Transplant Flashcards
(32 cards)
Why can’t basiliximab (Simulect) be used as a treatment for organ rejection?
- Basiliximab is an interleukin-2 (IL-2) receptor (expressed on activated T-cells and is a critical pathyway for activting T-cells to attack and reject the organ) antagonist.
- Does not deplete immature T-cells.
Antithymocyte Globulin MOA
Atgam (equine), Thymoglobulin (rabbit)
Bind to antigens on T-cell and causing T-cell depletion of both mature and immature T-cells.
Which immusuppressant can be used for both induction and treatment of organ rejection?
Antithymocyte Globulin
Antithymocyte globulins are indicated in patients who are
at higher risk of rejection
Which immunosuppressant requires premedication?
Antithymocyte globulins
Calcineurin Inhibitor MOA
Tacrolimus (Prograf), Cyclosporine (Gengraf, Neoral, Sandimmune)
Suppress cellular immunity by inhibiting T-cell activation.
Which medication is an alternative treatment option if patients experience significant side effects such as nephrotoxicity from a calcineurin inhibitor?
Belatacept
Use in EBV seropositive patients only
Belatacept MOA
Inhibits T-cell activation and production of inflammatory mediators by binding to CD80 and CD86 on antigen presenting cells, blocking costimulation with CD28 on T-cells.
Which medication is used as an alternative to antiproliferative agent?
mTOR kinase inhibitors
Everolimus, Sirolimus
Mammalian target of rapamycin (mTOR) kinase inhibitor MOA
Inhibit T-cell activation/proliferation.
Antiproliferative Agent MOA
Mycophenolate Mofetil (CellCept), Mycophenolic Acid (Myfortic), Azathioprine
Inhibit T- and B-cell proliferation by altering purine nucleotide synthesis.
Common side effects of both tacrolimus and cyclosporine
- Hyperkalemia
- Hypomagnesemia
- Hypertension
- Hyperlipidemia
- Hyperglycemia
- Infections
- Nephrotoxicity
- Neurotoxicity
- QT prolongation
Unique side effects of cyclosporine
- Gingival hyperplasia
- Hirsutism
Unique side effects of tacrolimus
Alopecia
Can you exchange Sandimmune with Neoral without prescriber’s approval?
No
* Non-modified (Sandimmune) formulation and modified (Neoral and Gengraf) formulation are not AB-rated.
* Modified formulation has greater bioavailability compared to the non-modified formulation.
Calcineurin inhibitor drug interactions
- Cyclosporine and tacrolimus are substrates of CYP3A4 and P-gp
- Cyclosporine is also an inhibitor of CYP3A4
Avoid grapefruit
Which immunosuppressant requires non-PVC bag and tubing for IV administration?
- Tacrolimus
- Cyclosporine
Which immunosuppressant requires genetic testing for TPMT prior to initiation?
Azathioprine
Patients w/ genetic deficiency of TPMT are at increased risk for myelosuppression
Which immunosuppresants are only available through REMS program?
- Mycophenolate mofetil
- Mycophenolic acid
Which immunosuppresants can decrease efficacy of oral contraceptives?
- Mycophenolate mofetil
- Mycophenolic acid
Unique side effects of antiproliferative agents
- Diarrhea
- GI upset
Common side effects of mTOR kinase inhibitors
Everolimus, Sirolimus
- Metabolic syndrome (hyperlipidemia, hyperglycemia, hypertension)
- Imapired wound healing
- Peripheral edema
mTOR kinase inhibitor drug interactions
Everolimus and sirolimus are substrates of CYP3A4 and P-gp
What test should be done prior to the initiation of belatacept?
TB
