Transplant medicaton education class


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Overview of medications for preventing rejection and infection in post-organ transplant patients. Presented by Methodist Hospital, Houston, TX

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Transplant medicaton education class

  2. 2. Meet the PharmacistsLeamon Samir PatelBlanton Kyle Dawson Jenny DeVos
  3. 3. This presentation will… Answer your questions on what medications you will take after transplant Why these medications are important Proper ways of taking these medications Explain to you the side effects associated with these medications
  4. 4. Medications that you will be taking  Anti-rejection medications  Anti-infection medications  Medications to protect your stomach  Blood pressure medications  Medications for high blood sugars  Supplements
  5. 5. Anti-Rejection Medications Lungs Immune System HeartLiver Pancreas Kidney
  6. 6. Anti-Rejection Medications Prograf® (Tacrolimus) Neoral® / Gengraf® (Cyclosporine) CellCept® / Myfortic ® (Mycophenolate) Imuran® (Azathioprine) Rapamune® (Sirolimus) Steroids (Prednisone)
  7. 7. Anti-Infection MedicationsAnti-Rejections drugsweaken the immunesystem They increase your risk of getting infections
  8. 8. Anti-Infection Medications Immune Infections SystemMonitor anti-rejection Anti-infectionmedications to balance medications helpbetween risk of rejection and prevent infection
  9. 9. Anti-Infection Medications Anti-fungal medications  Fluconazole, Vfend®, nystatin, clotrimazole Anti-bacterial medications  Bactrim®, pentamidine, dapsone, atovaquone Anti-viral medications  Acyclovir, Valcyte®
  10. 10. Anti-Rejection Medications
  11. 11. Prograf® (Tacrolimus)  Anti-rejection Medication  Mostly used anti-rejection medicationYellow = 0.5 mg you are put on Prograf® OR  Typically Neoral® (Cyclosporine)White = 1 mg  Do not allow pharmacy to substitute without physician approval  Many drug interactions Red = 5 mg
  12. 12. Cyclosporine (Neoral®)  Anti-rejection medication  Neoral® or Prograf®25 mg capsule  Also comes as Sandimmune®, Gengraf®)  Do not allow pharmacy to substitute100 mg capsule without physician approval  Store capsule in original package  Many drug interactions
  13. 13. Prograf® (Tacrolimus),Neoral® (Cyclosporine)  Take every 12 hours at the same time every day 8:00 AM 8:00 PM  Levels are checked before morning dose and the dose may be changed according to the drug level  On lab days, DO NOT take Prograf® or Neoral® Instead, bring them with you and take after lab work
  14. 14. Prograf® (Tacrolimus),Neoral® (Cyclosporine) Side Effects:  Hand tremors  Water retention  Headaches  High potassium  Confusion  Low magnesium  High blood sugar  Low phosphorus  High blood pressure  Kidney problems
  15. 15. Prograf® (Tacrolimus),Neoral® (Cyclosporine) Side Effects:  Hair Loss (Prograf®)  Hair Growth (Neoral®)
  16. 16. Prednisone  Typically take once daily in the morning5 mg tablet  Best to take with food10 mg tablet  Side effects of prednisone can get20 mg tablet better as the dose decreases40 mg tablet
  17. 17. PrednisoneSide effects: Fluid, salt retention  Facial puffiness High blood sugar  Increased appetite High blood pressure  Weak bones/bone Mood changes loss Insomnia  Weak muscles/loss Weight gain  Stomach irritation  Acne
  18. 18. Mycophenolate(CellCept®, Myfortic®) CellCept®  Anti-rejection medication  You may take either CellCept®250 mg 500 mg OR Azathioprine (Imuran®)  Myfortic® is a “slower release” Myfortic® form of CellCept®  Take every 12 hours, same time180 mg 360 mg every day
