Pharmacotherapeutics Flashcards
Induction regimens
Intense, early post-op immune suppression
Maintenance regimens
Used throughout the patients life to prevent acute and chronic rejection
How does prednisone work
Prevents production of cytokines and vasoactive substances. T cells are primarily affected
What is the main adrenocorticoid used in immunosuppression
prednisone
What is prednisone used for
Induction and maintenance of immunosuppression.
Types of conditions prednisone is used in
Lupus, RA, asthma
AE of prednisone
- CATARACTS
- Osteoporosis
- Weight gain
- Hypertension
- Hypercholesterolemia
(do not give with anti-inflammatory, will cause peptic ulcer disease)
How does cyclosporine work
Inhibits production/function of cytokines (IL, IFN, TNM). Comes from a soil fungus
What are cyclosporines used for
Induction and maintenance of allografts to prevent rejection. May be used in psoriasis
AE of cyclosporines
- Nephrotoxicity
- HTN
- Hyperkalemia
- Hemolytic-uremic
- Hyperlipidemia
- Glucose intolerance
Require trough testing
MOA of tacrolimus
Similar pathway of cyclosporine, but slightly different.
Use of tacrolimus
Used orally or IV for preventing solid organ rejection. Can also be used for atopic dermatitis
AE of tacrolimus
Same as cyclosporine but more severe nephrotoxicity and neurotoxicity
Name the selective inhibitors of cytokines
- cyclosporine
- Tacrolimus
Aka - calcineurin inhibitors
Name the adrenocorticoids used in immunosuppression
Prednisone (methylprednisolone, prednisolone also used)
Name the 3 Antimetabolites
- Azathioprine
- Mycophenolate mofetil
Generally used in combo with corticosteroids and cytokine inhibitors. Helps reduce adverse affects of some of the other drugs when used in combo) - Methotrexate
What is the MOA of azathioprine
Impairs DNA synthesis and may also function as apoptotic signal
What is azathioprine used for
2nd line drug for maintenance of immunosuppression
AE of azathioprine
- Leukopenia
- Thrombocytopenia (due to bone marrow suppression)
- Hepatotoxicity
MOA of mycophenolate mofetil
Impairs B and T cell proliferation while sparing other rapidly dividing cells
What is mycophenolate mofetil used for
Used in heart, kidney, liver transplants (pretty much replaced azathioprine). Improved safety and efficacy in prolonged graft survival
AE of mycophenolate
- NVD - prominent GI!
- Anemia
- Leukopenia
- Thrombocytopenia
Name the 2 antibodies (biologic agents/biologic immune modulators)
- Adalimumab
- Daclizumab
Used in induction or tx of rejection.
Created by immunization of rabbits/horses with human lymphoid cells.
More targeted or focused effect
MOA of Adalimumab
Inhibits TNF, helps prolong graft and induce immunosuppression.
What is adalimumab used for
- ankylosing spondylitis
- crohns
- psoriasis
- RA
AE of adalimumab
Reactivation of latent infections and solid organ cancers (as a combo drug)
MOA of daclizumab
Monoclonal activity to IL 2 which suppresses T cell activation
Use of daclizumab
Prevent graft rejection and GVHD following bone marrow transplant (discontinued in US - mostly used for MS patients)
AE of daclizumab
- Tremor
- HTN
- GI upset
- Infections
- Hepatotoxicity
What 2 drugs should not be given together (causes peptic ulcer disease)
Antiinflammatory and steroid
MOA of methotrexate
Anitfolate agent that interferes with folate metabolism and DNA synthesis. Stops cells from proliferating
Use of methotrexate
- In Cancer with combo drugs
2. Inflammatory disorders like RA and crohns
AE of methotrexate
- NVD
- Stomatitis - inflammation around openings
- Myelosuppression
- Nephrotoxicity