Flashcards in Transplant Deck (22):
What is the purpose of induction immunosuppression?
To prevent acute rejection during early post-transplant. This provides high dose of immunosuppression
What is the most common induction drug?
Basiliximab IL-2 antagonist
If basiliximab doesnt work whats next line?
Anti-thymoctyes reverse rejection
Example of anti-thymocyte? and what are important notes?
You should pre medicate with diphenhydramine, steroids or acetaminophen to lessen infusion related issues.
Basilliximab (Simulect) MOA
Chimeric (murine/human) mAB, inhibiting IL-2 receptor not allowing t-lymth cause rejection
with or without steroids (Prednisone)
Mycophenolate Mofetil (CellCept)
Mycophenolate Acid (Myfortic) MOA
Inhibits t-lymph proliferation by altering purine synthesis
CellCept boxed warning
increase risk of infection, lymphoma, skin malignincies, congenital malformations and spontaneous abortions
Which anti-proliferative is enteric coated?
What are some notes on Mycophenolate products?
Cellcept must be diluted in D5W only
Take on an empty stomach
Dont use if allergic to Poly80
Warning with Azathiprine (Azasan, Imuran)
patients with deficiency in TPMT are are higher risk for myelosuppression
Prograf side effects?
Prograf monitoring parameters
Trough levels, K/Mg, Renal fxn, LFTs, BP, Lipid panal
Interacts with CYP450 3A4 so avoid a lot lol
Must be administered in NON-PVC
Whats the difference between Cyclosporine (Neoral,Gengraf) *Sandimmune
Neoral and Gengraf are modified and Sandimmue in not-modified
Modified has better bioavailability, they cannot be interchanged
Boxed warning for Cyclosporine?
Renal impairment, lymphoma and malignancies, skin cancer
Cyclosporine SE and notes
Notes- do not administer in plastic or styrofoam
mTOR kinase inhibitors, name them and there MOA
Everolimus (Zostress)*3a4 substrate, inhibit T activation and proliferation
mTOR kinase inhibitor SE
Do not use within 30 days of transplant if thrombosis occurs
Sirolimus (Rapamune) Warning and SE
impaired wound healing, Hyperglycemia
SE- Irreversible pneumonitis, bronchitis, cough, hyperglycemia
Siolimus Monitoring and Notes
Tabs and Oral solution are not bioequivalent
Siro and Everlimus are both CYP 3A4 Substrates