  19. 19. Azathioprine (Imuran®)  Anti-rejection medicine50 mg tablet  May take in place of CellCept ® or Myfortic®  Once daily dosing  Drug interaction with allopurinol  Decrease azathioprine dose by
  20. 20. Mycophenolate (CellCept®, Myfortic®),Azathioprine (Imuran®) Side effects: CellCept ®, Myfortic® Azathioprine  Nausea, cramping (Imuran®)  Diarrhea  Decreased white  Decreased white blood cell count blood cell count  Decreased red blood cell count
  21. 21. Sirolimus (Rapamune®)  Anti-rejection medication  Take once daily, separate from 1mg tablet Cyclosporine (Neoral®) by 4 hours Neoral® Rapamune® 8:00 AM 12:00 AM 2 mg tablet  Many drug interactions, askAlso available as a solution transplant team before taking any new medication
  22. 22. Sirolimus (Rapamune®)Side effects: Slow wound healing  Increase in Increase in triglycerides cholesterol  Decrease in red Decreased white blood cell count blood cell count  Stomach cramping Decrease in
  23. 23. Drug Interactions forPrograf®, Neoral®, Rapamune® Drug/Food Interactions:  Blood pressure medications (diltiazem, verapamil)  Seizure medications (phenytoin, carbamazepine)  Anti-infection medications (voriconazole, fluconazole)  Grapefruit, careful of foods high in potassium  ALWAYS ask transplant team BEFORE taking a NEW medication or stopping an OLD medication if it will affect your anti-rejection medication
  24. 24. Over-the-counter medicationsto AVOID  Anti-inflammtory drugs: ibuprofen, naproxen (Aleve®, Advil®, Motrin®)  Herbal supplements  Decongestants (phenylephrine, pseudoephedrine)  Diet pills  Cimetidine (Tagament®)
  25. 25. Over-the-counter medicationsthat are OK  Zyrtec®, Claritin®, Benadryl® - Allergies  Pepcid®, Zantac®, Prilosec® - Upset stomach  Immodium® - Diarrhea  Bisacodyl, Senna, Docusate Sodium – Constipation  Tylenol® - Headache, pain, fever
  26. 26. Anti-infection Medications
  27. 27. Risk of infection Lower immune system can increase risk of infection Infection can come from germs in and around the body, environment, animals or people, food, insects Signs of infections: fever, fatigue, diarrhea, symptoms of upper respiratory infection, frequency/burning when urinating, red/irritated skin
  28. 28. Kinds of infections after transplantthat we try to prevent against:  Fungal infections:  Oral “thrush”, fungal infection invading body  Viral infections:  Herpes (simplex, zoster), Cytomegalovirus (CMV)  Bacterial infections:  Pneumocystic jiroveci pneumonia (PCP)
  29. 29. Anti-fungal medicationsOral “thrush” medications: Nystatin swish and swallow 5 ml four times daily Clotrimazole (Mycelex®) troches four times daily Do not eat or drink for 15 minutes after
  30. 30. Anti-fungal medicationsFor invasive fungal infections: Fluconazole (Diflucan®) Itraconazole (Sporonox®) Voriconazole (Vfend®)
  31. 31. Anti-fungal medicationsKey points: Clotrimazole, fluconazole, itraconazole and voriconazole WILL affect Prograf®, Neoral®, and Rapamune® levelsAlways ask: What will happen to my anti-rejection medicine? Itraconazole (Sporonox ) ®  Capsules should be taken WITH FOOD  Solution should be taken on an EMPTY STOMACH Voriconazole (Vfend®)
  32. 32. Anti-viral medicationsHerpes virus, Cytomegalovirus (CMV) Acyclovir (Zovirax®)  200mg-800mg two to four times daily Valacyclovir (Valtrex®)  500mg-1000mg one to two times daily Valgancyclovir (Valcyte®)  450 mg one to two times daily
