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46 Cards in this Set

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Which drugs are calcineurin inhibitors?
cyclosporine
tacrolimus
Which drugs are anti-metabolites?
azathioprine
mycophenolate
Which drugs categories are combined in typical triple immunosuppression therapy for transplant?
calcineurin
anti-metabolite
prednisone
What is the general MOA of calcineurin inhibitors?
decreases circulating B and T calls by decreasing IL-2 secretion (which primes the B and T cells to proliferate)
What is azathioprine often used for besides prevention of kidney rejection?
Active Rheumatoid
What parameters must be monitored with azathioprine?
CBC
LFTs
With which drug might you do TPMT genotyping or phenotyping?
azathioprine
thiopurine methytransferase genotyping or phenotyping?
What 4 main drugs does azathioprine interact with?
ACEs
Allopurinol
Aminosalicylates
Warfarin
Name 2 aminosalicylates
mesalamine
sulfasalazine
what might happen when azathioprine and ACEIs are taken concomitantly?
may induce anemia and severe leukopenia (Myelosuppression)
Why should you avoid giving azathioprine with allopurinol?
allopurinol slows elimination of 6-MP by inhibiting xanthine oxidase
What can happen when aminosalicylates are taken with azathioprine?
may increase toxicity/myelosuppression b/c they need the same enzyme (TPMT) to be broken down)
What will azathioprine do to warfarin?
will dec warfarin
What are the ADRs of azathioprine?
myelosuppression
hepatotoxicity
infection
malignancy
N/V/anorexia
What are the two most common malignancies that renal transplant patients are at increased risk for?
SCC of the skin
non hodgkins lymphoma
How does mycophenolate work?
just like azathioprine but mostly inhibits T cell proliferation
What needs to be monitored when pt is on mycophenolate?
CBC
With which drug do you need to monitor LFTs, azathioprine or mycophenolate?
azathioprine
What drugs interfere with mycophenolate?
Iron
antacids
cholestyramine
(the above will dec absorption)
azathioprine and mycophenolate have overlapping toxicity
What are the ADRs of mycophenolate?
N/V/D/abd cramping
myelosuppression
infections
lymphoid tumors
What infections are common when taking mycophenolate or azathioprine?
viral - CMV and zoster
What is the MOA of cyclosporine?
decreases production/release of interleukin-2 -> less activation of T-lymphocytes
Are the two formulations of cyclosporine interchangeable? (Neoral and Sandimmune)
NO!!
What is cyclosporine used for besides transplants?
refractory RA or psoriasis
Opthalmic emulsion
graft-versus-host-disease
What needs to be monitored when a patient is taking cyclosporine?
trough levels
BMP (glucose!)
LFTs
blood pressure
lipids
What are the cytochrome interactions of cyclosporine?
3A4 substrate and inhibitor
What drugs increase concentration of cyclosporine?
itra/ketoconazole
clarithro/erythromycin
cimetidine
grapefruit juice
diltiazem, verapamil
nicardipine
fluconazole
rabeprazole/lansoprazole
methylprednisone
allopurinol
metoclopramide
colchicine
amiodarone
What drugs decrease cyclosporine levels?
rifampin
carbamazepine
phenobarbital
phenytoin
St john's wort
nafcillin
What are the ADRs of cyclosporine?
nephrotoxicity
HTN
neurotoxicity
metabolic abnormalities
infections
malignancy
What is the most common and clinically significant ADR?
nephrotoxicity
What drug will you often have to switch to if a pt develops azotemia on cyclosporine?
tacrolimus
Why does cyclosporine cause HTN?
renal vasoconstriction and Na retention - may require antihypertensives
What is the antihypertensive of choice to treat hypertension from cyclosporine?
diltiazem (CCB)
What transplant drug may cause symptoms similar to hypertensive encephalopathy?
cyclosporine
Which transplant drugs can cause PTDM?
cyclosporine
tacrolimus
sirolimus
What tranpslant drug causes gingival hyperplasia and hirsuitism?
cyclosporine
What is FK506?
tacrolimus
What immunosuppressant is sometimes used in topical form for severe atopic dermatitis?
tacrolimus
With which transplant drugs must you monitor bp?
tacrolimus
cyclosporine
sirolimus
Which transplant drugs are 3A4 substrates?
cyclosporine
tacrolimus
sirolimus
Which transplant drug most frequently induces PTDM?
tacrolimus
What are the ADRs of tacrolimus?
nephrotoxicity
More than cyclosporine. . .
tremor and HA
PTDM
alopecia
diarrhea, dyspepsia
Which ADRs are lessened with tacrolimus compared to cyclosporine?
hirsutism
gingival hyperplasia
hypertension
Which transplant drug may be used to coat stents? (NOT a calcineurin inhibitor)
sirolimus
What needs to be monitored when a patient is on sirolimus?
drug level in certain pts
lipids
bp
BMP
(same as tacrolimus)
Which pts need sirolimus levels monitored?
peds
hepatic impairment
those on inhibitors or inducers