Transplant Rejection and Immunosuppressants Flashcards Preview

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Flashcards in Transplant Rejection and Immunosuppressants Deck (28):
1

what kind of HSN (so what is causing) causes hyperacute transplant rejection; timeframe?

Type II (antibody mediated!!)--> preformed anti-donor Abs attack graft vessels = ischemia and necrosis
* w/in minutes

2

what type of HSN causes Acute transplant rejection; timeframe

Type IV--> cytotoxic T cells react against foreign MHC I
*occurs weeks later, usually within 3 mo

3

Cause of chronic transplant rejection; timeframe

Months to years--> MHC I on donor tissues is perceived by host CTL as being a self- MHC I presenting foreign antigen when it isnt = obliterative vascular fibrosis and fibrosis of graft tissue

4

what two things mediate chronic transplant rejection

Abs AND T-cell

5

what type of transplant rejection is irreversible? reversible?

1. Chronic is irreversible
2. Acute is irreversible with immunosuppresants

6

What causes graft vs host dz

Grafted T cells proliferate in the host and start reacting against all tissues (since it recognizes everything in host as foreign) --> severe organ dysfunction

T-cells causing, so is a Type IV hsn rxn

7

what two transplant can lead to GVH dz

1. Bone marrow transplant
2. Liver transplant

*both organs rich in lymphocytes

8

4 symptoms of GVH

1. maculopapular rash (neck, shoulders, ears, palms)
2. Hepatosplenomegaly
3. hemolysis/ jaundice
4. G.I. sx (N/V abdominal pain, diarrhea)

9

binds to cyclophilin and inhibits calcineurin

Cyclosporine

10

AE of cyclosporine

1. nephrotoxicity --> due to vasoconstriction of afferent and efferent arterioles in kidney; this also leads to HTN

11

binds to FK-binding protein to inhibit calcineurin

Tacrolimus (FK-506)

12

AE of tacrolimus

like cyclosporine, can cause nephrotoxicity and HTN

13

what other two AEs do tacrolimus and cyclosporine share

1. gingival hyperplasia
2. hirsutism

14

function of calcinuerin, why is blocking it helpful

transcription factor for IL-2--> no IL-2 = impaired T-cell proliferation and differentiation

15

binds FKBP-12 and inhibits mTOR

Sirolimus (rapamycin)

16

prodrug for 6-mercaptopurine

Azathioprine

17

interferes with metabolism and synthesis of nucleic acids

Azathioprine

18

must be avoided when taking allopurinol

Azathioprine (6-mercapturine is metabolized by xanthine oxidase, so inhibiting with allopurinol is a dumb idea)

19

AE of azathiprine

Bone marrow suppression--> esp when taking allopurinol at some time

20

inhibits IMP-dehydrogenase--> preventing synthesis of guanine

Mycophenolate

21

binds to CD25 (IL-2 receptor)

Daclizumab

22

interferes with TNF-alpha

Thalidomide

23

3 drugs used for lupus nephritis (2 are of label, so mainly know on-label one)

1. Azathioprine
2. Cyclosporine
3. Mycophenolate

24

TNF-alpha mabs (2) used mainly for seronegative spondyloarthropathies and sometime for RA

1. inflixumab
2. adalibumab

25

mAb against glycoprotein IIb/IIIa

Abcixumab--> used to prevent cardiac ishemia in unstable angina (prevents platelet interactions)

26

mAb against HER2 used in HER2+ breast CA

Trastuzumab

27

mAb against CD20, used for B-cell non-Hodgkins

Rituxumab

28

mAb to IgE

Omalizumab

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