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  • • Doses are adjusted on the basis of serum level monitoringPrevention of Transplant Rejection (Sandimmune)• PO (Adults and Children): 14–18 mg/kg/dose 4–12 hr before transplant then 5–15 mg/kg/day divided q 12–24 hr postoperatively, taper by 5% weekly to maintenance dose of 3–10 mg/kg/day.• IV (Adults and Children): 5–6 mg/kg/dose 4–12 hr before transplant, then 2–10 mg/kg/day in divided doses q 8–24 hr; change to PO as soon as possible.
  • Cyclic 11-amino acid polypeptide Suppresses humoral immunity (antibodies)Blocks transcription of cytokines (interleukin-2, -4)Enters T cells --> binds to cyclophorine --> cylosprin-cyclophorin complex inhibits the desphosphorylating activity of calcineurin --> inactivation of calcineurin inhibits the NFAT (nuclear factor of activated T cells) pathway of transcription factors --> no NFAT activity means no gene expression of cytokines (interleukin-2, -4)Long story short: ***Cyclosporine prevents gene expression of interleukin-2 and -4, which suppresses the immune response***Interleukins distinguish self cells from foreign antigens --> graft vs. host disease in organ transplantsCyclosporin does not:Affect phagocytosisCause myelotoxicity (bone marrow suppression, decreased blood cell counts)About 90% is bound to plasma lipoproteins
  • Measure serum creatinine, BUN, CBC, magnesium, potassium, uric acid, and lipids at baseline, every 2 wk during initial therapy, and then monthly if stable. Nephrotoxicity may occur; report significant increases» May cause hepatotoxicity; monitor for ↑ AST, ALT, alkaline phosphatase, amylase, and bilirubin» May cause ↑ serum potassium and uric acid levels and ↓ serum magnesium levels» Serum lipid levels may be ↑
  • Cyclosporine

    1. 1. Cyclosporine<br />Immunosuppressant<br />Ashley Huffman, Nichole Klemz, Alison Peine, Emily Wyman<br />
    2. 2. Nursing Student Objectives<br /> Identify 2 priority nursing dx for a pt taking Cyclosporine <br />Verbalize 3 side effects of Cyclosporine<br />Briefly verbalize the mechanism of action of Cyclosporine<br />
    3. 3. Client Objectives<br />Verbalize the purpose of Cyclosporine therapy<br />Identify 3 adverse reactions to report immediately to the physician <br />
    4. 4. What is Cyclosporine?<br />Trade Names<br />Neoral, Sandimmune, Gengraf<br />Uses<br />Prevent transplant rejection, arthritis, psoriasis <br />Dosage/Route<br />PO ~ dose varies<br />onset: unknown, peak: 2-6hr, duration: unknown<br />IV ~ dose varies<br />onset: unknown, peak: end of infusion, duration: unknown<br />
    5. 5. Mechanism<br />Inhibits normal immune response by inhibiting interlukin-2, a factor necessary for initiation of T-cell activity<br />Interleukins distinguish self cells from foreign antigens <br />
    6. 6. Side Effects<br />CNS- Seizures, tremor<br />CV- Hypertension<br />GI- diarrhea, hepatotoxicity, nausea, vomiting<br />GU- Nephrotoxicity<br />Dermatitis- Hirsutism<br />
    7. 7. Patient Education<br />Take medication at the same time each day <br />Avoid grapefruit and grapefruit juices <br />Discuss common side effects with patient<br />
    8. 8. Nursing Considerations<br />Prevention of Transplant Rejection<br />Assess for symptoms of organ rejection throughout therapy<br />Psoriasis<br /> Assess skin lesions prior to and during therapy<br />Arthritis<br />Assess pain and limitation of movement prior to and during administration<br />
    9. 9. Nursing Considerations<br />PO<br />Mix oral solution with milk, chocolate milk, apple juice or orange juice, preferably at room temperature, stir well and drink at once<br />IV<br />Dilute each 1 mL (50 mg) of IV concentrate immediately before use with 20–100 mL of D5W or 0.9% NaCl <br />Infuse slowly over 2–6 hr via infusion pump<br />Check Y-site compatibility<br />
    10. 10. Nursing Dx<br />Risk for Infection<br />Chronic Pain<br />Fatigue <br />Impaired skin integrity<br />Impaired tissue integrity<br />