00 Immunosuppressants Flashcards
What is the generic name of Simulect?
Basiliximab (approved for renal transplant induction therapy)
What are the most common ADRs with Simulect?
GI!!! HTN, edema. Electrolyte abnormalities. HA, insomnia, tremor. Anemia
What is the generic name of Atgam?
Anti-Thymocyte Globulin, equine (polyclonal antibody)
What is the generic name of Thymoglobulin?
Anti-Thymocyte Globulin, rabbit (polyclonal antibody)
How does the dosing differ between Atgam and Thymoglobulin?
Atgam: 15mg/kg/day x14 days.
Thymoglobulin: 1.5mg/kg/day x 14 days
What do you need to remember when giving Polyclonal antibodies?
Always give first dose in monitored setting d/t risk for anaphylaxis. Pre-medicate with Benadryl and Tylenol
What classes of medications are primarily used for maintenance therapy?
Calcineurin inhibitors (cyclosporine, tacrolimus). mTOR inhibitors (sirolimus)
What are the typical maintenance therapy regimens?
Cyclosporine based (+steroid + MMF or sirolimus). Tacrolimus based (+steroid + MMF or sirolimus). Sirolimus based (+ steroid + MMF). DO NOT combine two CNIs, two mTOR inhibitors, or two purine antagonists
What is the BBW for oral CNI (Calcineurin inhibitor)?
Increased risk of infection. May be associated with the development of malignancy, including lymphoma and skin cancer
What is the generic name of Sandimmune?
Cyclosporine (non-modified)
What is the generic name of Neoral/Gengraf?
Cyclosporine (modified or microemulsion). Not interchangeable with the non-modified version
What is the BBW associated with Cyclosporine?
HTN, nephrotoxicity
What is the generic name of Prograf?
Tacrolimus (CNI)
What is the BBW associated with Prograf?
For Prograf XL only: Increased mortality in female liver transplant recipients
What are the common CNI side effects?
Nephrotoxicity! Hyperglycemia, HTN, Hyperlipidemia
What are the target Cyclosporine trough levels?
100-400
What are the target Tacrolimus trough levels?
5-20
What do you need to monitor for CNI’s?
Renal function (CrCl)
What is the generic name of Rapamune?
Sirolimus (mTOR inhibitor)
What is the BBW associated with Rapamune (Sirolimus)?
Not recommended for liver transplant d/t increased risk of fatal hepatic artery thrombosis. Not recommended for lung transplant d/t increased risk of bronchial anastomotic dehiscence
What do you need to monitor with Rapamune (Sirolimus)?
Lipid panel, reduce dose in hepatic impairment
What is the generic name of Zortress?
Everolimus (mTOR inhibitor)
What are the BBWs associated with Zortress (Everolimus)?
Increased risk of renal arterial and venous thrombosis; may result in graft loss. Increased mortality (usually associated with infections) after heart transplant; use in heart transplant is not recommended. Increased risk for nephrotoxicity in renal transplantation; avoid standard dose of cyclosporine in combination with everolimus
What are the corticosteroids used for immunosuppression?
Prednisone, Methylprednisolone. Usually a part of most immunosuppressive regimens
What is the generic name of Cellcept?
Mycophenolate mofetil (Purine Antagonists)
What is the generic name of Myfortic?
Mycophenolic acid (Purine Antagonist)
What is the generic name of Imuran?
Azathiprine (Purine Antagonist)
What is the most common ADR with Cellcept (MMF)?
GI!!!
What is a big DDI to look out for with Imuran (Azathioprine)?
DDI with allopurinol and febuxostat. Prevents metabolism of 6-MP, leads to increased levels and risk for toxicities
What is the BBW associated with Cellcept (MMF)?
Teratogenicity
What is the generic name of Nulojix?
Belatacept. ONLY USED in patients who are EBV (+)
What counseling needs to be done when they start immunosuppression?
Compliance! Avoid NSAIDs, grapefruit juice. Always use sun protection
