Immunosuppressive Medications

Question 1

What is the purpose of Calcineurin inhibitors and what are the 2 drugs in this class

Answer 1

• Tacrolimus (Prograf)
• Cyclosporin (Neoral)

Both are used for the prophylaxis of rejection

Question 2

What must you monitor with calcineurin inhibitors and what are some side effects of these medications?

Answer 2

• Tacrolimus (Prograf) - tremor, renal dysfunction, hyperglycemia
• Cyclosporin (Neoral) - Same as above. Patients can also have HTN, hirsutism and gingival hyperplasia

With both medications monitor trough levels and renal function

Question 3

What is the purpose of mTOR inhibitors and what are the 2 drugs in this class?

Answer 3

• Everolimus (Zortress)
• Sirolimus (Rapamune)

Both medications are used in the prophylaxis of rejection

Question 4

What must you monitor with mTOR inhibitors and what are some side effects of these medications?

Answer 4

• Everolimus (Zortress) - HTN, edema, rash, HLD, hyperphosphatemia, anorexia, increased LFTs, thrombocytopenia, fatigue, fever
• Sirolimus (Rapamune) - edema, rash, HLD, abdominal pain, N/D, thrombocytopenia, aches, fever

With both medications monitor trough levels, renal function, CBC, LFTs, lipids

Question 5

What is the purpose of antimetabolites and what are the 2 drugs in this class?

Answer 5

• Azathioprine (Imuran)
• Mycophenolate (Cellcept)

Both of these drugs are used in the prophylaxis of rejection

Question 6

What must you monitor with Antimetabolites and what are some side effects of these medications?

Answer 6

Azathioprine (Imuran)

• Monitor CBC and liver function tests
• SE: Leukopenia, hepatotoxicity, neoplasia

Mycophenolate (Cellcept)

• Monitor CBC
• SE: Diarrhea, leukopenia, sepsis

Question 7

What is the purpose of Monoclonal Antibodies and what are the 3 drugs in this class?

Answer 7

Used for induction therapy:

• Basiliximab (Simulect)
• Alemtuzumab (Campath)

Used for desensitization and treatment of rejection:

• Rituximab (Rituxan)

Question 8

What must you monitor with Monoclonal antibodies and what are some side effects of these medications?

Answer 8

Basiliximab (Simulect) -

• Monitor for signs of infection
• SE: Fever, chills, malaise, HTN

Alemtuzumab (Campath) -

• Monitor CBC, renal infection, infusion-related reactions
• SE: Hypotension, rash, urticaria, MSK pain, bronchospasm, fever, fatigue, cardiac dysrhythmias, toxic optic neuropathy

Rituximab (Rituxan) -

• Monitor CBC, renal infection, infusion related reactions
• Hypotension, peripheral edema, rash, abdominal pain, arthralgia, infection

Question 9

What is the purpose of polyclonal Antibodies and what are the 2 drugs in this class?

Answer 9

Used for Induction and treatment of rejection

• Anti-lymphocyte globulin (ATG, thymoglobulin)

Used for treatment of rejection

• IV immunoglobulin (Gamunex, Carimune)

Question 10

What must you monitor with polyclonal antibodies and what are some side effects of these medications?

Answer 10

Anti-lymphocyte globulin (ATG, thymoglobulin)

• Monitor WBC and platelet count
• SE: fever, leukopenia, thrombocytopenia, anaphylaxis, dyspnea

IV immunoglobulin (Gamunex, Carimune)

• CBC, renal function and blood pressure
• SE: Headache, itching, hypo/hypertension, thrombotic complications, ARF