C H A P T E R 1 7
Immune modulators
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DISCUSSION
T.B.’s medical regimen will include a very complicated
combination of rehabilitation, nutrition, drug therapy
and prevention. T.B. should know the risks of transplant
rejection and the measures that will be used to prevent
it. He also should know the names of his medications and
when to take them, the signs and symptoms of rejection
to watch for, and what to do if they occur. T.B. must
understand the need to prevent exposure to infections
and the precautions required, such as avoiding crowded
areas and people with known diseases, avoiding injury, and
taking steps to maintain cleanliness and avoid infection if
an injury occurs.
The medications that T.B. is taking may cause him
to experience flu-like symptoms, which can be quite
unpleasant. A restful, quiet environment may help to
decrease his stress. Paracetamol may be ordered to help
alleviate the fever, aches and pains.
T.B. also may experience gastrointestinal upset,
nausea and vomiting related to drug effects. A nutritional
consultation may be requested to help T.B. maintain a good
nutritional state. Frequent mouth care and small, frequent
meals may help. Proper nutrition will help T.B. to recover,
heal and maintain his health.
T.B.’s primary healthcare provider will need to work
with the transplantation surgeon, rehabilitation team,
dietician and cardiologist to coordinate a total program that
will help T.B. to avoid problems and make the most of his
transplanted heart.
CARE GUIDE FOR T.B.: CYCLOSPORIN,
MYCOPHENOLATE AND CORTICOSTEROIDS
Assessment: History and examination
• Assess for history of allergies to any immune suppressant,
renal or hepatic impairment, history of neoplasm,
concurrent use of cholestyramine, theophylline,
phenytoin, other nephrotoxic drugs, digoxin, statins,
diltiazem, metoclopramide, amiodarone, androgens, azole
anti
–
fungals, macrolides; grapefruit juice
• Review physical examination findings, including
orientation, reflexes, affect (neurological); temperature
and weight (general); pulse, cardiac auscultation, blood
pressure, oedema, electrocardiogram (cardiovascular);
liver evaluation (GI); and laboratory test results (FBC, liver
and renal function tests, condition being treated)
Implementation
Arrange for laboratory tests before and periodically during
therapy.
Administer drug as indicated.
Protect person from exposure to infection.
Provide supportive and comfort measures to deal with
adverse effects.
Monitor nutritional status and intervene as needed.
Provide teaching regarding the drugs and their dosage,
adverse effects, precautions and warning signs to report
to care provider.
Evaluation
Evaluate drug effects: prevention of transplant rejection,
improvement of autoimmune disease.
Monitor for adverse effects: infection, flu-like symptoms,
GI upset, fluid overload, neoplasm.
Monitor for drug–drug interactions and drug–food
interactions.
Evaluate effectiveness of teaching program and of comfort
and safety measures.
TEACHING FOR T.B.: CYCLOSPORIN,
MYCOPHENOLATE AND CORTICOSTEROIDS
• You will need to take a combination of drugs to prevent
your body from rejecting your new organ. These drugs
include cyclosporin, mycophenolate and corticosteroids.
They suppress the activity of your immune system and
prevent your body from rejecting any transplanted tissue.
• You should never stop taking your drugs without
consulting your healthcare provider. If your prescription
is low or you are unable to take the medication for
any
reason, notify your healthcare provider.
• You should not take your cyclosporin with grapefruit juice.
• Some of the following adverse effects may occur:
•
Nausea, vomiting:
Taking the drug with food and eating
small frequent meals may help. It is very important
that you maintain good nutrition. A consultation with
a dietician may be needed to help you if these GI
problems are severe.
•
Diarrhoea:
This may not decrease; ensure ready access to
bathroom facilities.
•
Flu-like symptoms:
Rest and a cool, peaceful environment
may help; paracetamol may be ordered to help relieve
discomfort.
•
Rash, mouth sores:
Frequent skin and mouth care may
ease these effects.
• You will be more susceptible to infection because your
body’s normal defences will be decreased. You should
avoid crowded places, people with known infections
and working in soil. If you notice any signs of illness or
infection, notify your healthcare provider immediately.
• Tell any doctor, nurse or other healthcare provider
involved in your care that you are taking these drugs.
• You will need to schedule periodic blood tests and
perhaps biopsies while you are being treated with these
drugs.
• Report any of the following to your healthcare provider:
unusual bleeding or bruising, fever, sore throat, mouth
sores, fatigue, and any other signs of infection or injury.
• Keep your medications safely out of the reach of children
and pets and do not share medications with anyone else.
