00 Immunosuppressants Flashcards Preview

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Flashcards in 00 Immunosuppressants Deck (32):
1

What is the generic name of Simulect?

Basiliximab (approved for renal transplant induction therapy)

2

What are the most common ADRs with Simulect?

GI!!! HTN, edema. Electrolyte abnormalities. HA, insomnia, tremor. Anemia

3

What is the generic name of Atgam?

Anti-Thymocyte Globulin, equine (polyclonal antibody)

4

What is the generic name of Thymoglobulin?

Anti-Thymocyte Globulin, rabbit (polyclonal antibody)

5

How does the dosing differ between Atgam and Thymoglobulin?

Atgam: 15mg/kg/day x14 days.
Thymoglobulin: 1.5mg/kg/day x 14 days

6

What do you need to remember when giving Polyclonal antibodies?

Always give first dose in monitored setting d/t risk for anaphylaxis. Pre-medicate with Benadryl and Tylenol

7

What classes of medications are primarily used for maintenance therapy?

Calcineurin inhibitors (cyclosporine, tacrolimus). mTOR inhibitors (sirolimus)

8

What are the typical maintenance therapy regimens?

Cyclosporine based (+steroid + MMF or sirolimus). Tacrolimus based (+steroid + MMF or sirolimus). Sirolimus based (+ steroid + MMF). DO NOT combine two CNIs, two mTOR inhibitors, or two purine antagonists

9

What is the BBW for oral CNI (Calcineurin inhibitor)?

Increased risk of infection. May be associated with the development of malignancy, including lymphoma and skin cancer

10

What is the generic name of Sandimmune?

Cyclosporine (non-modified)

11

What is the generic name of Neoral/Gengraf?

Cyclosporine (modified or microemulsion). Not interchangeable with the non-modified version

12

What is the BBW associated with Cyclosporine?

HTN, nephrotoxicity

13

What is the generic name of Prograf?

Tacrolimus (CNI)

14

What is the BBW associated with Prograf?

For Prograf XL only: Increased mortality in female liver transplant recipients

15

What are the common CNI side effects?

Nephrotoxicity! Hyperglycemia, HTN, Hyperlipidemia

16

What are the target Cyclosporine trough levels?

100-400

17

What are the target Tacrolimus trough levels?

5-20

18

What do you need to monitor for CNI's?

Renal function (CrCl)

19

What is the generic name of Rapamune?

Sirolimus (mTOR inhibitor)

20

What is the BBW associated with Rapamune (Sirolimus)?

Not recommended for liver transplant d/t increased risk of fatal hepatic artery thrombosis. Not recommended for lung transplant d/t increased risk of bronchial anastomotic dehiscence

21

What do you need to monitor with Rapamune (Sirolimus)?

Lipid panel, reduce dose in hepatic impairment

22

What is the generic name of Zortress?

Everolimus (mTOR inhibitor)

23

What are the BBWs associated with Zortress (Everolimus)?

Increased risk of renal arterial and venous thrombosis; may result in graft loss. Increased mortality (usually associated with infections) after heart transplant; use in heart transplant is not recommended. Increased risk for nephrotoxicity in renal transplantation; avoid standard dose of cyclosporine in combination with everolimus

24

What are the corticosteroids used for immunosuppression?

Prednisone, Methylprednisolone. Usually a part of most immunosuppressive regimens

25

What is the generic name of Cellcept?

Mycophenolate mofetil (Purine Antagonists)

26

What is the generic name of Myfortic?

Mycophenolic acid (Purine Antagonist)

27

What is the generic name of Imuran?

Azathiprine (Purine Antagonist)

28

What is the most common ADR with Cellcept (MMF)?

GI!!!

29

What is a big DDI to look out for with Imuran (Azathioprine)?

DDI with allopurinol and febuxostat. Prevents metabolism of 6-MP, leads to increased levels and risk for toxicities

30

What is the BBW associated with Cellcept (MMF)?

Teratogenicity

31

What is the generic name of Nulojix?

Belatacept. ONLY USED in patients who are EBV (+)

32

What counseling needs to be done when they start immunosuppression?

Compliance! Avoid NSAIDs, grapefruit juice. Always use sun protection