Principles of Immunosuppressive Therapy

Purpose and Uses

• Objective: Decrease or suppress the normal immune response to reduce inflammation.
• Conditions Treated:
  • Asthma and pulmonary diseases.
  • Spinal cord injuries: Steroids decrease degeneration and functional deficits post-injury.
  • Cerebral trauma or stroke.
  • Organ transplant and rejection: Requires lifelong drug therapy.

Selected Agents

Steroids

• Function: Decrease inflammation, prevent/treat organ transplant rejection.
• Examples:
  • Dexamethasone.
  • Prednisone.
  • Methylprednisolone.
• Reference: Unit 4 respiratory for complete drug list.

Anti-Rejection Immunosuppression Agents

• Purpose: Prophylaxis and rejection prevention.
• Prototypes:
  • Mycophenolate mofetil.
  • Cyclosporine.
  • Tacrolimus.
• Special Agent: Muromonab (both prevention and reversal of ongoing rejection).

Patient Education

• Compliance: Critical to take medication exactly as directed.
  • Must be taken at the correct time daily.
  • Do not stop medication without provider's consent.
  • May take with food to minimize GI upset.

Potential Interactions

• Over-the-counter Medications: Review with provider due to possible interactions.
• Important Tables:
  • Page 759, Table 48.3: Interaction review.
  • Page 758, Table 48.2: Side effects.

Side Effects and Infection Control

• Common Side Effects:
  • Hypertension.
  • Tremors.
  • Oral Candida: May require antifungal prescriptions.
  • Gingival hyperplasia.
• Infection Control:
  • Monitor signs of infection, WBC counts, and avoid large crowds.
  • Risk of opportunistic infections.
  • Avoid live vaccines (e.g., MMR, varicella).

Signs of Organ Rejection

• Symptoms:
  • Fever, chills, flu-like symptoms.
  • Pain/tenderness at transplant site.
  • Decreased urine output (especially post-kidney transplant).

Labs and Diagnostics

• Monitored Tests:
  • BUN and creatinine for renal function.
  • LDH for tissue damage assessment (elevated in infection or rejection).
  • AST and ALTs for liver function.

Support Needs

• Emotional and Spiritual: Lifelong support and socialization are essential for transplant patients.