Lecture 65 - Immunosuppression post transplant

Question 1

Induction Agents of immunosuppresion:

2 classes, 3 drugs

Answer 1

Lymphocyte Depletion:
ATG –

Alemtuzumab

Non Lymphocyte Depletion:
basiliximab

Question 2

ATG – mechansim and side effects

Alemtuzumab: mechanism

Answer 2

Anti-thymocyte Globulin (ATG) – rabbit antibodies whch attack human thymus

SE: Infusion related side effects; TTP, Leukopenia

Alemtuzumab – Anti CD52 antibody;

No acute side effects

Question 3

Basilixumab

mechansim

Answer 3

antibody against CD25 (IL2 Receptor on T cells)

Question 4

maintenance drugs:

5 classes

Answer 4

Calcinuerin inhibition

Anti Metabolite agents

MTOR Inhibition

Corticosteroids

Co-stimulatory Blockade

Question 5

Calcinuerin inhibition: 2 Drugs, describe the mechanism, and main side effect

Answer 5

Cyclosporin
Tacroliumus

Inhibits calcineurin, decreases IL2, reduced function effector T cells

Side effect: Nephrotoxicity

Question 6

Cyclosporin
Tacroliumus

metabolized by______ therefore what drugs must be taken into account

Answer 6

metab by CYP3A4

Drugs that increase CYP3A4 function lead decreased CSA/Tacro and therefore acute rejection (rifampin, phenytoin)

Drugs that decrease CYP3A4 lead to increases CSA/TACro therefore nephrotoxicity
(ketonazole, clarithromycin)

Question 7

increased risk of skin cancer with _____

why?

Answer 7

Azathioprine

					Sensitizes to UV Radiation

Question 8

Anti metabolite drugs inlcude_____(2 drugs)

mechanism:

which has less side effects and why?

Answer 8

Azathioprine – pro drug of 6MP which inhibits purine metabolism and synthesis of DNA/RNA

MMF (mycophenolate Mofetil) – prodrug of inhibitor of inosine monophosphate DHG ; only inhibits de novo purine synthessis, but salvage pathway still available
(less side effects)

Question 9

mechanism of corticosteroids

Answer 9

binds to cytoplasmic recpetor; translocates to nucleus and decrases IL_-2 transcription

Question 10

MTOR Inhibitors – 2 drugs

what does MTOR do?

Answer 10

Serolimus and Everoliumus

Inhibtion of MTOR
controls entrance into cell cycle and progression

Question 11

Belatacept

mechanism:

Answer 11

Binds to B7 (CD80, CD86) on APC

Blocks CD28 mediated T cell Co stimulation

Question 12

which drug is contraindiated with allopurinol use in gout patinets

Answer 12

Azathioprine (6MP)

Question 13

which drugs are teratogenic

Answer 13

MMF