Muromonab CD-3 (Orthoclone, OKT-3)

A monoclonal antibody against mature T lymphocytes, OKT-3 is primarily used to treat acute rejection episode. IV for 10-14 days. Effect monitorcd by T lymphocytes count and by serum levels of OKT-3.

Adverse effect:

Chills, fever lasting upto one hour. Respiratory symptoms may occur and be life-threatening if the patient is fluid overloaded. Aseptic meningitis, infection with cytomegalo-virus or herpes simplex virus can occur.

Headache and flue-like symptoms may develop.

Most side-effects occur during the first two doses. To reduce some of the side- effects, the patient may be given methylprednisolone, acetaminopen and anti- histamine before OKT-3 is administered. Monitor the patient intensively for the
first two doses, vital every 15 minutes.

Signs and symptoms of acute rejection in heart transpIants patients Sjmptoms: fatigue, lethargy, dyspnea, decreased tolerance for exercise.

Signs:

fluid retention, peripheral edcma, jugular venous distention, crackles, pericardial friction rub, ECG changes-dysrhythmias and decreased voltage, decreased cardiac output, hypotension, cardiac enlargcrnent.

Identify the signs and sylnptoms and assist with treatment to improve the condition.

Endocardial biopsy is the major diagnostic test used to assess rejection. The patient showing signs of rejection may be treated with increasing doses of immunosuppressive agents. For prevention of infection specially pulmonary infection-hand washing, use of aseptic technique for all invasive procedures. Provide care that protects surface barriers form organism-mouth care after every meal, upon rising and at bed time, cleaning the skin folds by daily washing, lubricating and keeping moisture free.

Deep breathing exercises two hourly. Adequate nutrition, fluid intake. Avoid contact with the patient if care giver is with active infection.