immunosupressant pharmacology Flashcards
what are the calcineurin inhibitors and what is their mechanism of immunosupression after transplant?
cyclosporine and tacrolimus
block T-cell activation by preventing IL-2 gene transcirption
cause dose dependent rise in BUN and creatinine
what is the major adverse drug effect from cyclosporine and tacrolimus?
Highly nephrotoxic
cause dose dependent rise in BUN and creatinine from renal alrteriolar vascocronsitction ==> hypertension and can lead to oblertative vasculopathy
what is the mechanism for sirolumus?
aka rapamycin - mTOR inhibitor
blocks T-cell activation and B-cell differentiation by preventing a response (blocked mTOR signal cascade) from binding of IL-2 to its receptor
what are daclizumab and basilizimab?
monoclonal antibidies against IL2
what drug using in transplant immunospression/rejection prevention works by inhibiting lymphocyte proliferation by blocking nucleotide synthesis?
azathioprine
antimetabolite pre-cursor of 6-mercaptopurine
what drug should azathioprine not be given with?
allopurinol - 6-MP metabolite is also degraded by xanthine oxidase — so increases marrow suprpession when given with allopurinol
which immunosupressant works by inhibiting NF-kB and thereby supresses both B and T cell function by decreasing transciption of cytokiness / induces apoptosis
corticosteroids
pt with kidney transplant develops avascular necrosis of the femoral head. What was the drug?
prednisone
what drug revsrsibly inhibits IMP dehydrogenase, thereby preventing purine synthesis of B and T cells?
mycophenolate mofetil
pt received kidney tansplans and took immunosupressant that was associated with an invasive CMV injection - what was the drug?
mycophenolate mofetil
pt received kidney tansplans and took immunosupressant developed gingival hyperplasia. what was the drug?
cyclosporine
what is anakinra?
IL-1 receptor blocker
does rutuximav affect pre-B lymphocytes or plasma cells?
NO only CD20+ mature B cells in the ciruclation
which drug inhibits calcineurin, thereby decreasing transcirption of the IL-2 gene in T cells
cyclosporine