Transplant Drugs Flashcards
What can you use to treat tertiary hyperparathyroidism that develops in end stage renal failure?
1,25 vit D analogues
cinalcet - very expensive
surgery - remove 3 parathyroid glands to prevent hyperplasia
What causes uremic symptoms?
middle molecules 500 to 60,000 daltons
What are four factors that replacement dosing depends on?
- size
- volume of distribution
- protein binding
- time on dialysis
Where does a kidney transplant occur? why?
right lower quadrant - attached to iliacs
-only a short amount of viable ureter - need to be close to bladder
What are the four types of drugs used in induction aka given at the time of transplant?
- T cell antibodies
- anti IL2 antibodies
- steroids
- anti CD52
What are the three types of T cell antibodies? Describe what they are
- ATGAM - polyclonal horse serum
- OKT3 - murine monoclonal antibody
- ALG - polyclonal rabbit serum
which of the T cell antibodies are actually used ? why?
ALG
- less cytokine release syndrome - shake and bake
- less lymphopenia
Which drugs fall under the anti-IL2 category?
Dacluzimab and bisliximab
What is a rare side effect of anti-IL2 drugs?
hypersensitivity reaction
Alemtuzimab is also used in induction, what is its function?
anti CD52
What are the side effects of steroids?
- weight gain and glucose intolerance
- hyperlipidemia
- htn
- osteoporosis and avascular necrosis
- cataracts
What are the categories of drugs used for maintenance in renal transplant?
- calcinurin inhibitors - block IL2 production
- steroids
- antimetabolites - inhibit de novo purine synthesis
- mTOR inhibitors - block G1 –>S
- Betalacept
Which drugs are calcinurin inhibitors?
cyclosporin and tacrolimus
what are the s/e of calcinurin inhibitors?
- nephrotoxicity
- gingival hyperplasia
- hypertrichosis
- hyperlipidemia
- tremor and neuropathy
- hyperuricemia
Which drugs fall under antimetabolites?
azathioprine and mycophenolate mofetil
