Transplant Immunosuppression Flashcards
Formula to calculate ALC
WBC (K) x Lymphs,auto (%)
Common induction agents in Kidney…liver
Kidney -methylprednisolone -MMF -basiliximab Liver -methylprednisolone
Where do steroids work on T-cells?
in the nucleus
Where do CSA/TAC work on T-Cells?
Calcinurin
-Prevent dephos of NFAT-P
Induction for high risk kidney transplant
For PSA above 30 or hx above 50,
-ATG (total 6mg/kg) over 3 doses
Where does ATG work on T-cells?
on the surface
mTOR inhibitors
Sirolimus and Everolimus
- inhibition downstream of IL-2 R
- inhibits cell cycle in all rapidly dividing cells
Which drug is an APS co-stimulation blocker
belatacept
Formula for all dose adjustments
New dose = current dose (target conc/act conc)
Target CSA maint levels
Day 1-29 300-350
30-89 250-300
90-365 200-250
Over 1yr 100-150
Drugs that have 3A4 metabolism
CSA
TAC
CSA ADEs
Hyperlipidemia
Gingival Hyperplasia
Hirsutism
+Nephrotox, HTN, Elec, CNS
Target TAC maint levels
Day 1-29 10-12
30-89 8-10
90+ 5-8
Normal starting dose for CSA
250-350mg BID
Normal starting dose for TAC
3-6mg BID
TAC ADEs
Diabetes
Allopecia
CNS
+GI, nephro, HTN, electro
Common Cyp3A4 INHIBITORS
CCB's -use nifedipine/monitor Azoles -50% except TAC/vori 66% Macrolides -use azith HIV (avirs) - monitor Sirolimus - sep dose if CSA Grapefruit - avoid
Common 3A4 INDUCERS
Monitor All except SJW (avoid) Rifampin Barbiturates Phenytoin Carbamazepine SJW - Avoid
Other drugs to avoid with CNI
Calcinurin Inh + monitor kidney -NSAIDS, aminoglycosides, ampho Take di-trivalent cations 2 hrs later -antacids Statins Contrast - hold CNI
PC for AZA
Pts also taking allopurinol should decrease dose of AZA by 75%
Where does AZA work on T-cell?
between G and S phase
Where does MMF work on T-cell?
between G and S phase
guanine, no salvage for T-lymphocytes
Which drug is a selective inhibitor of lymphocyte proliferation?
MMF
Blocks guanine, T-cells have no alt path
Which drug is always adjunctive? …used with?
MMF
-used with CNI and Prednisone
