Autoimmune Diseases – A large group of

diseases characterized by the subversion of

or alteration of the function of the immune
system where the immune response is
directed against normal tissues of the body,
resulting in pathologic conditions.
 Graft – the term used for a transplanted tissue
or organ.

• Immune- Mediated Diseases – A large group of

diseases that result when the cells of the immune
system react to a variety of situations such as
transplanted organ tissue or drug altered cells.
Immunosuppressant – An agent that decreases or
prevents an immune response.

• Immunosuppressive Therapy – A drug treatment

used to suppress the immune system.
• Murine Antibodies – are protective proteins.
• Muromonab – CD3 – is a murine antibody used
to reverse graft rejection.
Immunosuppressant Agents
• Mechanism of Action and Drug Effects –
They all selectively suppress certain T-
lymphocyte cell lines, thereby preventing their
involvement in the immune response.
 Indications
•They are primarily indicated for the prevention of
organ rejection.
•Some are used for other immunologic illnesses
such as rheumatoid arthritis and multiple sclerosis .
 
 Contraindications – Drug allergy, renal or hepatic
failure, and concurrent radiation therapy. Use of
immunosuppressants in pregnant women should only
occur in clinically urgent situations.

• Side Effects and Adverse Effects – heightened

susceptibility to opportunistic infections is a major
risks factor in immunosuppressive patients.
Interactions – use of immunosuppressants
mostly involve cyclosporine.
• Cyclosporine is capable of many drug
interactions and can be harmful. If taken with
grapefruit juice, there is an increase in
bioavailability of 20% to 200%.
 DRUGS THAT MAY INCREASE ITS ACTION ARE:

• Diltiazem, Nicardipine, Verapamil, Fluconazole,

Fluconazole, Itraconazole, Clarithromycin,
Allopurinol, Metoclopramide, Amphotericin B,
Cimetidine and Ketokonazole
DRUGS THAT MAY DECREASE ITS ACTION ARE:

•Nafcillin, Carbamazepine, Phenobarbital,

Phenytoin, Rifampin.
IMMUNOSUPPRESSANT
AGENTS
 1. Azathioprine ( Imuran)

• Mechanism Of Action – Blocks metabolites of purines,

inhibiting the synthesis T cell DNA , RNA, and proteins,
thereby blocking immune response.
• Indications – Organ rejection prevention, in kidney
transplantation, rheumatoid arthritis.
• Side/Adverse Effects - leukopenia, thrombocytopenia,
hepatotoxicity
 Pharmacokinetics
• Half Life – 5 hour
• Onset - 2-4 days
• Peak – 1-2 hour
• Duration – Unknown
*6 to 8 weeks for rheumatoid arthritis
 2. Muromonab – CD3

• Mechanism of Action – Binds to CD3 glycoproteinon T-cell receptors, which

blocks antigen recognition and reverses graft rejection that is already in progress.
• Indications – Treatment of acute organ rejection in kidney, liver and heart
transplantation.
• Side/Adverse Effects – chest pain, pyrexia, chills, tremors, vomiting, nausea,
diarrhea, dyspnea, wheezing, pulmonary edema, flulike symptoms, fluid retention
 Pharmacokinetics

• Half life – Unknown

• Onset – very rapid
• Peak - 3 days
• Duration – Unknown
 3. Cyclosporine

• Mechanism of Action – Inhibits activation of T cells by blocking the production and

release of the cytokine mediator IL-2.
• Indication – Organ rejection prevention in kidney, liver, and heart transplantation;
rheumatoid arthritis, psoriasis, Unlabeled uses includes pancreas, bone marrow, and
heart/lung transplantation.
• Side/Adverse Effects – Moderate hypertension in many as 50% of patients, neurotoxicity
including tremors in about 20% of patients, hepatotoxicity, nephrotoxicity, hypersensitivity
reactions.
 Pharmacokinetics
• Half Life – 1-2 hour (parent compound) then 10-27 hour
(metabolites)
• Onset – 3-5 hour
• Peak – Unknown
• Duration- Unknown
 4. Glatiramer acetate ( Copaxone)
• Mechanism of Action- Precise mechanism unknown. Believed to modify
immune system processes that are associated with multiple sclerosis symptoms.
• Indications – Reduction of relapse frequency in patients with relapsing
-remitting multiple sclerosis.
• Side/Adverse Effects – redness, pain, swelling, itching or a lump at the
injection site, rash, shortness of breath, flushing, chest pain.
 5. Tacrolimus (Prograf)
• Mechanism of Action – Inhibits cell activation
• Indication – Organ rejection prevention in liver transplantation.
• Side/ Adverse Effects – opportunistic infection, DM, headache,
hyperglycemia, hyperkalemia, increased BUN, increased serum
creatinine, mental status changes, nephrotoxicity, sensation disorder
and tremor.
 6. Mycophenolate mofetil ( CellCept)

• Mechanism Of Action – Prevents proliferation of T cells by

inhibiting intracellular purine synthesis.
• Indication - Organ rejection prevention in kidney, liver and heart
transplantation.
• Side/ Adverse Effects – diarrhea, low RBC and WBC counts, BP
problems, tachycardia, Swelling of the lower legs, ankles , feet,
hyperglycemia
 7. Daclizumab ( Zenapax)
• Mechanism Of Action – Suppresses cell activity by blocking the
binding of the cytokine receptor.
• Indication - Organ rejection prevention in kidney transplantation.
• Side/ Adverse Effects -nasapharyngitis, URTI, rash, influenza,
dermatitis, oropharyngeal pain, brochitis, eczema,
lymphadenopathy.
 Pharmacokinetics

• Half Life- 20 days

• Onset – less than 1 day
• Peak – 3-5 days
• Duration – Unknown
 8. Baxiliximab (Simulect )
• Mechanism Of Action - Suppresses cell activity by blocking the
binding of the cytokine receptor.
• Indication - Organ rejection prevention in kidney transplantation.
• Side/ Adverse Effects – nausea, abdominal pain, diarrhea,
constipation, pain or redness at the injection site, acne, insomnia,
headache, swelling on the hands and feet.
 Pharmacokinetics

• Half Life- 7-9 days

• Onset – less than 1 day
• Peak – 3-4 days
• Duration – Unknown
 9. Sirolimus ( Rapamune)
• Mechanism of Action – Inhibits T cell activation by a unique
mechanism. Binding to an intracellular protein then creating a complex
that binds to a cellular component which prevents cellular proliferation.
• Indication - Organ rejection prevention in kidney transplantation.
• Side/ Adverse Effects- nausea, abdominal pain, diarrhea, constipation
site, acne, insomnia, headache, vomiting, joint pain, skin rash.
 Pharmacokinetics

• Half Life- 57-68 hours

• Onset – unknown
• Peak – 1-3 hour
• Duration – Unknown
 NURSING CONSIDERATIONS :
1. Monitor laboratory results.
2. Must be taken with food.
3. The nurse should inspect the oral cavity as often as necessary for
any white patches on the tongue , mucous membranes and oral
pharynx.
4. Patients should be encouraged to report any fever, sore throat,
chills, joint pain, fatigue.
5. Instruct the patient taking any of the
immunosuppressant drugs to avoid crowds.

6. Patients should be aware that lifelong

therapy is indicated with organ transplantation.
 
Thank you