Transplant Flashcards
1
Q
Allograft
A
Transplant from one individual to another
2
Q
Isograft
A
Transplant from genetically identical donor
3
Q
Autograft
A
Transplant from same patient (e.g. skin grafting)
4
Q
Induction Immunosuppression
A
- Prevents acute rejection in early-post transplant
- Basiliximab is commonly used for induction but CANNOT be used in tx
- Antithymycyte globulin can be used for patients with higher risk for rejection and can be used as induction or treatment
5
Q
Atgem/Thymoglobulin
A
- Antithymocyte globulin (equine/rabbit respectively)
- Binds to T-cells and interferes with their function (depletes mature and immature T-cells)
- Can be used for induction and tx
6
Q
Antithymocyte Globulin Information
A
- Box Warning: anaphylaxis
- SE: infusion-related rxns (fever, chills, pruritis, decreased BP)
- Premedicate with benadryl, APAP, and steroids to lessen infusion-related rxns
7
Q
Basiliximab
A
- Interleukin-2 antagonist; monoclonal antibody that inhibits IL-2 on T-cells to prevent rejection
- Doesn’t deplete immature T-cells, therefore can’t be used for treatment
8
Q
Maintenance Immunosuppression
A
Combination of:
- Calcineurin inhibitor (Tacrolimus = first-line)
- Antiproliferative agent (Mycophenolate = first line, mostly)
- +/- Steroids (usually prednisone) - not needed in low immunologic risk pts
- *Suppressing mechanisms via different classes helps lower toxicity and reduce risk of rejection**
- Take ideally on empty stomach or be consistent about what you eat with meds
9
Q
Short-term Steroid SE
A
- Fluid Retention
- Upset stomach
- Emotional instability
- Insomnia
- Increased appetite
- Weight gain
- Acute risk in BG and BP
10
Q
Long-term Steroid SE
A
- Adrenal suppression/Cushing’s syndrome
- Impaired wound healing
- Increased BP
- Diabetes
- Acne
- Osteoporosis
- Impaired growth in children
11
Q
CellCept
A
- Mycophenolate Mofetil
- Antiproliferative agent, potential adjuvate to CNI
- Stable in D5W only
- Myfortic = mycophenolate acid (DR capsule, EC to help decrease diarrhea)
12
Q
Mycophenolate Information
A
- Box Warning: Increased risk of infection, lymphomas, skin malignancies, and congenital malformations/spontaneous abortion
- SE: diarrhea, GI upset
- Two formulations are NOT interchangeable
- Decreases efficacy of oral contraceptives
13
Q
Imuran
A
- Azathioprine (also Azasan)
- Antiproliferative agent, potential adjuvate to CNI
- Warning: patients with TPMT deficiency (increases risk for myelosuppression - box warning/SE)
- Avoid use with xanthine oxidase inhibitors (allopurinol, febuxostat)
- SE: GI upset
14
Q
Prograf
A
- Tacrolimus
- Calcineurin inhibitor (inhibits T-cell activation)
- Many formulations available
- Must be given exactly Q12H - draw trough right before next dose
15
Q
Tacrolimus Information
A
- Box warnings: increases susceptibility to infection and lymphomas
- SE: increase BP, nephrotoxicity, increased BG, neurotoxicity, hyperkalemia, hyperlipidemia, QT prolongation
- Monitor: trough level, electrolyte (K/Mg/Phos), renal function, LFTs, BP, BG, and lipids
- Don’t interchange XL and IR formulations
- IV must be non-PVC bag
- CYP3A4 and Pg substrate (MANY DDI)
