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|DRUG NAME||cyclosporine (Sandimmune, Gengraf, Neoral), tacrolimus (Astagraf XL)||mycophenolate (Cellcept, Myforic)||sirolimus (Rapamune)||cyclophosphamide|
|MECHANISM of ACTION||Inhibition of transcription||Inhibition of nucleotide synthesis||Inhibition of growth factor signal transduction||DNA alkylation|
|INDICATIONS||Prevention of organ transplant rejection and graft-versus-host disease (GvHD)|
|ROUTE(S) of ADMIN.||PO|
|NURSING CONSIDERATIONS for|
|ASSESSMENT AND MONITORING||Assessment and monitoring: cyclosporine |
Antirejection immunosuppressants are medications used to prevent organ rejection after a transplant, which can occur when the recipient’s immune system attacks the transplanted organ. These medications are also used to prevent graft-versus-host disease, or GvHD for short, which can occur after a bone marrow transplant. GvHD is similar to transplant rejection but works the other way around, so it’s the donor or graft T cells that reject the recipient or host; and as a result, the recipient can develop life-threatening inflammation involving various organs.
Now, based on their primary mechanism of action, antirejection immunosuppressants can be classified into several groups. The first group covers inhibitors of transcription, and the main representatives here are cyclosporine and tacrolimus; the second group includes inhibitors of nucleotide synthesis, like mycophenolate; while the third group covers inhibitors of growth factor signal transduction, such as sirolimus. Finally, the fourth group includes DNA alkylating agents, like cyclophosphamide. These medications are primarily administered orally or intravenously, and once administered, all immunosuppressants ultimately suppress and disrupt the inflammatory process and prevent the progression of the disease.
Unfortunately, these medications can also increase the risk of side effects like myelosuppression; development of new infections; or reactivation of previous infections, such as hepatitis B. Some immunosuppressants, like tacrolimus and mycophenolate, have a boxed warning for the development of certain cancers, especially lymphoma and skin cancer.
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