Question 1

What does the nurse tell a patient who is to take sirolimus (Rapamune)orally?&#10;A)&#34;Take the medication on an empty stomach.&#34;&#10;B)&#34;It is all right to dilute the medication in a Styrofoam cup.&#34;&#10;C)&#34;Change the time that you take the medication each day by 1 hour.&#34;&#10;D)&#34;This drug has a prolonged onset of action, so it is important to take it with your midday meal.&#34;

Accepted Answer

Oral dosages of tacrolimus are given on an empty stomach.As with cyclosporine,oral doses of tacrolimus are not to be put in Styrofoam cups or containers.Inform the patient to avoid the consumption of grapefruit within 2 hours of taking the drug.Both sirolimus and tacrolimus have long half-lives,so toxicity is an added concern because of possible cumulative effects.

Question 2

Which immunosuppressant is the only one currently indicated for the treatment of relapsing forms of multiple sclerosis?&#10;A)azathioprine (Imuran)&#10;B)fingolimod hydrochloride (Gilenya)&#10;C)mycophenolate mofetil (CellCept)&#10;D)sirolimus (Rapamune)

Accepted Answer

Fingolimod hydrochloride (Gilenya),a new sphingosine 1-phosphate receptor modulator,failed as an antirejection drug but was approved for treating multiple sclerosis.It is the only oral drug for relapsing forms of multiple sclerosis.

Question 3

Which drug may increase the action of azathioprine (Imuran)?&#10;A)nafcillin&#10;B)rifampin&#10;C)allopurinol&#10;D)phenobarbital

Accepted Answer

Allopurinol may increase the action of azathioprine.

Question 4

A female patient has started azathioprine (Imuran)therapy in preparation for her kidney transplant surgery.Which expected adverse effect of azathioprine therapy should the nurse tell the patient about?

A)Tremors
B)Diarrhea
C)Leukopenia
D)Fluid retention

Accepted Answer

Leukopenia is an expected adverse effect of azathioprine therapy.

Question 5

How is cyclosporine (Neoral)usually given intravenously?&#10;A)In a single intravenous (IV) injectable form to minimize adverse effects&#10;B)Initiated by an oral test dose, then an IV infusion started after 2 hours&#10;C)Diluted and infused with an infusion pump&#10;D)Given as an IV bolus for the first dose, then with an infusion pump for following doses

Accepted Answer

With intravenously administered cyclosporine,the dose must be diluted as recommended by the manufacturer and given according to the standards of care and institutional policy.Always infuse using an infusion pump and over the recommended period.Monitor the patient closely during the infusion,especially during the first 30 minutes,for any allergic reactions.Cyclosporine is not given by using an IV bolus or with an oral test dose.

Question 6

The nurse will monitor which laboratory result when the patient is receiving an infusion of cyclosporine?&#10;A)Hemoglobin&#10;B)Hematocrit&#10;C)Alanine aminotransferase (ALT)&#10;D)Bilirubin

Accepted Answer

The nurse needs to closely monitor the patient's blood urea nitrogen,L-lactate dehydrogenase (LDH),aspartate aminotransferase (AST),and ALT during therapy,as ordered,to detect possible kidney and liver impairment.

Question 7

When providing patient education related to immunosuppressive therapy,which items of information will the nurse include?&#10;A)If a dose is missed, double the next scheduled dose.&#10;B)Take the medication with any type of juice or water.&#10;C)It is important to have a 1-week supply of medication.&#10;D)If the blister-pack pills have an odour, discard them.

Accepted Answer

Tell the patient about the complexity of dosing and about the need to always have a 1-week supply of medication available so that there is never a risk of running out.If a dose is missed,the patient is to contact the health care provider.The medication cannot be taken with grapefruit juice.Pills in blister-packs normally have a characteristic odour.

Question 8

A patient about to undergo kidney transplantation will be given azathioprine (Imuran)to minimize organ rejection.What important preoperative information should the nurse give the patient about this drug?

A)Before the surgery, the medication will be administered orally.
B)The oral doses should be taken 1 hour before meals, to maximize absorption.
C)Blood pressure should be monitored for the development of moderate hypertension.
D)For several days before surgery, the patient will need to visit the office daily for intramuscular (IM) injections.

Accepted Answer

Several days before transplant surgery,immunosuppressant drugs should be taken by the oral route,if possible,to avoid IM injections and the risk of infections caused by them.

Question 9

Which statement is true in regard to cyclosporine?&#10;A)Any leftover solution should be refrigerated.&#10;B)It should be mixed with water only.&#10;C)The use of Styrofoam containers should be avoided.&#10;D)It can be given only intravenously.

Accepted Answer

Styrofoam containers should be avoided because the drug has been found to adhere to the inside of the container.Oral solutions may be mixed with chocolate milk,regular milk,or orange juice and served at room temperature.After the solution is mixed,the patient must drink it immediately.Oral solutions of cyclosporine should not be refrigerated.Cyclosporine can be given orally or intravenously.

Deck 50: Immunosuppressant Drugs