Transplant Flashcards
prevention of graft rejection, DDI, transplant complications, key counseling
what blood type is the universal donor
type O
what blood type is the universal receiver
AB
what two medications can be used for induction treatment?
basilixumab (Simulect)
or
Antithymocyte Globulin
basiliximab
MOA
pearls
IL-2 receptor antagonist
used for prevention only! Does not deplete T cells so cannot be used for acute rejection
induction therapy usually consists of
a McAb and high dose IV steroids
what are the treatment strategies for acute rejection
increase immunosuppressant and steroid doses
antithymocyte globulin
dosing
use
pearls
has two types, equine and rabbit derived
equine (Atgam): 5–15mg/kg/d
rabbit (Thymoglobulin): 1-1.5mg/kg/d IV
for patients with a high rejection risk
high risk of anaphylaxis, pre tx w benedryl, APAP and steroids
what drug am I?
what are the treatment options for maintenance immunosuppression
CYA
tacrolimus
MMF
prednisone/steroids
everolimus
sirolimus
CYA
MOA
brand names
SE and monitoring
CN-i
Gengraf and Neornal are modified CYA
Sandimmune is a non-modified CYA
forms are not interchangeable
ADE: nephrotoxicity, malignancies, infxn risk, HTN, hyperkalemia, dec Mg, inc BG, gingival hyperplasia
monitor: K, Mg, BG, BP, renal function, CBC, trough
tacrolimus
MOA
brand names
SE and monitoring
CN-i
Prograf
BBW: inc risk mortality in women with liver transplant
SE: HTN, inc BG, nephrotoxicity, neurotox, QTp, HLD, alopecia, hyperkalemia
monitoring: K, renal function, BP, BG, lipids
goal trough 3-15 ng/mL
T or F
Tacro can be taken without regard to food
false, must be taken with or without food consistently
MMF
forms
MOA
SE
monitoring
pearls
Cellcept = mycophenolate mofetil
Myfortic = mycophenolic acid
forms are NOT interchangeable
MOA: block T and B - cell proliferation by changing purine synthesis
BBW: congenital malformations, spontaneous abortion
ADE: HTN, inc BG, dec Mg, dec Ca, acne, N/V/D, leukopenia
monitoring: BP, BG, electrolytes, CBC
pearls: has REMS program, myfortic is EC so less diarrhea
Azathioprine
BBW
warnings
not used overly often
BBW: inc risk malignancy, heme toxicities, mutagenic potential
warnings: inc risk of myelosuppression in patients with low TPMT
Everolimus
brand
MOA
warnings
monitoring
(Zortress)
mTOR kinase-i
warnings: impaired wound healing, pneumonitis, proteinuria, anemia, thrombocytopenia, DM, male infertility
monitor: trough, renal function, BG, BP, LFTs, CBC, lipids
sirolimus
MOA
warnings
monitoring
pearl
mTOR kinase-i
warnings: impaired wound healing, HLD
SE: IRREVERSIBLE pneumonitis/cough/bronchitis, inc BG, peripheral edema
tab is NOT bioequivalent to solution
prednisone short term SE
fluid retention
inc BG
irritability
weight gain
inc appetite
insomnia
stomach upset
HTN
prednisone long term SE
impaired wound healing
HTN
DM
OP
adrenal suppression/Cushings
stunted growth in adolescents
CYA metabolism
metabolized via p-gp and 3A4 and also inhibits 3A4
CYA and tacro are both metabolized by
p-gp
CYA will dec [ ] of _______, but inc [ ] of _______
will dec MMF conc
will inc siro and evero conc
tacrolimus absorption dec/inc with food?
dec
azathioprine is metabolized by ______, and therefore interacts with _______
XO
XO-i (allopurinol, febuxostat)
what medications dec MMF Cp
antacids, PPIs
multivitamins
CYA
metronidazole
FQ
rifampin
BAS
sevelamer
CN-is tacro and CYA should be used with caution in combo with
grapefruit and nephrotoxins
which immunosuppressants cause nephrotoxicity
CN-is
which immunosuppressants cause DM
CYA, tacro and steroids
which immunosuppressants cause HLD
CYA, mTOR (evero and siro), steroids
which immunosuppressants cause HTN
all except MMF
