Immunosuppressants+(Transplantation)

=**Immunosuppresants:**=

Almost all organ transplant patients receive a similar regimen of post transplant medications. Immunosuppressants are cornerstone to successful long term transplantation. Often used in conjunction with corticosteroids, which block the inflammatory and immune reactions and decrease initial damage to the cells. The immunosuppressants include T and B cell suppressors
 * Drug Therapy **

Prolonged immunosuppression predisposes patient to malignancies Increase susceptability to infection Organ dysfunction Steroid induced side effects such as hyperglycemia, weight gain, bone dysfunction
 * Side Effects **

(Neoral, Sandimmune, Gengraf)** -Major drug to prevent allograft rejection -Activity highly specific to helper T cells -Patient then able to maintain some degree of immunity -Associated w/ multiple serious side effects including hepatotoxicity, nephrotoxicity, neurotoxicity, hyperglycemia, hirsutism, gingival hyperplasia. Causes increase in BP -Teratogenesis (Pregnancy Risk Category C) -Increased risk of infection, osteoporosis, fluid retention, bone marrow depression -Consumption of grapefruit juice increases cyclosporine levels by 50%; increase risk of toxicity -Good oral hygiene; may cause unusual gum growth & gum bleed. -Monitor BP, glucose levels, liver & kidney function ATI, p. 111
 * Cyclosporine

SoluMedrol - Prednisone Used as an adjunct immunosuppresssant therapy drug following transplant** -Has both anti-inflammatory and immunosuppressant capabilities -Significantly decrease the number of lymphocytes, particularly T lymphocytes by interfering w/ the production and secretion of interleukin-2. -Large doses suppress B lymphocyte production, particularly immunoglobulin G (IgG) and IgA and significantly impair monocyte-macrophage function. -Side Effects: Long term use is associated w/ severe bone disorders, DM, cataracts. Post operatively to prevent rejection, it is associated with complications of decreased wound healing, increased risk of dehiscence, or tearing of the anastomosis. Causes increase in BP. Steroid psychosis. -Drug interactions: No NSAIDS -Take in morning with food -Monitor BP, weight -Monitor glucose levels (chemically induced diabetes)
 * Corticosteroids

An immunosuppressive macrolide antibiotic that was originally derived from a soil fungus Unrelated to cyclosporine but acts in a similar fashion in its attack on helper T lymphocytes Side Effects: Increased BP & glucose levels Food interactions – no grapefruit Monitor liver function, blood pressure, glucose levels
 * Macrolide Antibiotics **
 * Tacrolimus FK506 (Prograf)**
 * serolimus (Rapimune)**

Certain drugs target immunocompetent cells and thus are of use as immunosuppressants. prevention of graft rejection before cyclosporine; toxic
 * Antimetabolites – Cytotoxic agents **
 * Azathioprine or AZA (Imuran)** - Used to be the drug of choice for
 * Mycophenolate Mofetil (MMF) (Cell Cept);** GI; Take after meals

Atgam Polyclonal Antibody**
 * Antibodies – Used in acute organ rejection **
 * OKT# Monoclonal Antibody

-Gram positive -Gram negative Medications -Septra DS
 * Bacterial Infection **
 * Bacterial**

Medications -Acyclovir -Ganciclovir -Cytovene HCV**
 * Viral Infection **
 * CMV**
 * EBV