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