Transplant/intro/induction/depleting Ab

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After the introduction of these drugs, rejection rate decrease and survival rate increased

Cyclosporine
Tacrolimus
MMF
Thymoglobulins
Sirolimus

In what time frame do we use LARGE doses of immunosuppressant drugs in early transplant period

From day they get new organ to 6 months

Immunosuppressive therapy is required for how long after transplant

indefinitely

Do we use a multi drug regimen after transplant?

yes, usually 2-3 drugs used

When does patient receive the first dose of immunosuppressant?

Before the surgery

What is the Induction IST: goals and target?

What are the guidelines for choosing IST

There are none. Based on local research results

How many classes of drugs are available for tx?

5 classes

What are the drug classes for tx?

What is the purpose of induction therapy?

What type of cells re depleted in the induction therapy

T cells

What are the significant SE from induction therapy

What two types of drugs do we use in Induction Therapy

Polyclonal and Monoclonal Abs

Which of the two classes of drugs used in induction tx are non specific and deplete all T-cells

Polyclonal Antibodies

what are the two sources of ATG?

What is ATG used for?

Induction

Rejection

What is the MOA of ATG?

What are some early stage adverse effects for ATG?

What are some delayed AE for ATG?

What meds to give for the hypersensitivity of ATG early phase AE?

Acetaminophen
benadryl:20-50mg
solu-medrol

What was the first Monoclonal Ab Used?

Muromonab CD3 (OKT3)

Which Ab binds to the CD3 antigen and forms complex with the T-call receptor (TCR)?

OKT3-Muromonab CD3

What can OKT3 be used for?

Which Ab is completely from a mouse source?

OKT3-Muromonab CD3

What is the big problem that we have with OKT3 and reason why we don't use as often?

Cytokine Release Syndrome

Which monoclonal Ab is no longer in the market?

Daclizumab (Zenapax)

What is the source of Basiliximab?

Chimeric

Which monoclonal Ab is an Interleukin 2 receptor antagonist and acts as a competitive inhibitor to the receptor?

Basiliximab

Which Mon. Ab don't affect quiescent T cells

Basiliximab

Which Mon. Ab is used only for induction in low risk patients?

Basiliximab

What is the dose of Basiliximab?

Does Basiliximab need dose adjustment for gender or renal impairment?

What are some AE of Basiliximab?

Less AE than OKT3

What are the Induction doses and duration for ATG?

10-20 mg/kg for 7-14 days

WHat is the induction dose and duration for Thymoglobulin?

1.5 mg/kg for 7-14 days

What is the induction dose and duration for OKT3?

5 mg for 7-14 days

What is the induction dose for Basiliximab and the duration?

20 mg on Day1 and Day4

When do we use IL2 receptor antagonists?

In INDUCTION tx

Is IL2 receptor antagonists better tolerated than ATGs?

Yes

Which drug class can be safely used with a low initial doses of cyclosporine?

IL2 receptor antagonists

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