Page 1905 - Saunders Comprehensive Review For NCLEX-RN

of other nephrotoxic medications.
D. Sirolimus
1. Sirolimus is used for the prevention of renal transplant
rejection by inhibiting the response of helper T
lymphocytes and B lymphocytes to cytokinesis.
2. It may be used with cyclosporine or tacrolimus and
corticosteroids.

3. Increases the risk of infection, increases the

risk of renal injury, increases the risk of lymphocele (a
complication of renal transplant surgery), and raises
cholesterol and triglyceride levels
4. Side and adverse effects include rash, acne, anemia,
thrombocytopenia, joint pain, diarrhea, and
hypokalemia.
E. Tacrolimus
1. Tacrolimus inhibits calcineurin and thereby prevents T
cells from producing interleukin-2, interferon-γ, and
other cytokines.
2. Tacrolimus is more effective than cyclosporine but is
more toxic.

3. Adverse effects are similar to those of

cyclosporine and include nephrotoxicity, infection,
hypertension, tremor, hirsutism, neurotoxicity,
gastrointestinal effects, hyperkalemia, and
hyperglycemia.
4. Tacrolimus should be used cautiously in
immunosuppressed clients and those with renal,
hepatic, or pancreatic impairment.
5. Tacrolimus is contraindicated for clients
hypersensitive to cyclosporine.
6. Monitor blood glucose levels and administer
prescribed insulin or oral hypoglycemics.
F. Prednisone
1. Prednisone is a glucocorticoid that inhibits
accumulation of inflammatory cells at inflammation
sites.

2. Hyperglycemia and hypokalemia can occur

with prednisone use; monitor glucose and serum
potassium levels.
3. See Chapter 47 for additional information about
prednisone.
G. Azathioprine
1. Azathioprine suppresses cell-mediated and humoral
immune responses by inhibiting the proliferation of B

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