Transplant Drugs

Question 1

Prograf

• MOA
• Dosage forms
• Administration instruction
• SEs
• MOnitor
• Conversion IV to PO
  Pediatric
  Renal/Liver dysfunction
• DDIs

Answer 1

Tacrolimus

• MOA: inhibits T lymphocyte cell activation
• Dosage forms: IV, 0.5, 1, 5mg cap, topical. Take on EMPTY stomach

SEs

• Increase Cr, blood sugar, K, cholesterol
• Decrease: WBC
• HTN
• Stomach upset, diarrhea
• Hand tremor: go away w/ time
• Hair loss

Monitor:
- Renal, hepatic, glucose, electrolytes, BP

Conversion

• IV to PO: 3x increase going from IV to PO
• Ped: 2x higher dose
• Renal/Liver dysfunction: decrease dose

DDIs: Major 3A4 substrate

• Inhibitors: voriconazole, grape fruit juice
• Inducers: St. John’s Wort
• Take on empty stomach
• Nephrotoxicity drugs

Question 2

CellCept

• MOA
• Dosage forms
• Administration instruction
  Separate from:
• ADEs
• BBW
• Monitor
• DDIs

Answer 2

Mycophenolate mofetil

• MOA: inhibit T and B lymphocytes
• Dosage form: IV, PO cap (PO and susp take on EMPTY stomach), oral suspension

ADES

• Decrease: WBC
• Increase: BP
• GI upset, diarrhea: most common

Monitor

• S/S of infection
• Pregnancy test prior to initiation
  
  • BBW: Incr risk of malformation/abortions
  • 2 forms of contraceptive 4 wks prior to therapy, during, and 6 wks after stop therapy

DDIs
- Ca+2: cannot take at the same time. Take 1H b/4 or 2H after.

Question 3

Sandimmune
Neoral
Gengraf

• MOA
• Non-modified
• Dose
• BBW
• DDIs

Sandimmune IV

• Storage
• Stable

Answer 3

Cyclosporin

• MOA: Inhibition of production and release of interleukin II and inhibits interleukin II induced activation of resting T-lymphocytes
• Non-Modified: Sandimmune
• Modified: Neoral, Gengraf => can substitute
• Dose: BID

BBW:

• Renal impairment
• Increase risk of lymphomas and other malignancies

DDIs
- Major P450 substrate
- Nephrotoxicity drugs can enhance
  ACEI/aminoglycosides/ Vanco/ Ampho B/ Cipro/ NSAIDs
  Bactrim

Sandimmune IV

• Storage: RT and protect from light
• Stable: 6H in PVC and 24H in excel or glass

Question 4

Sirolimus
Rapamycin

• MOA
• Oral sol’n storage
• Tablet storage
• SEs
• Monitor
• DDIs

Answer 4

Rapamune

• MOA: suppresses cytokine mediated T-cell proliferation, halting G1 and S phase of the cell cycle
• Oral sol’n storage: fridge, protect from light
• Tablet storage: RT, protect from light

SEs

• GI
• Decrease: WBC, wound healing
• Increase: cholesterol, LFT
• Mouth/lips ulcers
• Rash

Monitor

• CBC, LFTs, Renal, TC, TG, BP
• Infection

DDIs
- P450 substrate

Question 5

Imuran

• MOA
• IV storage
• Tablet storage
• SEs
• Monitor

Answer 5

Azathioprine

• MOA: derivative 6-mercaptopurine; antagonizes purine metabolism. May inhibit DNA, RNA and proteins synthesis
• IV storage: RT, protect from light, stable 24H at RT and 16 days in fridge
• Tablet storage: RT and protect from light

SEs

• Decrease WBC
• GI: stomach upset and dirrhea

Monitor
- CBC, LFT Q3M,

Question 6

Solo-Medrol

• Indication
• SEs

Answer 6

methylprednisolone

• Indication: help prevent an immune response against transplants, tx acute rejection

SEs

• Increase BP, BP, cholesterol
• Stomach upset, diarrha
• Wt gain
• Cataracts
• Acne
• Bone lost/night sweat/mood swings

Question 7

Orthoclone OKT3

Answer 7

Muromonab CD3

Question 8

Simulect

• Indication
• Dose

Answer 8

Basiliximab

• Indication: help prevent acute rejection within the first few weeks after the transplant
• Dose: 1st dose given during transplant and 2nd dose will be given 4 days later. Most pt requires 2 doses

Question 9

Thymoglobulin

• Indication
• Dose

Answer 9

Thymoglobulin

• Indication: IV to help prevent acute rejection w/in first few weeks after transplant
• Dose: 4 doses: during transplant and 3 doses after transplants