Therapeutics - Transplant 1

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Author:
kyleannkelsey
ID:
300295
Filename:
Therapeutics - Transplant 1
Updated:
2015-04-08 18:14:13
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Therapeutics Transplant
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Therapeutics - Transplant
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  1. When is induction therapy started?
    Day of surgery or first few days after surgery
  2. What drug classes are given during induction therapy?
    Antibody agents and Corticosteroids
  3. When is maintenance therapy started?
    Day of surgery and continued indefinitely
  4. What drugs are given during maintenance therapy?
    Calcineurin inhibitors, Mamilian target of rapamycin inhibitors, corticosteroids, antimetabolites
  5. When is acute rejection therapy started?
    Anytime acute rejection occurs, usually in the first few months to 1 year
  6. What drugs are given for acute rejection therapy?
    • Antibody agents
    • Corticosteroids
  7. What types of antibody agents exist?
    Depleting and Non-depleting
  8. What are the depleting antibody agents (aka anti-thymocyte globulin)?
    • Polyclonal antibodies: ATGAM (horse derived) and Thymoglobulin (RATG – rabbit – less immunogentic than ATGAM)
    • Monoclonal antibodies: Alemtuzumab (Campath)
  9. What are the Non-depleting antibody agents?
    Basiliximab (Simulect)
  10. What is the MOA of Alemtuzumab?
    • Antagonist of CD52
    • CD52 expressed on T and B-cells
    • Once alemtuzumab binds, causes cell death
  11. What is the MOA of Basiliximab (Simulect)?
    • Interleukin 2 receptor antagonist
    • Prevents activation of T-cells WITHOUT CAUSING CELL DEATH
    • Saturation of IL-2 receptors is fast and so immunosuppression is immediate.
  12. What is the mechanism of action of Anti-Thymocyte globulins/Depleting antibody agents, ATGAM and Thymoglobulin?
    • Action against lymphocytes T-cells (CD4 & CD8) and B-cells
    • Coated lymphocytes removed from circulation by liver or spleen or undergo apoptosis
  13. What drug requires premedication and why?
    • Anti-Thymocyte globulins/Depleting antibody agents, ATGAM and Thymoglobulin
    • Why: cause cells to undergo apoptosis
  14. How long does it take for a patient to regenerate total lymphocyte count after taking Anti-Thymocyte globulins/Depleting antibody agents, ATGAM and Thymoglobulin?
    2-6 months
  15. A single dose of Anti-Thymocyte globulins/Depleting antibody agents, ATGAM and Thymoglobulin causes lymphocytes to drop how much?
    80%
  16. What should you use to premedicate Anti-Thymocyte globulins/Depleting antibody agents, ATGAM and Thymoglobulin?
    • Corticosteroids
    • APAP
    • Diphenhydramine
  17. Dosing and Administration for Anti-Thymocyte globulins/Depeling antibody agents, Thymoglobulin:
    • Induction – IV 1-1.5 mg/kg, Start 1st dose preop or intraop then repeat days 1-4 post op
    • Round to nearest 25mg due to vial size – b/c so expensive
    • Requires a 0.22 micron filter at admin
  18. How can you determine if Thymoglobulin is working?
    • Graft is functioning
    • CD3 counts are less than 10 cells/mm3
  19. What are the AE for Thymoglobulin?
    • Leukopenia 30% (May hold therapy when WBC < 3000 cells )
    • Thrombocytopenia 30% (Decrease dose by 50% if platelets <100,000)
    • Others: fever, chills, arthralgia, malaise, tachycardia – caused by cytokine release
  20. What are the administration/dosing concerns for Alemtuzumab (Campath)?
    • 30 mg SUBCUTANEOUSLY pre-operatively – SQ decreases HYPOtensive effects over IV
    • Premediate w/ steroids, APAP and diphenhydramine
  21. What are the AE of Alemtuzumab (Campath)?
    Fever, Chills, Arthalgia and Hypotension
  22. What is the DOA of Basiliximab?
    6-12 weeks
  23. What is the dosing/administration concerns for Basiliximab (Simulect)?
    • 20 mg IV 2 hours prior to surgery
    • 20 mg IV 4 days after transplant
  24. What Antibody agent does not require premedication, as it does not cause cell death and subsequent cytokine release?
    Basiliximab (Simulect)
  25. What is a normal steroid regimen for maintenance therapy in Transplant?
    Methylprednisolone 3 mg/kg IV pre-op
  26. What antibiotic would you use to prophylax in Liver Tranplant?
    • Unasyn
    • If beta-lactam allergy, Clindamycin or Vancomycin + Aztreonam
  27. What antibiotic would you use to prophylax in Liver/Small Bowel Tranplant?
    • Zosyn post op
    • If beta-lactam allergy, Clindamycin or Vancomycin + Aztreonam
  28. What antibiotic would you use to prophylax in Kidney OR Heart Tranplant?
    • Cefazolin post op
    • If beta-lactam allergy, Clindamycin or Vancomycin + Aztreonam
  29. What antibiotic would you use to prophylax in Kidney/Pancreas Tranplant?
    • Cefoxitin post op
    • If beta-lactam allergy, Clindamycin or Vancomycin + Aztreonam
  30. What is the anticoagulation for surgical prophylaxis used in transplant?
    • Heparin 5,000 Units x1 SUBQ pre-op, then Q8H
    • Lovenox 40mg SUBQ x1 preop, then QD
  31. What are the Calcineurtin inhibitors?
    • Cyclosporine A (CSA, Sandimmune, Neoral)
    • Tacrolimus (FK-506, Prograf)
  32. What is the mTOR inhibitor?
    • Sirolimus (SRL, Rapammune)
    • Everolimus (Zortress)
  33. What are the Maintenance Immunosuppressive agents?
    • Calcineurin Inhibitors: Cyclosporin and Tacrolimus
    • mTOR Inhibitors: Sirolimus and Everolimus
    • Corticosteroids: Prednisone, Prednisolone and Methylprednisolone
    • Antimetabolites/Antiproliferatives: Azathioprine and Mycophenolate Mofetil
  34. Which versions of Cyclosporine are interchangeable?
    Neoral and Gengraf
  35. Which versions of Cyclosporine are NOT interchangeable?
    Sandimmune and Neoral

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