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Tables for:
Immunosuppressive Therapies in Organ Transplantation

[Organ Transplant 2002. © 2002 Medscape]


Azathioprine Therapy: Summary of Side Effects and Nursing Implications


Side Effects

Assessment Parameters

Nursing Interventions

Cardiovascular: Fluid and Electrolytes
    Renal toxicity


Serum creatinine, BUN
Creatinine clearance
Urine output
Peripheral edema


Restrict fluids
Administer diuretics
Decrease dosage

Gastrointestinal
   Nausea, vomiting
   Anorexia
   Diarrhea
   Hepatotoxicity
   Pancreatitis


Appetite, elimination pattern, bilirubin, serum transaminases and phosphatases, coagulation factors, serum amylase and lipase, serum calcium


Administer oral dose with meals
Consult dietician
Institute enteral or parenteral nutrition

Hematologic
   Leukopenia
   Thrombocytopenia
   Macrocytic anemia


WBC count with differential and platelet count
RBC count
Bleeding (oozing, hemorrhage)
Signs, symptoms of infection
Inspect mucous membranes


Increase attention to infection control measures
Administer platelets
Administer packed RBCs
Administer oral anti-infectives
Decrease dosage

Dermatologic
   Stomatitis


Inspect mucous membranes


Maintain good oral hygiene
Administer analgesics

BUN, blood urea nitrogen; RBC, red blood cell; WBC, white blood cell


Clinical Characteristics of Commonly Used Corticosteroids


Drug

Anti-inflammatory
Potency

Equivalent Dosage* (mg)

Mineralocorticoid Activity

Hydrocortisone

1.0

20.00

2+

Cortisone

0.8

25.00

2+

Prednisone

4.0

5.00

1+

Prednisolone

4.0

5.00

1+

Methylprednisolone

5.0

4.00

0

Triamcinolone

5.0

4.00

0

Betamethasone

20-30

0.60

0

Dexamethasone

20-30

0.75

0

*For example, prednisone is 4 times more potent than hydrocortisone (eg, 5 mg of prednisone is equivalent to 20 mg of hydrocortisone).


Corticosteroid Therapy: Summary of Side Effects and Nursing Interventions


Side Effects

Assessment Parameters

Nursing Interventions

Cardiovascular: Fluid and
Electrolytes
   Sodium retention
   Potassium wasting
   Calcium and phosphorous
       wasting
   Metabolic alkalosis
   Fluid retention
   Arterial hypertension


Serum electrolytes, calcium,
   phosphorus, albumin
Intake and output
Acid-base status
Peripheral edema
Blood pressure


Low-sodium, high-
   potassium diet
Oral electrolytes
Calcium, phosphorous
Instruct patient about side
   effects
Decrease dosage

Gastrointestinal
   Peptic ulcers (esophagus,
      stomach, duodenum)
   Pancreatitis
   Hepatitis
   Increased appetite
   Diarrhea


Guaiac stools and vomitus
Serum amylase, lipase,
   calcium, transaminases,
   phosphatases, bilirubin
Coagulation factors
Peritoneal signs


Administer oral corticosteroids with food
Antacids, H2 receptor
   blocker
Consult dietician
Decrease dosage

Endocrine
   Impaired glucose tolerance
   Diabetes mellitus
   Cushing's syndrome
   Hypothyroidism
   Impaired carbohydrate
      tolerance
   Adrenopituitary
      suppression
Osteoporosis


Serum glucose
Polydipsia, polyuria
Cushingoid signs - moon
   face, truncal obesity,
   buffalo hump, striae
T3, T4
During period of steroid
   withdrawal or stress:
   headache, lethargy, weakness, hypotension
Complaints of back or limb
   pain


Insulin
Thyroid hormones
Instruct patients about
   consequences of sudden steroid withdrawal
Avoid sudden steroid
   withdrawal
Calcium, vitamin D

Hematologic
   Neutrophilia, eosinophilia,
      basophilia
   Lymphocytopenia
   Opportunistic infection,
      impaired wound healing
   Aseptic necrosis of femoral
      and humoral heads


WBC count with differential
Inspect mucous membranes
Signs and symptoms of
   infection
Wound healing


Increase attention to
   infection control
Oral anti-infectives

Neurologic
   Headache
   Insomnia
   Vertigo
   Seizures
Muscle weakness


Neurologic status
Sleep pattern


Analgesics
Administer dose in
   morning if possible
Facilitate environment
   for proper sleep
Seizure precautions in
   susceptible patients
Consult physical therapist
Decrease dosage

Psychological
   Psychosis
   Euphoria
   Depression


Mental status


Consult psychiatrist if
   indicated
Instruct patient about
   side effects
Decrease dosage

Dermatologic
   Thin, fragile skin
   Petechiae, ecchymoses
   Erythema
   Acne
   Hirsutism
   Stomatitis


Inspect skin
Inspect mucous
   membranes


Topical anti-acne medication
Avoid adhesive tape
Avoid skin trauma
Counsel regarding
   hirsutism

Other
   Blurred vision
   Cataracts


Patient complaints about
   alteration in vision


Consult ophthalmologist