications

Hypersensitivity to drug or vehicle.

Precautions

Use cautiously in patients with infections. Safety in pregnancy and lactation not established.

Interactions

Allopurinol inhibits the metabolism of azathioprine. Drugs that alter liver-metabolizing processes may change the effect of cyclosporine, tacrolimus, or sirolimus. The risk of toxicity with methotrexate may be ↑ by other nephrotoxic drugs, large doses of aspirin, or NSAIDs. Muromonab-CD3 has additive immunosuppressive properties; concurrent immunosuppressive doses should be ↓ or eliminated.

Nursing Implications

Assessment

• Monitor for infection (vital signs, sputum, urine, stool, WBC). Notify physician or other health care professional immediately if symptoms occur.
• Assess for symptoms of organ rejection throughout therapy.
• Monitor CBC and differential throughout therapy.

Potential Nursing Diagnoses

• Risk for infection (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Protect transplant patients from staff and visitors who may carry infection.
• Maintain protective isolation as indicated.

Patient/Family Teaching

• Reinforce the need for lifelong therapy to prevent transplant rejection. Review symptoms of rejection for transplanted organ and stress the need for patient to notify health care professional immediately if they occur.
• Advise patient to avoid contact with contagious persons. Patients should not receive vaccinations without first consulting with health care professional.
• Emphasize the importance of follow-up exams and lab tests.

Evaluation/Desired Outcomes

• Prevention or reversal of rejection of organ transplants or decrease in symptoms of autoimmune disorders.