Therapeutics - Transplant 4

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kyleannkelsey
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300298
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Therapeutics - Transplant 4
Updated:
2015-04-08 18:14:49
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Therapeutics Transplant
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Therapeutics - Transplant
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  1. 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
  2. Why is Azathioprine not used much anymore?
    • BBB – risk of neoplasia
    • SE: hematologic, mutogenic
  3. 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
  4. 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?
    Azathioprine (Imuran)
  5. What DDIs does Azathioprine (Imuran) have?
    Allopurinol (inhibits XO which
  6. What are the AE of Azathioprine (Imuran)?
    • BM suppression (1-2 weeks postop)
    • Hepatotoxicity (rare)
    • Dermatologic (alopecia and photo)
  7. What monitoring should be performed when using Azathioprine (Imuran)?
    WBC <3000 cells/mm3
  8. What drugs cause Alopecia and should not be used together?
    Azathioprine and Tacrolimus
  9. When is Belatacept (Nulojix) used/not used?
    • Used for Kidney transplant
    • Not used for Liver
  10. What are the dosing/admin concerns with Belatacept (Nulojix)?
    Administer with Basiliximab, MMF and Corticosteroids
  11. What is the advantage of Belatacept (Nulojix)?
    No Calcineurin inhibitor is needed
  12. What are the AE of Belatacept (Nulojix)?
    • Anemia
    • UTI
    • Peripheral edema
    • Constipation, N/V
    • Hypercalemia
    • Hyperpyrexia
  13. What are the dosing concerns with Belatacept (Nulojix)?
    • No pregmedication
    • 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
  14. Which Transplant drugs cause Myelosupression?
    • Sirolimus/Everolimus
    • Mycophenolate
    • Azathioprine
  15. Which transplant drugs cause HTN?
    Cyclosporine, Tacrolimus and Corticosteroids
  16. Which Transplant drugs cause HLD?
    Cyclosporine, Tacrolimus, Sirolimus, Everolimus
  17. Which Transplant drugs cause N/V?
    • Mycophenolate
    • Azathioprine
    • Belatacept
  18. Which Transplant drugs cause Hyperglycemia?
    • Cyclosporine, Tacrolimus
    • Corticoseroids
  19. Which Transplant drugs cause OP?
    Corticosteroids
  20. Which Transplant drugs cause Altered mood?
    Corticosteroids
  21. Which Transplant drugs cause Anemia?
    Belatacept
  22. Which Transplant drugs cause Tremors/Parathesias?
    Cyclosporine and Tacrolimus
  23. Which Transplant drugs cause Peripheral edema?
    Belatacept
  24. What drugs are available for Acute rejection?
    • Steroids (Methylpred)
    • RATG
    • Basiliximab
    • Alemtuzumab
  25. 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
  26. What are the major concerns of using immunosuppressants?
    • Infection
    • Vaccination
    • Malignancies
  27. 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
  28. How should you treat BK virus in an immunosuppressed transplant patient?
    Cidofovir
  29. 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
  30. What vaccinations should a patient with a transplant get?
    • Pneumococcal prior to surgery then repeat 5 years later
    • Inactivated influenza
    • HBV? Prior to transplant
    • No live vaccines
  31. 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
  32. How do you treat HTN in patients on CI, Corticosteroids?
    CCBs (Amlodipine)
  33. How do you treat HLD in Transplant patients?
    Statins (caution increased risk of rhabdo and hepatotoxicity in liver treansplant)
  34. What is the brand name for Alemtuzumab?
    Campath
  35. What is the generic name for Campath?
    Alemtuzumab
  36. What is the other name for Thymoglobulin?
    RATG
  37. What is the other name for RATG?
    Thymoglobulin
  38. What is the brand name for Basiliximab?
    Simulect
  39. What is the generic name for Simulect?
    Basiliximab
  40. What are the brand names for Cyclosporine?
    CsA, Sandimmune and Neoral
  41. What is the generic name for Sandimmune and Neoral?
    Cyclosporine, Gengraf
  42. What is the brand name for Tacrolimus?
    • FK-506
    • Prograf
  43. What is the generic name for Prograf?
    Tacrolimus
  44. What is the generic name for FK-506?
    Tacrolimus
  45. What is the brand name for Sirolimus?
    SRL and Rapammune
  46. What is the generic name for Rapammune?
    Sirolimus
  47. What is the brand name for Everolimus?
    Zortress
  48. What is the generic name for Zortress?
    Everolimus
  49. What is the brand name for Azathioprine?
    Imuran
  50. What is the generic name for Imuran?
    Azathioprine
  51. What is the Brand name for Mycophenolate Mofetil?
    MMF, Cellcept and Myfortic
  52. What is the generic name for Cellcept and Myfortic?
    Mycophenolate mofetil
  53. What is the brand name for Belatacept?
    Nulojix
  54. What is the generic name for Nulojix?
    Belatacept

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