Life after Nclex-RN

Transplant medicines work together to play a key role in treatment after a transplant. One group of medications taken are antirejection. They are used to prevent rejection (attack of a transplanted organ by the immune system of a person receiving the organ) in people who have received a new organ. They lower your immune system response, which increases the risk of infection and the possible development of lymphomas or other neoplasms aka tumors. Look for signs of infection like fever, tiredness, headache, redness of skin/wound or enlarged glands.

Here are the most common ones we use on my unit:

Cyclosporin A (Sandimmune) Cyclosporin is a drug that inhibits production of certain types of cells that can cause rejection. It is usually taken twice daily am/pm. Side effects of cyclosporin include high blood pressure, tremor (shakes), hair growth, overgrowth of gum tissue, increased levels of cholesterol and damage to the liver or kidney. These side effects, however, can usually be controlled by careful monitoring and dose adjustment. The monitoring includes blood tests to measure the amount of Cyclosporin in the blood, and such tests are usually done 11 to 12 hours after taking the evening or nighttime dose. Many drugs interact with Cyclosporin, as does grapefruit juice. Cyclosporin is in common usage for kidney and other organ transplants. As a rule, most patients would be taking either Cyclosporin or Prograf.

Prograf (Tacrolimus) Prograf is also a drug that prevents certain cells from causing rejection. Like Cyclosporin, it is usually given in a morning and evening dose. Side effects include high blood pressure, diabetes, “shakes,” headache, nausea and kidney toxicity. These problems also can be addressed by monitoring drug levels and adjusting dosage. Prograf does not cause hair growth, but may cause hair to fall out. It does not have the same effect on gum overgrowth as Cyclosporin does. It shares many of the same drug and food interactions with Cyclosporin. Prograf is monitored in the same fashion as Cyclosporin and sometimes substituted for that drug.

CellCept (Mycophenolate Mofetil) CellCept prevents certain cells from being produced nd is believed to be a more effective drug at preventing rejection. It is usually given twice daily am/pm and blood levels of the drug are measured as well. It has few side effects, but it can depress blood cell development and cause abdominal pain, vomiting and diarrhea in some patients. Those problems are addressed by lowering the dose. CellCept has few drug interactions and it is generally well tolerated.

Prednisone (Deltasone, Methylprednisolone, steroids) Prednisone and similar steroid medications continue to be used in most patients who receive organ transplants. Steroids reduce inflammation, which is part of rejection. Ordinarily, Prednisone is given once daily, and the dose may be decreased over time as the patient enjoys a successful transplant. Prednisone has many side effects including a change in appearance of the patient by development of a rounded face. In addition, Prednisone may be accompanied by a tendency towards diabetes, hypertension, joint problems, cataracts, stomach ulcers, acne and weight gain. There are few drug interactions with Prednisone, and blood levels are seldom measured. Many centers are attempting to minimize Prednisone dose in modern kidney transplantation.

Myfortic (mycophenolic acid) delayed-release tablet is a prescription medicine given to prevent rejection (antirejection medicine) in patients who have received a kidney transplant. Rejection is when the body’s immune system senses the new organ as “foreign” and attacks it. Myfortic is taken in combination with other antirejection medicines (cyclosporine and corticosteroids). Take it on an empty stomach 1 hour before eating or 2 hours after. Remember to swallow it whole - no crushing, chewing, or cutting. The enteric coating allows the medicine to pass through your stomach and dissolve in your intestine.