Organ transplant Flashcards

Question

What is the recommended trough level for tacrolimus?

Answer 1

5-15 ng/mL

Answer 2

NO- they must be prescribed by brand. Additionally, there is different bioavailablities with different formulations e.g. Oral cyclosporin dose is approx 3x that of the IV dose and tacrolimus is 3-5 x

Answer 3

Azathioprine Mycophenolic acid

Answer 4

Azathioprine is metabolised to mercaptopurine and then thioguanine nucleotides which interfere with DNA synthesis. - inhibits proliferation of t and b cells - Is a OD dose

Answer 5

Mainly haematological side-effects that are dose-dependent e.g. myelosuppression can occur with over 50% of patients developing leukopenia. This can be reversed by stopping the drug. - N+V- give with food or in divided doses - Thromboytopenia requires - Requires FBC monitoring -

Answer 6

Azthoprine interacts with allopurinol = decrease the azathioprine dose to 1/4 because allopurinol inhibits xanthine oxidase which metabolises azathioprine.

Answer 7

- Mycophenolic acid Acid is the active ingredient of mycophenolate motefil - MPA blocks inosine monophosphate dehydrogenase- which is the enzyme required for de novo synthesis of guanosine monophosphate nucleotides = blocks Purine synthesis = prevents t and B-cell proliferation - mycophenolic acid is more potent than azathioprine so has an increased reduction in rejection. - BD dose

Answer 8

- Haemological: leukopenia, neutropenia, mild anemia - GI e.g. diarrhoea- can be dose limiting = decrease dose - Enteric coated MPA may help with gI effects (Myfortic)

Answer 9

- Iron, antacids, rifampicin- decrease mycophenolate motefil levels - Aciclovir, ganciclovir = increase mycophenolate motefil levels

Answer 10

- It inhibits mTOR by binding to the immunophillin, FKBP12 which forms a complex that inhibits mTOR. - mTOR is a serine/threonine protein kinase involved in regulation of cell growth, proliferation, protein synthesis and ribosome biogenesis. - Blocking mTOR, inhibits cell proliferation in response to cytokines e.g. IL-2 - Can be used in combination with calcineurin inhibitors

Answer 11

12-20 ng/mL

Answer 12

- Is less nephrotoxic than calcineurins- but some glomerular effects and can cause proteinuria. - less likely to cause DM - Risk of pneumonitis- stop drug - Impaired wound healing- as doesn't just act on lymphocytes but also other praise dividing cells e.g. fibroblasts. Therfore, don't start drug immediately post-transplant to allow wound to heal. - Hyperlipidemia - Thrombocytopenia - HTN Note, is CYP P450 metabolised

Answer 13

Impaired wound healing- as doesn't just act on lymphocytes but also other praise dividing cells e.g. fibroblasts. Therfore, don't start drug immediately post-transplant to allow wound to heal.

Answer 14

Balatacept - Can be used as an alternative to calcineuring inhibitors- but found to have increased incidence of acute rejection.

Answer 15

Binds to CD80 & CD86 receptors on antigen-presenting cells, preventing CD28 on the t-cell from binding = no activation.

Answer 16

Balatacept can lead to post-transplant lymphoproliferative disease- associated with b-cells that have been infected by Epstein-Barr virus = increased proliferation of infected cells, and as the patients immunosupressed, there is no t-cell control like there normally wild be.

Answer 17

Has 2 phases (not everyday): Initial: Day 1 Day 5 Ends of weeks 2, 4, 8 and 12 Maintenance: End of week 16 and then every 4 weeks thereafter

Answer 18

Induction: - Alemtuzumab SC- has risk of cytokine release ( Flu symptoms, HTN, tachycardia)- Give pre-medication: Chlorphenamine Paracetamol Methylprednisolone - Also at induction: Methylprednisolone IV- then switch to oral and decrease to stop - Calcineurin inhibitor = immediate release Tacrolimus e.g. Prgograf - After transplant = azathioprine or mycophenolate = 3 immunosuppressive agents are continued post transplant.

Answer 19

Pre-med and induction: - Mycophenolate - IV Methylprednisolone - IV Basaliximab (OR Aletuzumab if increased immunologic risk r.g. previous transplant, previous rejection) Need 2nd dose of Basiliximab 4 days later From day 1 post-transplant: - Prednisolone 20mg OD- decrease overtime - Advagraf (calcineurin I- prolonged release tacrolimus) - 0.15mg/kg OD - Mycophenolate motefil (after basiliximab)- 750mg BD after transplant, drugs perviously needed for dialysis will be stopped e.g, eponymous, renavit, iron, phosphate binders

Answer 20

Patients have an increased risk of infection: - Pneumocystic Jiroveci (PCP): A fungal infection that symptoms are fever, chills, cough, fatigue. This can cause a loss of graft and can be fatal. THEREFORE, ALL kidney transplant patients are given 6 month prophylaxis with co-trimoxazole - Fungal infections e.g. Candida Prophylaxis: give all patients Nystatin solution for 4 weeks post-transplant - Tuberculosis- patient risk is reviewed: where are they from? have they been exposed to TB? Are they a carrier of latent TB? If there is a risk, give prophylactic Isoniazid and Pyridoxine - Cytomegalovirus: Can be asymptomatic, may have flu like symptoms but can lead to end-organ damage. Is passed on by contact of bodily fluids when virus is active- often people are infected as a child, so has zero-positive antibodies against CMV. BUT, transplanting organs = risk of passing on infection- if patient has CMV and was latent, the immunosuppression now suppresses the immune system and the infection becomes active. Give Valganciclovir prophylaxis to anyone who is at risk. Dose is dependent on renal function for 3-6 months. Not infection but still important: - Risk of transplant renal vein thrombosis and DVT: Give patients LMWH prophylaxis while in hospital (is weight and renal function dependent). Note the renal function won't be the best post renal transplant but will increase so dose may need to increase top. - Use of steroids and surgery- need gastric mucosal protection e.g. PPI, omeprazole 20mg OD - pain relief- paracetamol, Fnetanyl PCA

Organ transplant Flashcards

(45 cards)