Transplant Flashcards
Atgam
Anthithymocyte Globulin
Thymoglobulin
Anthithymocite Globulin
What would be used for high risk induction and can also be used for tx of rejection?
Atgam/Thymoglobulin (aka anthithymocite globulin)
What are the side effects of Anthithymocite globulins (atgam and thyroglobulin)
infusion reactions, must premedicate with (dihphenhydramine, acetaminophen, and steroids)
What is the MOA of Anthithymocite globulins (atgam and thyroglobulin)
Binds to antigens on T-lymphocytes (killer cells) and interferes with their function
What is the MOA of Basiliximab
monocolonial antibody that inhibits the IL-2 receptor on the surface of activated T-lymphocyte sprecenting rejection
What is the maintenance therapy for immunosuppression?
1) A Calcineurin inhibitor (CNI) - Tacrolimus
2) A antiproliferative agent - mycophenolate
3) With or without steroids
Prednisone side effects
fluid retention, stomach upset, emotional instability, insomnia, increased appetite, weight gain, acute rise in blood glucose and blood pressure
long term may cause cushings, impaired wound healing, diabetes, osteoporosis, impaired growth in children
CellCept
Mycophenolate Mofetil *only good in D5W
Myfortic
Mycophenolic Acid *enteric coated to decrease GI upset
Antiproliferative agents (i.e. Mycophenolate) effects
Warnings: increased risk of infection, increased development of malignancies, increased risk of birth defects and abortions, decrease efficacy of birth control
Side effects: Diarrhea, GI upset
Who is at risk for myelosupression
genetic deficiency of thiopurine methyltransferase (TPMT)
Prograf
Tacrolimus
Tacrolimus boxed warning
increased susceptibility to infection and possible lymphoma
Side effects of tacrolimus and monitoring
increased BP, K, BG, lipids
nephrotoxic, neurotoxic, QT-prolonging
Monitor: Serium electrolytes (K, Phos, and MG), renal function, LFTs, BP, blood glucose, lipid profile
Non PCD pneumonics
Leach - Lorazepam Absorbs - Amiodarone To - Tacrolimus In - Insulin Nutrients - Nitroglycerin
What is the MIA of everolimus/sirolimus
MTOR kinase inhibitor to inhibit T lymphocyte activation and proliferation
neograf
cyclosporine
gengraf
cyclosporine
side effects of mtor (everolimus, sirolimus)
warning - hyperlipidemia *do not use witrhin 30 days of transplant
side effects - peripeheral edema, increased BP
sirolimus warnings
warnings: impaired would healing, hyperlipidemia, impaired wound healing
MOA of belacept
binds to CD80 and CD86 to block T cell costimulation and production of inflammatory mediators
boxed warning of belacept
increased risk of post-transplantlymphoproliferative disorder therefore use in EBV seropositive patients only
must treat latent TB prior to use
Major cyp inhibitors
PACMAN G - C = cyclospirine
Which immunosupressians cause nephrotox
tacrolimus and cyclosporing
which immunosupressants worsen diabetes
tacrolimus, steroids, and cyclosporine
which immunosupressants worsen lipid parameters
mtor*, steroids, cyclosporine
which immunosupressants worsen hypertension
steroids, cyclosporine, tacrolimus
what causes acute recection
T-cell (cellular) or B-cell (humoral or antibody) which can be distinguished via biopsy
Vaccins for transplant recipients
influenza, pneumonicoccal 8 weeks apart, varicella (if not previously received)
how often to take tacrolimus
every 12 hourson an empty stomach
