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62 Cards in this Set
- Front
- Back
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Risk factors for acute rejection after transplant |
1. increased HLA mismatch 2. factors affecting previous sensitization 3. ethnicity 4. age 5. donor source 6. prolonged preservation time 7. noncompliance |
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Induction phase |
**early phase intended to provide highly potent, multifocal suppression of hte immune system for several days to a few weeks 1. steroids 2. monoclonal antibodies 3. polyclonal antibody |
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Maintenance Phase |
**immunosuppression regimen designed to provide chronic, balanced immunodeficiency |
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Types of medications used in Solid Organ Transplant |
1. Calcineurin inhibitors 2. Steroids 3. Antimetabolites 4. mTOR inhibitor |
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Calcineurin Inhibitors |
1. Cyclosporine (Sandimmune, Neoral) 2. Tacrolimus (Prograf) |
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Cyclosporine |
MOA: inhibits calcineurin-dependent translocation of the cytosolic subunit of NFAT - inhibits IL-2 mediated monoclonal T-cell proliferation ADRs: seizures, hallicinations, insomnia, gingival hyperplasia, HTN, hepatotoxicity, Nephrotoxcity |
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Tacrolimus |
MOA: inhibits translocation of the cytocolic subunit of NFAT - inhibits IL-2 mediated monoclonal T-cell proliferation ADRs: seizures, hallucinations, insomnia, alopecia, HTN, QT prolongation, hetapo & nephro toxicity, anemia |
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mTOR inhibitors |
1. Sirolimus (Rapamune) 2. Everolimus (Zortress) |
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MOA of mTOR inhibitors |
bind to FKBP-12 to form a complex that binds and inhibits activation of its target protein that is critical in IL-2 mediated cell-cycle progression |
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Everolimus
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ADRs: fatigue, headache, oral ulcers, nephrotoxicity (with calcineurin inhibitors), HTN, anorexia, N/D, rash, acne, anemia |
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Sirolimus |
ADRs: anorexia, oral ulcers, diarrhea, esophagitis, gastritis, nephrotoxicity (with calcineurin inhibitors), HTN, rash, acne, arthralgias |
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Selective T-cell co-stimulation Blocker |
Belatacept |
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Belatacept |
MOA: binds to co-stimulation proteins CD80 & CD86 on the APC, to prevent binding to hte T-cell proteins ADRs: headache, insomnia, anxiety, HTN, N/V/D, anemia, hematuria, proteinuria,acne, UTI |
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Antiproliferative Agents fOR SOT |
1. Azathioprine 2. Mycophenolate mofetil 3. Mycophenolate sodium |
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Azathioprine |
MOA: purine analogue pro-drug; can be incorporated directly into DNA as thiopurine as well as interfere with RNA and DNA synthesis ADRs: retinopathy, N/V/D, pancreatitis, rash, skin cancer, leukopenia |
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Mycophenolate |
MOA: noncompetitive, reversible inhibition of inosine monophosphate dehydrogenase - inhibits purine synthesis ADRs: N/V/D, ab pain, leukopenia, anemia |
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Corticosteroids |
MOA: bind to glucocorticoid receptors where the complexes bind to regulatory DNA sequences ADRs: delirium, mood swings, insomnia, glaucoma, HTN, increased appetite, PUD, edema, HLD, hirsutism, impaired wound healing, arthralgia, myopathy |
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Basiliximab |
*monoclonal antibody* MOA: monoclonal IgG specifically binds to CD25 - competitively inhibits IL-2 and facilitates preferential ilimination of activated lymphocytes ADRs: severe acute hypersensitivity reactions |
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Antithymocyte globulin (Equine & Rabbit) |
*polyclonal antibody* MOA: includes IgG directed against multiple surface markers - targets multiple phases of immunity ADR: infusion related (fever, chills, dyspnea), rash, leukopenia |
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Peptic Ulcer Disease |
group of disorders of hte upper GI tract characterized by ulcerative lesions that depend on acid and pepsin for their formation |
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Clinical presentation of PUD |
epigastric pain 1-3 hours after meals relieved by ingestion of food or antacids |
