Page 637 - Cardiac Nursing

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C HAPTER 2 5 / Cardiac Surgery 613
Table 25-5 ■ MAJOR ADVERSE SIDE EFFECTS OF IMMUNOSUPPRESSIVE AGENTS AND CLINICAL MANIFESTATIONS
Drug Adverse Effects Clinical Manifestations
Cyclosporine Nephrotoxicity Elevated BUN and creatinine.
Decreased urine output
Weight gain, edema
Hypertension Elevated blood pressure
Hepatotoxicity Elevated bilirubin
Elevated alkaline phosphatase, AST, and ALT levels
Jaundice
Hypertrichosis Excessive hair growth all over body
Tremors, seizures Fine motor tremors, especially hands
Associated paresthesias
Seizure activity
Increased risk of malignancy when associated with Dependent on type and location of malignancy
high doses of multiple agents
Gingival hyperplasia Growth of gums over teeth
Bleeding of gums
Tacrolimus Nephrotoxicity associated with high doses Elevated BUN and creatinine
Decreased urine output
Hyperkalemia Elevated potassium levels
Insomnia Sleep disturbances
Malaise Headaches, nausea, and vomiting associated with IV administration
Hyperglycemia Elevated serum glucose
Hypertension Elevated blood pressure
Corticosteroids Aseptic necrosis of bone, osteoporosis Pain in weight-bearing joints
Pathologic fractures
Hyperglycemia, steroid-induced diabetes mellitus Elevated serum glucose
Polydipsia, polyuria
Salt and water retention Weight gain or fluctuations associated with edema
Hypertension Elevated blood pressure
Skin alterations
Acne Rash or pimples on face and trunk
Sun sensitivity Susceptibility to sunburn
Skin malignancies
Hirsutism Excessive hair growth on face, trunk, and extremities
Growth retardation in children Failure to reach normal height for age
Gastritis/gastrointestinal ulcerations Abdominal pain, dysphagia
Hematemesis, guaiac-positive stools
Cataracts Visual acuity problems
Azathioprine Bone marrow depression Leukopenia, thrombocytopenia, anemia
Hepatotoxicity Elevated bilirubin
Elevated alkaline phosphatase, AST, and ALT levels
Jaundice
Increased risk of malignancy when associated with Dependent on type and location of malignancy
high doses of multiple agents
Sun sensitivity of skin Susceptibility to sunburn
Skin malignancies
Orthocione OKT3 Pyrexia, malaise Fever, chills, influenza-like symptoms
Headache, diarrhea
Respiratory distress associated with initial doses and Chest tightness, dyspnea, wheezing
fluid overload
Increased risk of malignancy when associated with Dependent on type and location of malignancy
high doses of multiple agents
Antithymocyte Anaphylactic reactions Hypotension, dyspnea, wheezing, fever, chills
preparations
Serum sickness associated with antibody formation to Fever, joint pain
foreign protein
Elevation of BUN and creatinine
Bone marrow depression associated with prolonged use Leukopenia
in conjunction with azathioprine
Thrombocytopenia
Anemia
Local inflammatory reactions associated with Pain, redness, extreme muscle soreness, swelling
intramuscular administration
Increased risk of malignancy when associated with Dependent on type and location of malignancy
high doses of multiple agents
Mycophenolate Bone marrow suppression Neutropenia
mofetil
Gastrointestinal disturbance Nausea, vomiting, diarrhea, constipation
Malaise Headache, nausea
(table continues on page 614)