  33. 33. Anti-viral medicationsKey points: Take medications WITH FOOD to help increase absorption Valcyte can decrease red and white blood cell counts and dose may be adjusted accordingly  Thiscould lead to infections and feelings of fatigue
  34. 34. Anti-PCP medicationsPneumocystis jiroveci pneumonia (PCP) Bactrim DS on MONDAYS, WEDNESDAYS, FRIDAYS Bactrim SS daily  Cannot take if you have an allergy to SULFA  Increase sensitivity to sunlight  Can decrease white blood cell counts
  35. 35. Anti-PCP medicationsOther anti-PCP medications Pentamidine Inhalation Treatments  Given once a month in a breathing treatment  May cause coughing, irritation Dapsone  100 mg tablet given once daily Atovoquone (Mepron®)  Banana flavored liquid, 750 mg two times daily
  36. 36. Other Medications
  37. 37. Supplements NeutraPhos (Phosphorus) MagOxide (Magnesium) Multivitamin Calcium Vitamin D
  38. 38. Other medications Blood pressure medications  Norvasc®, Metoprolol, Hydralazine Blood sugar lowering medications  Insulin, Januvia®, Actos® Osteoporosis prevention/treatment medications  Boniva®, Fosamax®, Actonel®  Take with full glass of water and sit/stand upright for 30 minutes
  39. 39. Other medications Acetylcysteine (Mucomyst) for inhalation – Lung  Lung secretions Ursodiol (Actigal®) – Liver  Prevention of bile stones Statins (pravastatin, simvastatin)  Caution: May cause muscle pain Aspirin
  40. 40. Other medications Water pills (Lasix®) Ulcer prevention medications  Prilosec®, Prevacid®, Nexium®, Pepcid®, Zantac® Pain medications  Maycause: constipation, nausea, confusion, drowsiness
  41. 41. Other information
  42. 42. Medication Calendar PILL BOX SLOT: MORN NOON EVE BED Used to treat / Noon / Supper / Special Drug Name/Strength/Instructions 7-9 am Bedtime prevent afternoon 7- 9 pm Instructions ***PROGRAF (TACROLIMUS); yellow = 0.5 mg Take ____ MG in the morning and ____ MG in Rejection   white = 1 mg the evening, 12 hours apart pink = 5 mg CELLCEPT 500 MG (MYCOPHENOLATE); Take _____ tablets twice daily every 12 hours (each Rejection   dose = _____ MG) PREDNISONE 5 MG; Take 5 tablets (25 mg) Rejection  Steroid Sparing Protocol once daily on 2/7 Last dose on: VALCYTE 450 MG (VALGANCICLOVIR) take Viral Infections  cmv d-/r+ one tablet every morning 05/03/10 CLOTRIMAZOLE 10 MG (MYCELEX); Take one Last dose on: Fungal tablet four times daily - do not eat/drink for 15     Infections 05/03/10 min. after each dose Last dose on: BACTRIM SS (SULFAMETHOX-TMP); Take one Pneumonia  tablet everyday in the evening 05/03/10 PROTONIX 40 MG (PANTOPRAZOLE); Take Heartburn /  one tablet once daily Reflux
  43. 43. Medication Calendar ALWAYS follow directions on Calendar and NOT on the pill bottle ALWAYS bring medication calendar to every clinic, lab and hospital visit ALWAYS make changes to medication on the calendar
  44. 44. NEVER stop taking yourmedicationsReasons Changes in financial income, insurance policy, etc Side effects from medications Laziness, forgetfulness Cost of medication
  45. 45. ALWAYS ask transplantteam when: A NEW medication is started An OLD medication is changed or stopped Make sure the change in therapy will NOT affect your anti-rejection medications
  46. 46. Suggestions: Get to know your pharmacists Check medications before leaving the pharmacy Use an alarm device to remind you to take your medications Be proactive in your healthcare
  47. 47. Frequently AskedQuestions What do I do if I vomit after taking my medication? What do I do if I forget to take my medications? Is there a difference between brand and generic medications?
  48. 48. Questions?