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504 (Immunology) > Transplant therapeutics 2 > Flashcards

Transplant therapeutics 2 Flashcards

1
Q

What is a typical dose for prednisone

A

5-15 mg per day

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2
Q

Who are the patients who would usually receive corticosteriod therapy

A

multiple rejections on a steroid free regimen, very high risk patients, no induction, patients who are already on steroids

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3
Q

What are the long term side effects of corticosteriods

A

osteoporosis,diabetes, cataracts, weight gain, hyperlipidemia

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4
Q

How can long term steroid side effects be avoided

A

a steroid taper

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5
Q

What is the best steroid removal time frame for the least amount of complications

A

5 to 14 days post transplant

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6
Q

What are the mTOR inhibitors

A

Sirolimus and Everolimus

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7
Q

T/F: Similiarly mTOrs block IL-2 production just like CNIs

A

False: Unllike CNIs which block IL-2 production, mTORs block IL-2 signal transduction

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8
Q

What is the MOA of mTORs

A

mTORs bind to FKBP-12 and complex with mTORs causing no phosphorylation of proteins

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9
Q

What enzyme metabolizes mTORs

A

CYP3A4 isotype

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10
Q

What enzyme inducers will decrease the levels of mTORs

A

phenytoin and carbamezapine, rifampin, naficillin

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11
Q

What enzyme inhibotrs will increase the levels of mTORs

A

ketoconazole, clarithomycin and erythromycin, dilitazem and verapamil, ritonavir

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12
Q

Competition with what CNI can cause complications with mTORs, how, how can this be avoided

A

cyclosporine, increased sirolimus levels, administer sirolimus 4 hours after cyclosporine

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13
Q

When are mTORs usually started, why

A

after their wounds are healed, due to lower healing side effects of mTORs

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14
Q

What side effect of mTORs would cause a discontinuation

A

mouth ulcers

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15
Q

What medication binds to the costimulatory receptor B7 on APCs, what are the consequences of this action

A

Belatacept, inhibits co-stimulattory signal 2 and promotes T-cell anergy and apoptosis

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16
Q

What are benefits of Belatacept

A

preserve renal function, improve long term outcomes

17
Q

What patients avoid Belatacept

A

Liver patients

18
Q

What patients can Belatacept only be used in, why

A

Epistein Barr Virus (EBV) serropositive, could cause PTLD in other patients

19
Q

What is PTLD

A

B-cell proliferation due to induced immunosuppresion

20
Q

What is the best regimen for keeping grafts successful

A

Triple regimen: CNI, antimetabolite, steroids

21
Q

What are high risk patient qualities for, what type of antibody induction do they get

A

Blacks, re-transplants/ Lympho depleting agents (Thymo, Atgam, and Alem)

22
Q

What type of antibody induction do low risk patients recieve

A

Basiliximab or no antibody therapy

23
Q

What is acute tubular necrosis (ATN), what type of anitbody induction do they receive

A

kidney disorder caused by lack of oxygen to kidney tissue (necrosis), Lympho depleting agents

24
Q

What are the two best ways to minimize steroid adverse effects, what is the downside

A

more potent induction and higher levels of CNIs, increased side effects of the CNI medications

25
Q

What are possible risk factors for ATN

A

donor age greater than 50 or less than 12, recipient age greater than 55, cold ischemic time greater than 24 hours, donor serum creatinine greater than 1.8 mg/dl prior to procurement, donation after cardiac death

26
Q

What is the difference in rejection in thymoglobulin vs Alemtuzumab

A

less early rejection with alemtuzumab, less late acute rejectopms seem with thymoglobulin

27
Q

What drug would swap out CNIs, why

A

Belatacept, has better long-term graft survival in kidney patients

28
Q

What should replace steroids in the 3 drug regimen for graft survival

A

Ab induction

29
Q

What drugs would swap out antimetabolites, why

A

mTOR inhibitors, MPA sideffects are intolearable with significant toxicities/ also patients who are at risk for tumor recurrence or those with skin cancer

30
Q

What is the biggest reason for graft failure

A

Non-adhearnace

504 (Immunology) (19 decks)

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