Antilymphocyte monoclonal antibodies - ANSWERSAlemtuzamab(Campath1-H) against
CD 52 lymphocyte (both T and B cells),anti-CD20 antibodies
Antilymphocyte monoclonal antibodies - ANSWERSRituxamib(rituxan) is a monoclonal antibody that depletes CD20 positive B cells
monoclonal antibody - ANSWERSEculizumab (Solaris) directed against the C5 fragment in the complement cascade
Interleukinn-2 (IL-2) receptor antibodies - ANSWERSBasiliximabc(Simulect) may be used off- label for induction and antibody- mediated rejection
Desensitization agents - ANSWERSPlasmapheresis and IVIG
Plasmapheresis (plasma exchange) - ANSWERSAlways done prior to the administration of IVIG or antibody therapy because plasmapheresis removes IVIG and other monoclonal antibodies during plasma exchange.
IVIG - ANSWERSAlemtuzumab (Campath) monoclonal antibody against CD52 lymphocyte (both T and B cells), anti CD20 antibodies
Rituximab (Rituxan) - ANSWERSMonoclonal antibody that depletes CD20 positive B cells
Eculizumab (Soliris) - ANSWERSMonoclonal antibody directed against the C5 fragment
in the complement cascade Used for desensitization and top of AMR
Interleukin-2 (IL-2) is used as adjuvant therapy for renal cell carcinoma - ANSWERSBasiliximab (Simulect)
Induction therapy - ANSWERSUsed immediate post transplant to neutralize the intimacy robust T cell mediated immune response.
Four types of agents used for induction therapy treatment of acute rejection - ANSWERSPolyclonal antibodies Monoclonal antibodies
Interleukin-2 (IL-2)) receptor antibodies
High dose glucocorticoids Use of polyclonal antibodies - ANSWERSHelps to prevent early post transplant ischemia-repercussion injury.
Patient may need to be treated with anti infective prophylaxis after use of polyclonal therapy - ANSWERSNystatin
Acyclovir (Zovirax). 400 mg po q 12 hrs
Valganciclovir (Valcyte) 900 mg po daily Trimethoprim/ sulfamethoxazole (Bactrim) double strength 1 tablet once daily, three times a week
monoclonal antibodies - ANSWERSAlemtuzumab (Campath)
Approved by FDA for treatingrefactory B cellchronic lymphocytic leukemia and multiple sclerosis
Used as off label for induction therapy in solid organ transplant
Alemtuzumab (Campath) - ANSWERSBlack box warning :
Increases risk of hematologic toxicities, infusion reactions, infection, and opportunistic infections
Interleukin2 (IL-2) - ANSWERSBasiliximab (Simulect) currently approved for induction therapy to prevent rejection in who have low to moderate risk of rejection
Calcineurin inhibitors CNI - ANSWERSCyclosporine and tacrolimus
CNI - ANSWERSPrimarily suppress the activation of T lymphocytes and inhibits intracellular gene transcription in the production of the lymphokine IL2 is essential for activation and proliferation of T cells response to alloantigens
Cyclosporine therapeutic range - ANSWERS12 hour trough levels appears to be between 100-40@ ng/mL
Antifungal Drugs that commonly interact with cyclosporine and tacrolimus - ANSWERSIncreAse concentration Clotrimazole, flucanozole, itraconazole, ketoconazole, variconazole, posaconazole
Calcium Channel Blockers that increase concentration s of Tacro and cyclo - ANSWERSDiltazem, nicardipine, nifedipine, verampamil
Macrolide antibiotics that increase concentrations of tacro and cyclo - ANSWERSClarithromycin, erythromycin
HMG-Coa reductase inhibitors that increase concentrations of tacro and cyclo - ANSWERSSimvastatin and lovastatin