Chapter 56: Transplant Flashcards
Induction Supression
Given at or before transplant to prevent acute rejection during early post-transplant period
Basiliximab
IL2 receptor antagonist
Does not deplete immature t-lymphocytes and cannot be used to treat rejection (only prevention)
Anithymocyte globulin
Depletes lymphocytes
Can be used for induction and tx of rejection
Infusion related reactions
Maintenance Immunosuppression includes
- Calcineurin inhibitor (CNI) (tacrolimus preferred)
- Antiproliferative agent (mycophenolate 1st line)
- With or without steroids
Prednisone Short-Term Side Effects
- Fluid retention
- stomach upset
- emotional instability
- insomnia
- increased appetite
- weight gain
- acute rise in blood glucose and BP
Prednisone Long-Term Side Effects
- Adrenal Suppression/Cushing’s syndrome
- impaired wound healing
- increased BP
- diabetes
- acne
- osteoporosis
- impaired growth in children
Mycophenolate mofetil
Cellcept
IV stable in D5W only
Mycophenolic acid
Myfortic
EC to decrease diarrhea
Mycophenolate Boxed Warnings
- Increased risk of infection
- increased development of lymphoma and skin malignancies
- increased risk of congenital malformations and spontaneous abortions
Mycophenolate SE and Notes
SE: diarrhea, GI upset
Notes: Cellcept and Myfortic are not interchangeable
Decreases efficacy of oral contraceptive
Azathioprine Warnings
(antiproliferative agent)
Warnings: patients with genetic deficiency of thiopurine methytransferase (TPMT) are at increased risk of myelosuppression
Tacrolimus Boxed Warnings and SE
Boxed warnings: Increased susceptibility to infections, possible development of lymphoma
SE: Increased BP and BG, nephrotoxicity, hyperkalemia, hyperlipidemia, QT prolongation
Tacrolimus Monitoring and Notes
Monitoring: trough level, serum electrolytes (k, phos, mg), and renal function, LFTs, BP, BG, lipids
Notes: Do not interchange, IV in non-PVC bag, drug interactions (Cyp3A4 and P-gp substrate)
Cyclosporine Boxed Warnings
Boxed warnings: renal impairment with high doses, increased risk of lymphoma and other malignancies including skin cancer, increased risk of infection, increased BP
Modified has 20-50% greater bioavailability then non-modified. Cannot be interchanged
Cyclosporine SE, Monitoring, and Notes
SE: Increased BP, nephropathy, hyperkalemia, hypomagnesemia, hirsutism, gingival hyperplasia, edema, increased BG, neurotoxicity, QT prolongation
Monitoring: Trough level, serum electrolytes, renal function, BP, BG, lipids
Notes: Drug interaction (Cyp3A4 inhibitor, substrate and P-gp substrate)
Do not administer oral liquid in a plastic or styrofoam cup
Everolimus Warnings, SE, Monitoring, Notes
Zortress (mtor kinase inhibitor) Warnings: hyperlipidemia SE: Peripheral edema, increase BP, do not use within 30 days of transplant Monitoring: trough Notes: Cyp3A4 substrate
Sirolimus Warnings, SE, Monitoring, Notes
Rapamune (mtor kinase inhibitor)
Warnings: impaired wound healing, hyperlipidemia
SE: Irreversible pneumonitis/bronchitis/cough (d/c if happens), increased BG, peripheral edema
Monitoring: trough level
Notes: tabs and oral solution are not bioequivalent, cyp3A4 substrate
Belatacept Boxed Warnings
Nulojix (binds to CD80 and 86 to block t-cell costimulation and production of inflammatory mediators)
Boxed Warnings: increased risk of post-transplant lymphoproliferative disorder, use in EBV seropositive patients only. Treat latent TP prior to use.
Induction Immunosuppressants
- basiliximap (IL-2 receptor antagonist)
- Antithymocyte globulin (in pts at higher risk of rejection)
- Maintenance drugs at higher doses)
Maintenance Immunosuppresants
- CNIs (tac or cyclosporine)
- adjuvant meds (antiproliferative agents [mycophenolate or azathioprine]) (mTOR kinase inhibitors [everolimus or serolimus]) (belatacept)
- Steroids
Vaccines
Flu
Pneumonia
Varicella