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PPIs |
MOA: suppress gastric acid secretion specifically by inhibiting the H+-K+-ATPase enzyme system on the surface of gastric parietal cells ADRs: increased risk of CDAD, increased risk of osteoporosis-related fractures, lower Mg levels chronically, headache, diarrhea, nausea **take 30-60 minutes before first meal of day** |
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MOA of H2RAs |
suppress gastric acid secretion by reversibly blocking histamine-2 receptors on the surface of the gastric parietal cell ADRs: headache, diarrhea, nausea **take antacids 1-2 hours before or after** |
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Sucralfate |
MOA: when exposed to gastric acid, forms a viscous adhesive that binds positively charged protein molecules in the ulcer crater forming a protective barrier ADRs: constipation **take 1 hour before meals and at bedtime** |
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Misoprostol |
MOA: synthetic prostaglandin E1 analog that moderately inhibits acid secretion and enhances gastric mucosal defense ADRs: diarrhea, ab cramping, nausea, flatulence, headache **Take with or after meals and at bedtime** |
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Treatment of PUD |
1. PPI/H2RA 2. Sucralfate 3. Misoprostol 4. Antibiotic (H. pylori) |
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Typical Reflux Syndrome |
presence of troublesome heartburn, regurgitation, or both may have epigastric pain, sleep problems |
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Reflux Chest Pain Syndrome |
GERD causes chest pain that is similar to ischemic cardiac pain |
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Reflux esophagitis |
visible breaks in the distal esophageal mucosa |
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Reflux Stricture |
persistent luminal narrowing of hte esophagus caused by GERD |
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Barrett's Esophagus |
esophageal squamous epithelium from the gastroesophageal junction is replaced with metaplastic columnar epithelium |
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Proton Pump Inhibitors |
1. Omeprazole (Prilosec) 20-40mg qd 2. Esomeprazole (Nexium) 20-40mg qd 3. Lansoprazole (Prevacid) 15-30mg BID 4. Dexlansoprazole (Dexilant) 30-60mg qd 5. Rabeprazole (Aciphex) 10-20mg qd 6. Pantoprazole (Protonix) 40-80mg qd |
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Histamine-2 Receptor Antagonists (H2RAs) |
1. Cimetidine (Tagamet) 2. Randitidine (Zantac) 3. Nizatadine (Axid) 4. Famotidine (Pepcid) |
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Antibacterials for H. pylori |
1. Clarithromycin (Biaxin) 2. Amoxicillin (Amoxil) 3. Metronidazole (Flagyl) 4. Tetracycline |
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Antacids and Absorbents |
1. Magnesium hydroxide (Milk of magnesia) 2. Aluminum hydroxide (ALternaGEL) 3. Aluminum carbonate (Basaljel) 4. Mag hydroxide + Aluminum hydrox (Maalox) 5. Magaldrate (Riopan) 6. Calcium Carbonate (Tums) 7. Sodium bicarbonate 8. Alginic acid + aluminum hyrox + Mag hydrox (Gaviscon) |
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Antacids |
MOA: neutralize gastric acid and inhibit the conversion of pepsinogen to pepsin, thus raising the pH of gastric contents ADRs: Mag - diarrhea; Alu - constipation |
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Ulcerative Colitis |
chronic mucosal inflammatory condition confined to the rectum and colon S/Sx: bloody diarrhea, rectal urgency, tenesmus |
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Crohn's Disease |
a transmural inflammation of hte GI tract that can affect any part of hte GI tract from mouth to anus S/Sx: chronic or nocturnal diarrhea, abdominal pain, weight loss, fever, rectal bleeding, pallor |
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Treatment of mild to moderate distal colitis |
1. oral aminosalicylates 2. topical mesalamine 3. topical steroids |
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Treatment of mild to moderate extensive ulcerative colitis |
1. aminosalicylates 2. oral steroids 3. thiopurines 4. infliximab |
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Treatment of Severe colitis |
1. infliximab & hospitalization 2. IV steroids 3. IV cyclosporine 4. thiopurines |
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Treatment of mild to moderate Crohn's localized to ileum or right colon |
1. controlled-release oral budesonide 2. oral mesalmine 3. oral sulfasalazine 4. rectal aminosalicylates |
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Treament of moderate to severe Crohn's disease |
