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BCTXP > Drugs-Induction > Flashcards

Drugs-Induction Flashcards

1
Q

rATG: mechanisms of T cell depletion

A
  1. Complement-dependent cytotoxicity

2. Opsonization / phagocytosis via macrophages

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2
Q

rATG: secondary effects besides T cell depletion

A
  1. Induction of B cell apoptosis
  2. Induction of Treg cells
  3. Modulation of adhesion molecules/cell trafficking
  4. Antibody-dependent cellular cytotoxicity
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3
Q

rATG is indicated for induction for which organs?

A

Kidney txp only

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4
Q

rATG - PI recommended dosing for induction

A

1.5 mg/kg x4 - 7 days

FIRST DOSE PRIOR TO REPERFUSION (reduce DGF)

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5
Q

rATG - PI recommended duration of infusion

A

1st dose: minimum of 6 hours

Subsequent doses: minimum 4 hours

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6
Q

rATG - PI recommended pre-medication

A

Corticosteroids, APAP, and/or an antihistamine 1 hour prior to each infusion

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7
Q

rATG - PI recommended dose modifications for WBC and platelet

A

WBC 2-3: 1/2 dose
WBC <2: Consider stopping
Plt 50-75: 1/2 dose
Plt <50: Consider stopping

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8
Q

rATG contraindications

A

History of allergy or anaphylactic reaction to rabbit proteins or to any product excipients, or who have active acute or chronic infections that contraindicate any additional immunosuppression

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9
Q

rATG - How supplied, reconstitution, BUD, Filter

A

Supplied: 10 mL vial with 25 mg lyophilized product
Reconstitute: 5mL SWFI
BUD: 24 hours @ RT
Filter: 0.22 micrometer

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10
Q

eATG is indicated for induction for which organs?

A

Kidney txp only

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11
Q

eATG - PI recommended dosing for induction

A

10-15 mg/kg daily x14d

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12
Q

eATG - PI recommended duration of infusion

A

At least 4 hours

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13
Q

eATG - How supplied, BUD, Filter

A

Supplied: 50 mg/mL concentrate
BUD: 24 hours @ RT
Filter: 0.2 to 1.0 micron

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14
Q

Alemtuzumab: Mechanism of depletion

A

Anti-CD52 monoclonal antibody (CD52 is a membrane glycoprotein on T cells, B cells, and innate cells)

  1. Complement-dependent cytotoxicity
  2. Antibody-dependent cellular cytotoxicity
  3. Induction of apoptosis
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15
Q

Alemtuzumab: indications in SOT

A

None

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16
Q

Alemtuzumab: IV infusion instructions

A 
Vial = 30 mg/mL (1 mL vial)
2 hours
Mix in 100 mL bag of NS or D5W
BUD: 8 hours
Incompatible with PVC
17
Q

Alemtuzumab: Premedication

A

Benadryl, APAP 30 minutes prior to each infusion

18
Q

Basiliximab: MOA

A

IL-2R Antagonist; competitively inhibits IL-2 mediated activation of lymphocytes by binding with high affinity to IL-2Ra on activated lymphocytes

19
Q

Basiliximab: indications in SOT

A

Kidney txp recipients receiving cyclosporine and corticosteroids

20
Q

Basiliximab: Administration per PI

A

Central or peripheral
Infusion: 20 - 30 minutes (bolus may be associatd with n/v, local rxn)
Dilute to 50 mL with NS or D5W
BUD: 24 hr fridge; 4 hr RT

21
Q

Basiliximab: Dosing per PI

A 
Adults: 20 mg 
 - Dose 1 within 2 hours prior to txp surgery
- Dose 2: 4 days after txp
Peds: (same schedule as adults)
 - <35 kg: 10 mg
 - >35 kg: 20 mg
22
Q

Basiliximab: Concentration for effect

A

Serum conc of 0.2 mcg/mL saturates IL-2R

23
Q

Antithymocyte globulin: central vs peripheral administraiton

A

PI: “high-flow vein”
IRL: peripheral (heparin + hydrocort + inc volume) or central

24
Q

Kidney txp: most common induction agent

A

T-cell depleting agent&raquo_space;> IL2RA > None

25
Q

Liver txp: most common induction agent

A

None&raquo_space;> IL2RA > T-cell depleting

26
Q

Pancreas txp: most common induction agent

A

T-cell depleting

27
Q

Intestine txp: most common induction agent

A

T-cell depleting > None > IL2RA

28
Q

Heart txp: most common induction agent

A

None&raquo_space; IL2RA > T-cell depleting

29
Q

Lung txp: most common induction agent

A

IL-2RA&raquo_space; None > T cell depleting

30
Q

Kidney txp: eATG vs rATG Efficacy

A

rATG = lower rates of BPAR and improved graft & patient survival

31
Q

Kidney txp: efficacy data supports which agent for high risk candidate?

A

T cell depleting agent (rATG or alemtuzumab)

32
Q

Liver txp: data supports which agent for induction?

A

Data sucks. Induction may reduce rates of rejection without clear effect on long term patient or graft outcomes

33
Q

Heart txp: data supports which agent?

A

Data sucks. Benefit with induction is unclear - may reduce rejection rates but long-term effects inconsistent. IL2RA may provide similar long term benefits compared with rATG. Consider in sensitized patients.

34
Q

Lung txp: data supports which agent?

A

Data sucks. Depleting therapy appears to reduce rejection with trade off of infection. IL2RA may be preferred though effect not clear.

35
Q

Intestinal txp: data supports which agent?

A

Alemtuzumab = lowest risk of rejection

rATG + rituximab = next lowest risk of rejection BUT lower risk of infxn compared with alemtuzumab

BCTXP (11 decks)

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