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Flashcards in Transplant Deck (22):
1

What is the purpose of induction immunosuppression?

To prevent acute rejection during early post-transplant. This provides high dose of immunosuppression

2

What is the most common induction drug?

Basiliximab IL-2 antagonist

3

If basiliximab doesnt work whats next line?

Anti-thymoctyes reverse rejection

4

Example of anti-thymocyte? and what are important notes?

ATGAM (Equine)
Thymoglubulin (Rabbit)

You should pre medicate with diphenhydramine, steroids or acetaminophen to lessen infusion related issues.

5

Basilliximab (Simulect) MOA

Chimeric (murine/human) mAB, inhibiting IL-2 receptor not allowing t-lymth cause rejection

6

Maintenance immunosuppression

CNI (tacrolimus)
anti-proliferative (mycophenolate)
with or without steroids (Prednisone)

7

Mycophenolate Mofetil (CellCept)
Mycophenolate Acid (Myfortic) MOA

Inhibits t-lymph proliferation by altering purine synthesis

8

CellCept boxed warning

increase risk of infection, lymphoma, skin malignincies, congenital malformations and spontaneous abortions

9

Which anti-proliferative is enteric coated?

Myfortic

10

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

11

Warning with Azathiprine (Azasan, Imuran)

patients with deficiency in TPMT are are higher risk for myelosuppression

12

Prograf side effects?

Hypertension
Nephrotoxicity
Hyperglycemia
Neurotoxicity
Hyperkalemia
QTprolongation
Hyperlipidemia

13

Prograf monitoring parameters

Trough levels, K/Mg, Renal fxn, LFTs, BP, Lipid panal

14

Prograf notes

Interacts with CYP450 3A4 so avoid a lot lol
Must be administered in NON-PVC
Q12H
Empty stomach

15

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

16

Boxed warning for Cyclosporine?

Renal impairment, lymphoma and malignancies, skin cancer

17

Cyclosporine SE and notes

Hypomagnesemia
Hirutism
Gingival Hyperplasia
Edema

Notes- do not administer in plastic or styrofoam

18

mTOR kinase inhibitors, name them and there MOA

Everolimus (Zostress)*3a4 substrate, inhibit T activation and proliferation

19

mTOR kinase inhibitor SE

Peripheral edema
Hypertension
Do not use within 30 days of transplant if thrombosis occurs

20

Sirolimus (Rapamune) Warning and SE

impaired wound healing, Hyperglycemia

SE- Irreversible pneumonitis, bronchitis, cough, hyperglycemia

21

Siolimus Monitoring and Notes

Tabs and Oral solution are not bioequivalent
Siro and Everlimus are both CYP 3A4 Substrates

22

Belatacept MOA, BW, Warning, notes

moa binds to CD-80/86 and blocks T mediators

BW- increased risk of PTLD, use in EBV seropositive pts only

warning- treat tb prior to use and make sure to test for tb