Page 30 - RxExam's Naplex Theory Book Part 2

www.pharmacyexam.com Krisman

Dose Special Notes

Muromonab 3). Anaphylactic and anaphylactoid reactions may occur following
Cd3 administration of any dose or course of Muromonab-CD3 (Orthoclone
(Injection) OKT3). In addition, serious, occasionally life-threatening or lethal,
systemic, cardiovascular, and central nervous system reactions have
been reported following administration of Muromonab-CD3. These
have included: pulmonary edema, especially in patients with volume
overload; shock, cardiovascular collapse, cardiac or respiratory arrest,
seizures, coma, cerebral edema, cerebral herniation, blindness, and
paralysis. Fluid status should be carefully monitored prior to and
during Muromonab-CD3 administration. Pretreatment with
methylprednisolone is recommended to minimize symptoms of
cytokine release syndrome.

4). Most patients develop an acute clinical syndrome [i.e., Cytokine
Release Syndrome (CRS)] that has been attributed to the release of
cytokines by activated lymphocytes or monocytes and is temporally
associated with the administration of the first few doses of
Muromonab-CD3 (particularly, the first two to three doses). This
clinical syndrome has ranged from a more frequently reported mild,
self-limited, "flu-like" illness to a less frequently reported severe, life-
threatening shock-like reaction, which may include serious
cardiovascular and central nervous system manifestations.
The syndrome typically begins approximately 30 to 60 minutes
after administration of a dose of Muromonab-CD3 (but may occur
later) and may persist for several hours. The frequency and severity of
this symptom complex is usually greatest with the first dose. With
each successive dose of Muromonab-CD3, both the frequency and
severity of the Cytokine Release Syndrome tends to diminish.
Increasing the amount of Muromonab-CD3 or resuming treatment
after a hiatus may result in a reappearance of the CRS.
Common clinical manifestations of CRS may include: high fever
(often spiking, up to 107°F), chills/rigors, headache, tremor,
nausea/vomiting, diarrhea, abdominal pain, malaise, muscle/joint
aches and pains, and generalized weakness.

Azathioprine Please Refer To Page 332 (Part 1) of Chapter 36-Rheumatoid Arthritis.

Terminology:

Post- Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized,
transplant although relatively uncommon, complication of both solid organ and
Lymphoprolife allogeneic bone marrow transplantation. In most cases, PTLD is
rative Disorder associated with Epstein-Barr virus (EBV) infection of B cells, either as a
(PTLD) consequence of reactivation of the virus post transplantation or from
primary post transplantation EBV infection acquired from the donor.

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