Transplant Flashcards
anti-thymocyte globulins
atgam- equine
thymoglobulin- rabbit
bind to antigens on T-lymphocytes and interfere w/ their function
- both induction and tx of reject
basiliximab
simulect
interleukin-2 recetpor antagonist
only for the prevention of rejection
maintenance immunosuppression
calcineurin inhibitors (CNI)- cyclosporin or tacrolimus (first line tac)
antiproliferative agents- mycophenolate or azathioprine (mycro first line)
with or w/o steriods- typically prednisone
mycophenolate
mycophenolic acid
cellcept- only stable in D5W
myfortic
not interchangeable
cellcept 500mg = 360 mg myfortic
Azathioprine
Azasan, Imuran
- genetic test! deficiency of TPMP (thiopurine methyltransferase) increases risk for myelosuppression!
tacrolimus
prograf
nephrotoxic, increased BG and BP
non-PVC bag
-suppress cellular immunity by inhibiting T-lymphocyte activation
- calcineurin inhibitors
cyclosporin
modified: gengraf, neoral
non-modified: sandiimmune
Restasis- eye drops
cyp3A4 inhibitor, nephrotoxic
-suppress cellular immunity by inhibiting T-lymphocyte activation
- calcineurin inhibitors
Everolimus
Zortess
-mtor inhibitor
sirolimus
rapamune
-mtor inhibitor
induction immunosuppressants tx
- basiliximab- an IL-2 receptor antagonist
- anti-thymocyte globulin in pt w/high risk of rejection
- high-dose IV steroids
maintenance immunosuppressants tx
- CNIs- (tacrolimus (primarily) or cyclosporine
—> Belatacept an alternative - Adjuvant meds given w/ SNI to achieve immunosuppression while decreasing the dose and toxicity of individual agents
—> antiproliferative agents (mycophenolate or azathioprine
—> mTOR inhibitors (everolimus or sirolimus) - storiods at lower or tapering doses
nephrotoxic
tacrolimus and cyclosproin
worsening or new onset of diabetes
tacrolimus, steroids and cyclosporin
hypertension
steroids, cyclosporin and tqacrolimus
vax
avoid live
–> pre-transplant do varicella and vax close contact
PCV 20 x1 or PCV15 followed by PPSV23 x1 after 8 weeks
