Transplant Medicine

Question 1

Azathioprine

Answer 1

Affects purine synthesis and metabolism (supresses highly proliferative cells more broadly vs. mycophenolate)
ADRs (bone marrow suppression, skin lesions, hepatic, pancreatic, alopecia)
Avoid using allopurinol if pt develops gout

Question 2

Mycophenolate

Answer 2

antiproliferative effect on lymphocytes (T and B cells)
more specific than azathioprine
mofetil (Cellcept) and sodium (Myfortic)
ADRs (GI, neutropenia, and MF teratogen)
DIs (divalent cations like Fe and Ca, cholestyramine, food reduces rate of absorption)

Question 3

Cyclosporine

Answer 3

Inhibit calcineurin (interferes with signal 1)
TDM required either CO or post 2h (within 15 min)
CYP3A4 metabolism and interactions
ADRs (more likely to cause gout)
Nephropathy
Hyperlipidemia ( more than tacro, but less than sirolimus)
Hirsutism

Question 4

Tacrolimus

Answer 4

Inhibit calcineurin (interferes with signal 1)
TDM required at C0 between 11.5 and 12.5h since last dose
CYP3A4
ADRs (headache and GI, hyperglycemia, alopecia)

Question 5

Sirolimus

Answer 5

mTOR inhbitor (interferes with signal 3)
TDM trough levels after 10 to 14 days after dosing bc half-life is 60h
ADRs (delayed wound healing, hyperlipidemia, rash, mouth sores)
Stop med if proteinuria