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Terms in this set (31)
calcineurin inhibitors: cyclosporine, tacrolimus
): azathioprine, mycophenolate
mTOR inhibitors: sirolimus(adjunct), everolimus
steroids: methylpred, prednisone
costimulatory blocker: Belatacept
Which drugs are used for maintenance of immunosuppression/rejection prevention?
Which drugs can be used for both prevention AND treatment of rejection?
inhibits calcineurin to block dephosphorylation of NFAT, which can't get into the nucleus and upregulate IL-2
-blocks Signal 3
What is the mechanism of action of CNIs?
HTN, gingival hyperplasia, hirsutism, hyperlipidemia, hand tremor, hypomagnesemia, hyperkalemia, nephrotoxicity
What are the adverse effects of cyclosporine?
hyperglycemia (new onset DM), nephrotoxicity, seizures, headaches, alopecia, hypomagnesemia, hyperkalemia
What are the adverse effects of tacrolimus?
S-phase to prevent DNA synthesis
Where do the antimetabolites work in the cell cycle?
CYP inducers: phenytoin, phenobarb, rifampin, St. Johns Wort
What drugs can decrease cyclosporine/tacrolimus levels?
CYP inhibitors: erythromycin, clarithromycin, diltiazem, verapamil, azole antifungals, grapefruit juice
What drugs can increase cyclosporine/tacrolimus levels?
What is the target trough for tacrolimus?
Azathioprine and mycophenolate are both category D in pregnancy. Which one is acceptable to use?
Astagraft XL, Envarsus XR
What forms of tacrolimus allow for once daily dosing?
1000mg of Cellcept (mycophenolate mofetil, MMF) is equal to ______ mg of Myfortic (mycophenolate sodium, MPA)
stops progression from G1 to S phase
Which part of the cell cycle do mTOR inhibitors work at?
A sudden increase in SCr, febrile, tenderness above graft, and low drug level would be indicative of ____________ (graft rejection or CNI nephrotoxicity)?
A local infiltrate on biopsy, gradual increase in SCr, normal blood flow on renal scan, and high drug level would be indicative of ________ (graft rejection or CNI nephrotoxicity)?
impaired wound healing
hepatic artery thrombosis (sirolimus)
renal artery thrombosis (everolimus)
What are the adverse effects of mTOR inhibitors?
NO, has to be IgG-positive
(IgM means nothing in relation to this drug)
If a patient was EBV IgM-positive, IgG-negative, would they be able to start belatacept?
anemia, leukopenia, infections (UTI, URI), N/V/D, constipation, peripheral edema, HTN, headache, electrolyte imbalances (K, Ca, Phos)
What are adverse effects of belatacept?
low risk for rejection
When can IL-2 antagonist basiliximab be used for induction therapy?
250-1000 mg methylprednisolone
What dose of steroids is used for both induction and rejection?
Signal 1 & 3
ATGAM and Thymoglobulin block which signal?
POD 0 & 4: 20 mg IV at least 2 hours pre-op
What dose of basiliximab is given and on which days of operation?
Which drug targets the alpha chain (CD25) of the IL-2 receptor to inhibit IL-2 mediated T-cell activation and proliferation?
fever, chills, serum sickness (fever/chills/muscular or articular pain)
- dose reduction in rabbit/Thymoglobulin especially
What are adverse effects of the polyclonal T-cell depleters?
WBC <3000 or platelets 50,000-100,000
-hold dose if counts fall further
What are indications of a 50% dose reduction in the polyclonal T-cell depleters?
Which drug binds to the CD52 receptor on the surface of lymphocytes for rapid and complete T- and B-cell depletion?
infusion-related (cytokine release): rigors, fever
profound bone marrow suppression: anemia, neutropenia
What are the side effects of alemtuzumab?
Induction: 15 mg/kg/day x 14 days
Rejection: 10-15 mg/kg/day x 14 days
What is the dosing in induction and rejection for ATGAM(horse)?
Induction: 1.5 mg/kg/day IV x2-10 doses
Rejection: 1.5 mg/kg/day IV x7-14 days
What is the dosing in induction and rejection for Thymoglobulin(rabbit)?
375 mg per meters squared IV infusion once weekly x2-5 doses
What is the dosing for rituximab in humoral rejection?
Which drugs work on the complement system to treat humoral rejection?
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