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Organ Transplant

Drugs used in Solid Organ Transplant

QuestionAnswer
Bacterial Infections - organisms Tuberculosis, Nocardiasis
Fungal Infections Aspergilosis, Blastomycosis, Candidiasis, Cocciodiomycosis, Histoplasmosis, Mucomycosis, PCP
Parasitic Toxoplasmosis
Viral CMV, Epstein-Barrm Herpes SV, Varicella-Zoster virus, Human herpes virus, Parvovirus, Polyomavirus
Cyclosporine Sandimmune, Neoral; Calcineurin Inhibitor
Cyclosporine MOA IL-2 inhibitor
Cyclosporine DDIs metabolized by 3A enzymes; Statins, Sirolimus, Mycophenolate
Cyclosporine Drug-Dz interactions DM, altered bilary flow, live vaccines
Cyclosporine ADRs seizure, hallucinations, insomnia, tremor, paresthesias, gingival hyperplasia, HTN, hepatotoxicity, nephrotoxicity, DM, HLP, hyperuricemia, hyperkalemia, hypomag, hirsuitism, hypertrichosis, acne
Cyclosporine monitoring trough, concentration at two hours
Cyclosporine PK highly protein bound
3A4 inducers phenytoin, phenobarb, rifampin, CBZ, rifabutin, Nevirapine, Efavirenz, St. John's wort
3A4 inhibitors nefazodone, delavirdine, indinavir, nelfinavir, ritonavir, saquinavir, azoles, diltiazem, verapamil, nicardipine, macrolides, GFJ
Tacrolimus Prograf; calcineurin inhibitor
Tacrolimus MOA IL-2 inhibitor
Tacrolimus DDI metabolized by 3A4 isoenzymes
Tacrolimus Drug-dz interactions DM, live vaccines
Tacrolimus ADRs seizures, hallucinations, insomnia, tremor, depression, psychosis, anorexia, alopecia, HTN, hepatotoxicity, nephrotoxicity, DM, HLP, Hyperkalemia, hypomag, hypercalcemia, hypophosphatemia, anemia
Tacrolimus monitoring trough (5-20)
Tacrolimus PK highly protein bound
Sirolimus Rapamune; mTOR inhibitor
Sirolimus DDI 3A isoenzymes; cyclosporine
Sirolimus Drug-Dz interactions liver transplantation, lung transplantation, live vaccines
Sirolimus ADRs anorexia, oral ulcers, diarrhea, esophagitis, gastritis, hepatotox, hepatic artery thrombosis, synergistic nephrotoxicity with calcineurin inhibitors, HLP, HTN, hyperkalemia, rash, acnem leukopenia, thrombocytopenia, pancytopoenia, thormbosis, pneumonitis
Sirolimus monitoring trough (5-20)
Azathioprine antiproliferative agent; prodrug to mercaptopurine; interferes with DNA and RNA synthesis
Azathioprine DDI Allopurinol; reduce Azath dose by 65-75%
Azathioprine Drug-Dz interactions renal insufficiency, live vaccines
Azathioprine ADRs retinopathy, N/V, diarrhea, anorexia, pancreatitis, hepatotoxicity, rash, skin cancer, leukopenia, thrombocytopenia, pancytopenia
Mycophenolate Mofetil antiproliferative agent
Mycophenolate mofetil DDI cycloprine, cholestyramine, colestipol, coleveselam, antacids, OC
MYco mofetil Drug-Dz interactions renal impairment, live vaccines
Myco Mofetil ADRs N/V, diarrhea, abdominal pain, leukopenia, thrombocytopenia, anemia, pancytopenia
Leflunomide DDI cholestyramine
LEflunomide Drug Dz interactions renal impairment; live vaccines
Leflunomide ADRs HA, dizziness, neuralgia, neuritis, alopecia, N/V, diarrhea, anorexia, gastroenteritis, esophagitis, colitis, DM, HLP, Hyperthyroidism
Orthoclone OKT3 MOA IgG that binds and facilitates removal of CD3
Orthoclone administration premed with IV steroids, APAP, and antihistamine one hour prior to first dose; check volume status
Orthoclone Drug-Dz interactions uncompensated CHF/volume overload; risk of pulmonary edema; live vaccine
ORthoclone ADRs dizziness, headache, photophobia, tachycardia, transient lymphophenia, pancytopenia, rigor, tremor, fever, chills, dyspnea, pulmonary edema
Orthoclone monitoring CD3<25
Basilixumab MOA chimeric monoclonal IgG that binds to CD25 and inhibits IL-2
Basilixumab ADR severe hypersensitivity
Antithymocyte Globulin (equine) polyclonal Ab; IgG
Antithymocyte Admin premedicate with IV steroids, APAP, and antihistamines
Antithymocyte ADRs infusion related reactions, leukopenia, thrombocytopenia, rash
antithymocyte monitoring CD2<50
antithymocyte globlin (rabbit) DDI immunoglobulins
Azathioprine brand Imuran
Mycophenolate Mofetil Brand Cellcept
Mycophenolate Sodium Brand Myofortic
Leflunomide Brand Arava
Basilixumab Brand Simulect
Daclizumab brand Zenapax
Antithymocyte globulin (equine) brand Atgam
Antithymocyte (rabbit) brand Thyroglobulin
Created by: cytoskeletor
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