CH 19: MEDICATIONS & LABS

MEDICATIONS
TRANSPLANT  REJECTION  MEDICATIONS  
THERAPY   DRUG   PURPOSE   IMPLICATIONS  
TYPE  
Specific   Induces  the  specific  and   Major  long  term  adverse  
immunosuppressants:   effective  suppression  of   reactions,  expensive;  all  
  rejection   dosages  adjusted  to  
Cyclosporine   immune  response  of  each  
(Sandimmune,  Neoral,   patient;  increased  risk  for  
Gengraf)   bacterial  and  fungal  
infections  and  for  cancer  
development  
Less  specific     Increased  risk  for  
immunosuppressants:   bacterial  and  fungal  
(combinations)   infections  and  for  cancer  
Azathioprine   development  
(Imuran)    
OR  
 Mycophenolate  
MAINTENANCE  THERAPY:    

(CellCept,  Myfortic)    
AND  ONE  OF  THE  
FOLLOWING  
corticosteroid  
Prednisone  or  
prednisolone  (Delta-­‐
Cortef)  
General  Suppression   Suppress  T-­‐cell  actions   Host  risk  for  infection  is  
Tacrolimus  (Prograf)   including  production  of   not  greatly  increased  
IL-­‐2  (leads  to  slow  
reproduction  of  helper  
and  cytoxic  T  cells  and  
they  don’t  perform  there  
usual  functions)  therefore  
organ  is  not  destructed,  
also  prevent  the  
activation  of  unsensitized  
cytoxic  T-­‐cells.  
Monoclonal  antibodies   Work  against  the  IL-­‐2   Given  IV  within  2  hours  
Basiliximab   receptor  site  on  activated   before  transplant  surgery  
(Simulect)  or   T-­‐cells  (esp  helper  T-­‐ and  within  first  few  days  
daclizumab   cells).    Binf  the  antibodies   after  surgery  
(Zenaprex)   to  the  IL-­‐2  receptor  site  
reducing  T-­‐cell  growth  
and  activation  for  months.  
 Antilymphocyte   Produced  in  animal  after   Given  only  for  a  short  

treatment  of  acute  rejection  episodes,  in  addition  to  or  in  
globulin  (ALG)   the  animal  has  been   time  to  combat  the  acute  
exposed  to  human   rejection  episode  because  
lymphocytes.    When  given   of  immunologic  s/e  (low  
to  humans,  they   grade  fever  and  malaise  to  
selectively  attack  and   serum  sickness  and  
place  of  maintenance  drugs  

clear  lymphocytes  from   anaphylaxis),  s/e  increase  

RESCUE  THERAPY:    

body  fluids,  blood  &  the   in  intensity  on  repeated  

transplanted  organ.   exposure  to  ALG  
Muromonab-­‐CD3   Antibody  directed   Most  effective  during  the  
(OKT3)   specifically  against  the   first  episode  in  which  it  is  
human  T-­‐cell  surface   used,  it  effect  in  
antigen  CD3  (generated  in   combatting  graft  rejection  
mice).    Patient  receiving   decreases  with  each  use.    
develops  antimouse   Given  for  only  short  
antibodies  that  attack  CD3   period  of  time  to  combat  
and  prevent  its  T-­‐cell   the  acute  rejection  
activities.   episode  because  of  the  
immunologic  s/e  which  
increase  in  intensity  on  
repeated  exposure  

LABS
 
  LAB   NORMAL  VALUE   INCREASED/+  
  ESR   Male:  up  to  15/hr   inflammation,  
  Female:  up  to  20/hr   infection  
hs-­‐CRP   1-­‐3   inflammation,  
infection  

WBC  TYPE   NORMAL  VALUE   NORMAL  RANGE  

SEGS   62%   NEUTROPHILS:  
BANDS   5%   55-­‐70%  
MONOS   3%   2-­‐8%  
LYMPHS   28%   20-­‐40%  
EOSIN   1.5%   1-­‐4%  
BASO   0.5%   0.5-­‐1%