1. Oral steroids 2. Azathioprine and 6-mercaptopurine 3. parenteral methotrexate 4. infliximab, adalimumab, certolizumab |
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Treatment of severe to fulminant Crohn's disease |
1. IV steroids & hydration 2. high dose flagyl or cipro 3. azathioprine, 6-mercaptopurine, infliximab |
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mesalamine |
MOA: inhibits COX and may also inhibit production of COX, thromboxane synthetase, platelet-activating factor synthetase, and IL-1 in macrophages ADRs: better tolerated than sulfasalazine (nausea, headaches) |
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infliximab, adalimumab |
MOA: chimeric monoclonal antibody that inhibits human TNF which inhibits subsequent cytokine-triggered inflammatory processes ADRs: infusion-related/injection site reactions, URIs, headache, rash, cough, nausea |
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certolizumab |
MOA: pegylated humanized antibody Fab fragment of TNF monoclonal antibody - inhibits TNF which inhibits cytokine inflammatory processes ADRs: injection-site reaction, URI, rash, UTI |
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Sulfasalazine |
MOA: cleaved by bacteria in the gut to form mesalamine ADRs: nausea, vomiting, anorexia, headache IRXN: digoxin |
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Immunosuppressant agents for ulcerative colitis and Crohn's |
1. corticosteroids 2. azathioprine 3. 6-mercaptopurine 4. cyclosporine 5. tacrolimus |
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Irritable Bowel Syndrome |
abdominal pain or discomfort that occurs in association with altered bowel habits over a period of 3 months S/Sx: crampy/achy ab pain, diarrhea, constipation, heartburn, dyspepsia, nausea |
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Aminosalicylates for Ulcerative Colitis & Crohn's |
1. Sulfasalazine (Azulfidine) 2. Mesalamine (Asacol, Pentasa, Lialda, Canasa) 3. Balsalazide (Colazal) |
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Immunomodulators used in UC & Crohns |
1. infliximab (Remicade) 2. adalimumab (Humira) 3. Cerolizumab pegol (Cimzia) 4. Natalizumab (Tysabri) |
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Antispasmodic/anticholinergics used in IBS1 |
1. dicyclomine (bentyl)
2. hyoscyamine |
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Dicyclomine (Bentyl |
MOA: decreases GI motility by relaxing smooth muscle in the gut ADRs: CNS depression, dry mouth, urinary retention, constipation, decreased sweating |
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Hyoscyamine |
MOA: anticholinergic agent that decreases GI motility by decreasing smooth muscle tone through antimuscarinic activity in the gut ADRs: CNS depression, dry mouth, urinary retention, constipation, decreased sweating |
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Amitriptyline (Elavil) |
MOA: TCA, delays intestinal transit and may blunt perception of visceral distension ADRs: CNS depression, dry mouth, urinary retention, constipation, decreased sweating |
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Tegaserod (Zelnorm) |
MOA: partial 5-HT4 agonist that stimulates the peristaltic reflex and intestinal secretion, inhibits visceral sensitivity by binding to receptors in the gut ADRs: diarrhea, nausea, headache, abdominal pain, increased risk of CV events |
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Loperamide (Imodium) |
MOA: inhibits peristalsis by directly affecting the circular and longitudinal muscles of the intestinal wall |
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Diphenoxylate (Lomotil) |
MOA: a meperidine congener that directly affects the circular smooth muscle in the gut slowing GI transit time |
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Alosetron (Lotrenox) |
MOA: selective 5-HT3 antagonist that inhibits activation of nonselective cation channels in hte gut ADRs: constipation, ab pain, nausea (obstruction, perforation, toxic megacolon, ischemic colitis, death have occured) |
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Lubiprostone (Amitiza) |
MOA: C-2 chloride channel activator that increases secretion of saltwater into the intestinal lumen ADRs: nausea, diarrhea, headache **approved ONLY FOR women with constipation-dependent IBS** |
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Linaclotide (Linzess) |
MOA: guanylate cyclase-C agonist which increases intra- and extracellular levels of cGMP. this stimulates the secretion of chloride and bicarb in the lumen increasing the transit time ADRs: diarrhea, ab pain, flatulence, URI, ab distention, sinusitis |
