Therapeutics - Transplant 4
Card Set Information
Therapeutics - Transplant 4
Therapeutics - Transplant
What are the AE for Mycophenolate (MMF)?
GI (D/V) – divide dose to reduce
PML – BBB (S/s = muscle control issues, one-sided weakness, apathy and confusion)
Hematological = Neutropentia, Thrombo, anemia
Teratogenicity = D
Why is Azathioprine not used much anymore?
BBB – risk of neoplasia
: hematologic, mutogenic
What is the MOA of Azathioprine (Imuran)?
Inhibits cell division
Converted to 6-mercaptopurine
Interferes w/ RNA and DNA synthesis
Non-specific = inhibition of B and T cells
What drug needs a dose reduction if genotyping indicated that the patient has a mutation in TPMT that breaks down 6-MP and causes toxicities?
What DDIs does Azathioprine (Imuran) have?
Allopurinol (inhibits XO which
What are the AE of Azathioprine (Imuran)?
BM suppression (1-2 weeks postop)
Dermatologic (alopecia and photo)
What monitoring should be performed when using Azathioprine (Imuran)?
WBC <3000 cells/mm3
What drugs cause Alopecia and should not be used together?
Azathioprine and Tacrolimus
When is Belatacept (Nulojix) used/not used?
Used for Kidney transplant
Not used for Liver
What are the dosing/admin concerns with Belatacept (Nulojix)?
Administer with Basiliximab, MMF and Corticosteroids
What is the advantage of Belatacept (Nulojix)?
No Calcineurin inhibitor is needed
What are the AE of Belatacept (Nulojix)?
What are the dosing concerns with Belatacept (Nulojix)?
10 mg/kg IV day of transplant, Day 5, end of weeks 2, 4, 8 and 12
5 mg/kg IV maintenance end of week 16, then Q4W
Must use corticosteroids at 15 mg until week 6
Expensive = requires infusion center
Which Transplant drugs cause Myelosupression?
Which transplant drugs cause HTN?
Cyclosporine, Tacrolimus and Corticosteroids
Which Transplant drugs cause HLD?
Cyclosporine, Tacrolimus, Sirolimus, Everolimus
Which Transplant drugs cause N/V?
Which Transplant drugs cause Hyperglycemia?
Which Transplant drugs cause OP?
Which Transplant drugs cause Altered mood?
Which Transplant drugs cause Anemia?
Which Transplant drugs cause Tremors/Parathesias?
Cyclosporine and Tacrolimus
Which Transplant drugs cause Peripheral edema?
What drugs are available for Acute rejection?
What is the dose of Methylpred for acute graft rejection?
1 g IV QD x 3-5 days, taper back to maintenance dose over several weeks
What are the major concerns of using immunosuppressants?
How should you treat a CMV infection in an immunosuppressed transplant patient?
Prophylax w/ Valgancyclovir 1st year
Acyclovir can be used in low risk patients
How should you treat BK virus in an immunosuppressed transplant patient?
How should you treat PCP (PJP) infection in an immunosuppressed transplant patient?
Bactrim, low dose (2-3 x a week)
Sulfa allergy = Dapsone
6-12 months post transplant
What vaccinations should a patient with a transplant get?
Pneumococcal prior to surgery then repeat 5 years later
HBV? Prior to transplant
No live vaccines
When should fungal prophylaxis be given to transplant patients?
Only for high risk (Prolonged ICU stay, Large Blood transfusion, Broad spectrum ABX use, known colonization) – usually lung transplant, also heart
How do you treat HTN in patients on CI, Corticosteroids?
How do you treat HLD in Transplant patients?
Statins (caution increased risk of rhabdo and hepatotoxicity in liver treansplant)
What is the brand name for Alemtuzumab?
What is the generic name for Campath?
What is the other name for Thymoglobulin?
What is the other name for RATG?
What is the brand name for Basiliximab?
What is the generic name for Simulect?
What are the brand names for Cyclosporine?
CsA, Sandimmune and Neoral
What is the generic name for Sandimmune and Neoral?
What is the brand name for Tacrolimus?
What is the generic name for Prograf?
What is the generic name for FK-506?
What is the brand name for Sirolimus?
SRL and Rapammune
What is the generic name for Rapammune?
What is the brand name for Everolimus?
What is the generic name for Zortress?
What is the brand name for Azathioprine?
What is the generic name for Imuran?
What is the Brand name for Mycophenolate Mofetil?
MMF, Cellcept and Myfortic
What is the generic name for Cellcept and Myfortic?
What is the brand name for Belatacept?
What is the generic name for Nulojix?