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