Basic principles of immunosuppressive therapy. So purposes and uses decrease or suppresses the normal immune response. So what we're looking for is decreased inflammation and some examples of disorders or conditions for which immunosuppression is used. Asthma and pulmonary disease, spinal cord injuries, cerebral trauma or stroke. So a spinal cord injury, let's say if we give a steroid, what we're trying or attempting to do is decrease the degeneration and functional deficits that can occur after injury.
So by decreasing the inflammation we hopefully decrease the functional deficits connect that can actually occur from the injury. Organ transplant and rejection. So you think any organ that can be transplanted the kidney, heart, liver, lung, pancreas, small bowel, bone marrow, these types of patients that have an organ transplant they're going to be on drug therapy for their entire lifetime. So it's really important to remember about those types of patients.
All right, selected agents. So steroids, we've already talked about steroids, right? Use-wise, we decrease inflammation. We can prevent and actually treat organ transplant rejection if that were to occur. So some examples we have here, these are medications you've already seen, right?
Dexamethasone, prednisone, methylprednisolone. You want to make sure you're reviewing your Unit 4 respiratory for that complete steroid drug list and details. So all the information about those drugs are in your Unit 4. This is not new to you, but those are just some examples of the steroids we can use to hopefully decrease inflammation, again prevent and treat organ transplant rejection.
All right, anti-rejection immunosuppression agents. We can give these medications that are listed here for prophylaxis and rejection. So the prototypes that are starred here for you, you have mycophenolate, mofetil.
You would give that for prevention of organ transplant rejection. Cyclosporine, also we would give for prevention. And then tacro. sorry tacrolimus is also given for prevention so those three starred prototype medications are given for prevention important remember those for prevention of organ rejection so number three here number three is kind of special number three you also want to remember um that prototype listed there for a medication that can be given for prevention but we can also give that medication for reversal and and prevention of ongoing rejection. So number three is anti-rejection, immunosuppression agent, and treat ongoing rejection.
So the medication listed there, and you're going to see some of these names, like on the previous unit nine, I told you, you don't have to worry about remembering some of these. As I'm referring to them, the couple from unit nine that you're going to see in this outline, you need to remember them from this outline. Okay. So Muromonab, right?
Very different name. That is... you want to remember that as a reversal agent and prevention of ongoing rejection. So that makes it and sets it apart basically from just the medications or prototypes listed under number two for anti-rejection. This particular drug not only prevents it, but it also can have a reversal effect for ongoing prevention and rejection.
Okay, so. all of these are for prevention, right? So those both prevent, but this is the one that is special for reversal and prevention.
And that's what sets that apart from the others. Patient education, drugs, uses, dosaging, really important to talk to our patients about compliance. Okay, huge. You need to remember this.
So yes, we always have to educate them on how to use the medication. what the dosaging is, but compliance is so important. These drugs must be taken exactly as ordered or directed. They must be taken at the correct time every day to avoid interactions, and they must not be stopped without being instructed by the prescriber, okay?
They need to consult with their provider if they're thinking about stopping this medication for whatever reason. They cannot just abruptly stop it. So, points and key to remember, right?
Must be taken exactly as ordered or directed. must be taken at the correct time every day to avoid interactions and must not be stopped without being instructed by the prescriber. Very important, okay? We can also educate them to take with food to help minimize the GI upset that occurs with them, but the affirmation points are very important to remember.
Potential interactions. There are many interactions. On page 759, table 48.3, you can review that. What I'm trying to get you to take from there is that it's really important to review over-the-counter medications that that patient may be taking with the provider just to determine safety because there's so many interactions with these types of drugs. Side effects, many, many adverse effects.
On page 758. Table 48.2, there's a list there for you. It can induce hypertension, tremors, oral candida, so they might become, you know, end up having an oral infection. So it's possible that they might need a prescription for antifungals. Oral care is very important. They can also develop that gingival hyperplasia.
We've talked about that before with some of the seizure medications that causes that overgrowth of the gums. So many side effects and things that can occur with these drugs. Infection control, that's key. So the patient needs to understand that they should be watching for signs and symptoms of infection, right? They're probably having white counts drawn pretty often.
So they should be paying attention to their WBCs, looking for things like thrush, right? So that would be like that oral candida, that growth in the mouth. It'll be white patches.
Typically, it's pretty sore. They want to also educate the patient that they should be minimizing exposure to large crowds, right? They're immunocompromised. They shouldn't be around large crowds.
It's going to be easier for them to contract something. And there's also increased risk for opportunistic infections. So we want to make sure that we're educating our patients appropriately about that.
And then also avoiding live vaccines such as MMR and varicella. More than likely, those were childhood vaccines they've already had, but at this point in their life, live vaccines would not be ideal. And then evidence of organ rejection.
So this is a big one too. The patient could develop fever, chills, maybe flu-like symptoms, fatigue. Typically they might have pain or tenderness at the site of transplant.
So at their transplant site, if there's organ rejection going on and they may even have decreased urine output. So let's just say it was a kidney transplant, right? So that maybe that kidney is not perfusing appropriately.
So they're going to have decreased output. confusion. Labs and diagnostics. So lots of things we want to look for here. We can look and watch the BUN and creatinine, right, that gives us an idea of renal function.
LDH, that is lactate dehydrogenase, and we have that in many of our body tissues. However, it's going to be elevated with these patients, especially if maybe they are going, if they have an infection or if they're going through organ rejection. So typically you'll see it elevated and we'll measure it to assess tissue damage.
So you'll see it more elevated if they're having organ transplant rejection. We're going to look at their AST and ALTs. Those are abbreviations for different types of liver enzymes. Want to make sure that their liver is functioning appropriately. And then just remember, these types of patients are going to need lifelong support.
This is a very emotional, spiritual journey. They're going to need a lot of socialization. and those types of things just to be aware.