NCLEX RN Practice Question 453

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MEDICATIONS FOR PREVENTING ORGAN REJECTION

Cyclosporine (Sandimmune, Gengraf, Neoral)

  • Cyclosporine inhibits calcineurin and acts on T lymphocytes to suppress the production of interleukin-2, interferon-g, and other cytokines.
  • Cyclosporine may be used to prevent rejection of allogeneic kidney, liver, and heart transplants.
  • Prednisone may be administered concurrently.
  • Oral administration of cyclosporine is preferred; intravenous administration is reserved for clients who cannot take the medication orally.
  • Blood levels of the medication should be measured regularly because of its nephrotoxic effects.
  • The most common adverse effects are nephrotoxicity, infection, hypertension, tremor, and hirsutism.
  • Assure the client that hirsutism is reversible; instruct on the use of a depilatory.
  • Other adverse effects include neurotoxicity, gastrointestinal effects, hyperkalemia, and hyperglycemia.
  • The risk of infection and lymphomas is increased with the use of cyclosporine.
  • Cyclosporine is contraindicated in the presence of hypersensitivity, pregnancy and breastfeeding, recent inoculation with live virus vaccines, and recent contact with an active infection such as chickenpox or herpes zoster.
  • Cyclosporine is embryotoxic, and women of childbearing age should use a mechanical form of contraception and avoid oral contraceptives.
  • The client should be informed about the possibility of renal damage and liver damage and the need for periodic liver function tests and determination of coagulation factors and blood urea nitrogen, serum creatinine, serum potassium, and blood glucose levels.
  • The client should be instructed to monitor for early signs of infection and to report these signs immediately.
  • Available in a pill form; if the client is unable to swallow the pill, instruct the client to dispense the oral liquid medication into a glass container by using a specially calibrated pipette, mix well, and drink immediately; rinse the glass container with diluent and drink it to ensure ingestion of the complete dose; dry the outside of the pipette

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