Immunosuppressants For Organ Transplant Flashcards Preview

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Flashcards in Immunosuppressants For Organ Transplant Deck (17):
1

Classes of immunosuppressants and their uses

Protein based biologics: induction during or immediately after transplant to prevent acute rejection
Non-biologics: maintenance, to maintain viability of the organ

2

Glucocorticoids MOA and AE

MOA: binds GR to inhibit gene expression of pro-inflamm genes (IL2, TNFa), blocks prostaglandins
AE: infxn, stunt growth, osteopenia, wound healing, HTN, DM

3

What makes glucocorticoids even more diabetogenic

When combined with calcineurin inhibitors

4

Examples of cytotoxic antimetabolites

Azathioprine
MM

5

Main mechanism of cytotoxic antimetabolites

Inhibit clonal expansion of lymphocyte/T cell population

6

Azathioprine

MOA: 6MP/thiodGTP incorporated into DNA -> T/B cell supp
AE: myelosuppresion, drug intxn w/ allopurinol, Ace-i

7

Drug interaction between Azathioprine and Allopurinol

allopurinol inhibits XO metab of 6mp --> life threatening immunosuppresion (reduce aza dosage

8

Drug intxn between azathioprine and ACE-i

potentiated myelosuppression

9

Why should you consider genotyping patients who you are giving azathioprine to?

if inactive allele of TPMT, build up can lead to massive myelosuppression

10

Comparison in selectivity in MM vs azathioprine

MM is newer and more selective for suppressing immune cells

11

Mycophenolate mofetil MOA, AE

MOA: inhibits type 2 IMPDH in b/t cells --> suppressed
AE: diarrhea, vomit, leukopenia, birth defects
Dec dose with tacrolimus

12

List the calcineurin and mTOR inhibitors

Calcineurin: cyclosporine, tacrolimus
MTOR: sirolimus

13

Main mechanism of calcineurin/mTOR inhibitors

Block intracellular signaling in T cells to block activation and expansion
Calcineurin: blocks IL2
MTOR: blocks protein synthesis

14

Cyclosporine use, MOA, AE

Use: organ transplant
MOA: binds cyclophilin, inhib calcineurin, inactive NFAT, dec IL2
AE: RENAL, HTN, infections/malig

15

Tacrolimus MOA, AE

MOA: binds FKBP-12, calcineurin inhib, inactive NFAT, dec IL2
AE: WORSE renal, HTN, neurotoxicity

16

Sirolimus MOA, AE

MOA: binds FKBP12, mTOR inhib, dec protein translation for T cells
AE: hyperlipidemia, myelosuppresion, HTN, lymphocele

17

Which calcineurin or mTOR inhibitor would you give to someone with kidney disease?

Sirolimus