Pharmacotherapeutics

Question 1

Induction regimens

Answer 1

Intense, early post-op immune suppression

Question 2

Maintenance regimens

Answer 2

Used throughout the patients life to prevent acute and chronic rejection

Question 3

How does prednisone work

Answer 3

Prevents production of cytokines and vasoactive substances. T cells are primarily affected

Question 4

What is the main adrenocorticoid used in immunosuppression

Answer 4

prednisone

Question 5

What is prednisone used for

Answer 5

Induction and maintenance of immunosuppression.

Question 6

Types of conditions prednisone is used in

Answer 6

Lupus, RA, asthma

Question 7

AE of prednisone

Answer 7

1. CATARACTS
2. Osteoporosis
3. Weight gain
4. Hypertension
5. Hypercholesterolemia
   (do not give with anti-inflammatory, will cause peptic ulcer disease)

Question 8

How does cyclosporine work

Answer 8

Inhibits production/function of cytokines (IL, IFN, TNM). Comes from a soil fungus

Question 9

What are cyclosporines used for

Answer 9

Induction and maintenance of allografts to prevent rejection. May be used in psoriasis

Question 10

AE of cyclosporines

Answer 10

1. Nephrotoxicity
2. HTN
3. Hyperkalemia
4. Hemolytic-uremic
5. Hyperlipidemia
6. Glucose intolerance
   Require trough testing

Question 11

MOA of tacrolimus

Answer 11

Similar pathway of cyclosporine, but slightly different.

Question 12

Use of tacrolimus

Answer 12

Used orally or IV for preventing solid organ rejection. Can also be used for atopic dermatitis

Question 13

AE of tacrolimus

Answer 13

Same as cyclosporine but more severe nephrotoxicity and neurotoxicity

Question 14

Name the selective inhibitors of cytokines

Answer 14

1. cyclosporine
2. Tacrolimus
   Aka - calcineurin inhibitors

Question 15

Name the adrenocorticoids used in immunosuppression

Answer 15

Prednisone (methylprednisolone, prednisolone also used)

Question 16

Name the 3 Antimetabolites

Answer 16

1. Azathioprine
2. 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)
3. Methotrexate

Question 17

What is the MOA of azathioprine

Answer 17

Impairs DNA synthesis and may also function as apoptotic signal

Question 18

What is azathioprine used for

Answer 18

2nd line drug for maintenance of immunosuppression

Question 19

AE of azathioprine

Answer 19

1. Leukopenia
2. Thrombocytopenia (due to bone marrow suppression)
3. Hepatotoxicity

Question 20

MOA of mycophenolate mofetil

Answer 20

Impairs B and T cell proliferation while sparing other rapidly dividing cells

Question 21

What is mycophenolate mofetil used for

Answer 21

Used in heart, kidney, liver transplants (pretty much replaced azathioprine). Improved safety and efficacy in prolonged graft survival

Question 22

AE of mycophenolate

Answer 22

1. NVD - prominent GI!
2. Anemia
3. Leukopenia
4. Thrombocytopenia

Question 23

Name the 2 antibodies (biologic agents/biologic immune modulators)

Answer 23

1. Adalimumab
2. Daclizumab
   Used in induction or tx of rejection.
   Created by immunization of rabbits/horses with human lymphoid cells.
   More targeted or focused effect

Question 24

MOA of Adalimumab

Answer 24

Inhibits TNF, helps prolong graft and induce immunosuppression.

Question 25

What is adalimumab used for

Answer 25

1. ankylosing spondylitis 2. crohns 3. psoriasis 4. RA

Question 26

AE of adalimumab

Answer 26

Reactivation of latent infections and solid organ cancers (as a combo drug)

Question 27

MOA of daclizumab

Answer 27

Monoclonal activity to IL 2 which suppresses T cell activation

Question 28

Use of daclizumab

Answer 28

Prevent graft rejection and GVHD following bone marrow transplant (discontinued in US - mostly used for MS patients)

Question 29

AE of daclizumab

Answer 29

1. Tremor 2. HTN 3. GI upset 4. Infections 5. Hepatotoxicity

Question 30

What 2 drugs should not be given together (causes peptic ulcer disease)

Answer 30

Antiinflammatory and steroid

Question 31

MOA of methotrexate

Answer 31

Anitfolate agent that interferes with folate metabolism and DNA synthesis. Stops cells from proliferating

Question 32

Use of methotrexate

Answer 32

1. In Cancer with combo drugs | 2. Inflammatory disorders like RA and crohns

Question 33

AE of methotrexate

Answer 33

1. NVD 2. Stomatitis - inflammation around openings 3. Myelosuppression 4. Nephrotoxicity