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INTRODUCTION

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HIGH ALERT

lymphocyte immune globulin (lim-foe-site im-myoon glob-yoo-lin)

ATG, antilymphocyte globulin, Atgam, LIG

Classification

Therapeutic: immunosuppressants

Pharmacologic: immune globulins

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Indications
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Management of allograft rejection in renal transplant patients. Treatment of aplastic anemia in patients who are not candidates for bone marrow transplantation.

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Action
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Decreases the circulating number of T lymphocytes, which are involved in both cell-mediated and humoral immunity. Therapeutic Effects: Resolution of rejection of renal allografts. Remission of aplastic anemia.

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Adverse Reactions/Side Effects
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CNS: headache. Resp: dyspnea. CV: chest pain, hypotension. GI: diarrhea, nausea, stomatitis, vomiting. Derm: dermatologic reactions, erythema, itching. Hemat: leukopenia, thrombocytopenia, anemia, hemolysis. Local: pain/phlebitis at IV site. MS: arthralgia. Misc: ALLERGIC REACTIONS. INCLUDING ANAPHYLAXIS, chills, fever, serum sickness–like reactions, clotted AV fistula, night sweats.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Monitor signs of serum sickness–like reactions, including muscle aches, joint pains, fever, and skin rash. Notify physician or nursing staff immediately if these reactions occur.

  • Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician or nursing staff.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

  • Assess any joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by arthritis or anatomic and biomechanical problems.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Patient/Client-Related Instruction
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  • Because of immunosuppressant effects, advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Instruct patient to report other untoward side effects such as severe or prolonged headache, chest pain, difficulty breathing, chills, fever, night sweats, skin reactions (rash, redness, warmth, itching), or GI problems (diarrhea, nausea, vomiting, inflammation in/around the mouth).

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: 5.7 days.

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Table Graphic Jump Location
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TIME/ACTION PROFILE (decreased circulating T lymphocytes)

ROUTE ONSET PEAK DURATION
IV rapid unknown unknown

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Contraindications/Precautions
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Contraindicated in: History of hypersensitivity during ...

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