post transplant meds C8

Question 1

why are medications like prednisolone and tacrolimus needed following a transplant

Answer 1

to prevent rejection

Question 2

MOA, use and monitoring: prednisolone

Answer 2

MOA: CCorticosteroid: Binds to glucocorticoid receptors – induces changes in gene expression.
Inhibition of prostaglandin synthesis via actions on TF
Prostaglandins are inflammatory mediators.
Structurally similar to cortisol.
they also limit the migration of leukocytes to sites of inflammation
Use: Autoimmune, transplant, asthma, inflammation
Monitoring: BP, glucose, bone density, weight
Counselling: Take with food. Don’t stop suddenly. Watch for infection signs. Take in morning ideally to mimic bodys natural secretion of cortisol

Question 3

MOA, use and monitoring: co-trimoxazole

Answer 3

Trimethoprim + Sulfamethoxazole

MOA: Inhibits bacterial folate synthesis
Sulfamethoxazole and trimethoprim are used in combination (as co-trimoxazole) because of their synergistic activity (the importance of the sulfonamides has decreased as a result of increasing bacterial resistance and their replacement by antibacterials which are generally more active and less toxic). (BNF)

Use: PJP prophylaxis, UTIs
Monitoring: FBC, renal function, K⁺
Counselling: Report rash. Photosensitivity. Drink plenty of fluids.

Question 4

MOA, use and monitoring: tacrolimus

Answer 4

MOA: Calcineurin inhibitor → inhibits T-cell activation and cytotoxic lymphocytes and t cell dependant b cell proliferation = Reduced immune response
Use: Organ transplant immunosuppression
Monitoring: Trough levels, renal function, BP, glucose
Counselling: Take at same time daily. Avoid grapefruit. Infection risk.

also surpresses expression of interleukin 2 receptor

Question 5

MOA, use and monitoring: mycophenylate

Answer 5

MOA: Inhibits guanine synthesis (inosine monophosphate dehydrogenase) → blocks T/B cell proliferation
Use: Immunosuppression in transplants
Monitoring: FBC, liver function
Counselling: Teratogenic – contraception needed. Report infections.
men need to make sure they arent getting women pregnant

Question 6

what other medication may be prescribed alongside prednisilone to protect the GI tract

Answer 6

PPI such as omeprazole, lansoprazole.

Question 7

what is calcineurin and what med inhibits this

Answer 7

calcium-dependent enzyme that dephosphorylates and activates the transcription factor required for t cell activation

tarcolimus inhibits calcineurin