Drugs used in Organ Transplantation Flashcards
What is the mechanism of glucocorticoids (Prednisone, prednisolone_?
Suppress distribution and reactivity of lymphoid and myloid cells, catabolic actions at GRE
What is the clinical use of glucocorticoids (Prednisone, prednisolone?
Acute use and emergency adjuncts to other suppressants
What are the toxicities of glucocorticoids (Prednisone, prednisolone)?
Catabolic state, hypertension, diabetogenic, avascular necrosis, osteopenia
What is the mechanism of Antithymocyte Globulin (ALG) and Antilymphocyte Globulin (ATG)?
Polyclonal suppression of thymocytes (T) or lymphocytes (T&B, NK), Allows early temp withdrawal of drug
Whats the clinical use of Antithymocyte Globulin (ALG) and Antilymphocyte Globulin (ATG)?
Induction, initial or steroid resistant rejection, GVH rxns
What are the toxicities of Antithymocyte Globulin (ALG) and Antilymphocyte Globulin (ATG)?
Fever, chills, hypotension, SERUM SICKNESS (type III), sensitization
What is the mechanism of Muromonab-CD3 (OKT-3)
MAB (monoclonal antibody) against the T-cell receptor
What is the clinical use of Muromonab-CD3 (OKT-3)
Induction, initial or steroid resistant rejection
What is the toxicities of Muromonab-CD3 (OKT-3)
‘Cytokine release’ syndrome so systemic shock (pretreat with steroid), infusion rxns,sensitization
What is the mechanism of Alemtuzumab
hMAB (monoclonal antibodies) against CD52 on lymphocytes monocytes macrophages NK leading to prolonged T&B depletion
What is the clinical use of Alemtuzumab
Induction, initial or steroid resistant rejection (same as OKT-3)
What treatments is Alemtuzumab used for?
Chronic lymphocytic leukemia (CLL) and transplants
What is the mechanism of Daclizumab and Basiliximab
Humanized and chimeric MAB (monoclonal antibodies) against IL2 receptor on T-cells. So when IL-2R is more active it becomes more selective
What is the clinical use of Daclizumab and Basiliximab
Acute renal rejection
What are the toxicities of Daclizumab and Basiliximab
Infusion rxns, tremor, headache, dypsnea, hypertension
What is the mechanism of Abatacept and Belatacept
Fusion of Fc of IgG1 and CTLA-4 binds to CD80,86 preventing second signal in T-cells, blocking activation
What is the clinical use of Abatacept and Belatacept
Used for rheumatoid arthritis, but allows temporary removal of more toxic agents in slow graft response or rejection
What are the toxicities of Abatacept and Belatacept
Infusion rxs, hypersenitivity, nasopharyngitis, URI, nausea, headache
What is the mechanism of Thalidomide?
Stimulates and changes specificity of T-cells, supresses B cells stimulates T cells but in a immunomodulatory fasion such as changes in immune reactivity and specificity. Used in combo for allogenic bone marrow transplantation.
What is the clinical use of Thalidomide?
Malignancy, GVHR
What are the toxicities of Thalidomide?
Teratogenic, peripheral neurotoxicity
What is the mechanism of Calcineurin inhibitors: Cyclosporine (CSA and Tacrolimus (FK-506)?
Calcineurin (phosphatase PP2b) inhibitor blocking signal transduction activating T-cells
What is the clinical use of Calcineurin inhibitors: Cyclosporine (CSA and Tacrolimus (FK-506)?
Primary agents used in organ transplantation of all kinds in combo with antimetabolites. CSA binds to cyclophilin and FK506 binds to tacrolimus
What is the toxicities of Calcineurin inhibitors: Cyclosporine (CSA and Tacrolimus (FK-506)?
Nephrotoxicity is limiting, neurotoxic, hypertension, hyperlipidemia, gum hyperplasia (CSA), diabetes (FK-506). Watch for drug interactions with CYP450s
What is the mechanism of Antiproliferative agents: Sirolimus (rapamycin), Everolimus?
inhib mTOR kinase, prevents CDK2 phosphorylation and so blocks cell cycle progression in T-cells. Binds to FK506BP12
What is the clinical use of Antiproliferative agents: Sirolimus (rapamycin), Everolimus?
Used in organ transplants of all kinds, not used in combo of calcineurin inhibs but as alternate primary drugs with antimetabolites
What are the Toxicities of Antiproliferative agents: Sirolimus (rapamycin), Everolimus?
Hyperlipidemia, Myelosupression esp thrombocytopenia, also anemia, delayed wound healing and used in vascualr stents watch with interaction at CYP450s
What is the mechanism of Antimetabolites: Mycophenolate and Mofetil?
Prodrug of mycophenolic acid and inhib of T&B cell inosine monophosphate dehydrogenase in the purine pathway for GMP synthesis. T and B cells are highly dependent on de novo purine synthesis hence are suppressed
What is the clinical use of Antimetabolites: Mycophenolate and Mofetil?
Used in secondary ancillary immunosuppressant drug combo with Calcineurin inhibs or Antiproliferative agents
What are the toxicities of Antimetabolites: Mycophenolate and Mofetil?
Leukopenia, diarrhea, nausea, vomiting, infection
What is the mechanism of Antimetabolites: Azathioprine?
Prodrug of 6-MP, an inhib of ATP and GTP synthesis. Can be genetic deficiencies in metabolism by thiopurine methyltransferase
What is the clinical use of Antimetabolites: Azathioprine?
Largely replaced by mycophenolate but is alt. Dose reduced with allopurinol
What are the toxicities of Antimetabolites: Azathioprine?
Bone marrow suppression, hepatotoxicity, GI toxicity, pancreatitis, alopecia
