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induction single thereapy?
monoclonal antibodies:
polyclonal antiyphocyte
mono: basiliximab
poly: thymoglobullin, atgam

maintance therapy mulitple drug regiment:
corticosteroids:
calcineurin inhibitors:
antiproliferative:
steroids: methylprednisone, and prednisone
calineurn inhbitors: cyclosprorin A and tacrolimus
antiproliferative drugs: MMF, AZA, sirolimus
when can you use steroids?
maintance, induction, and high doses for rescue
with high doses they can cause the hep C to come back
what is the rescue drug with steroids
methylprednisone 500mg IV for 3 days
what are the calcineurin inhibitors and when do you use them
cyclosporin and tacrolimus
MOA: suppress activation and release of IL-2
use for prevention and resucue
cyclosporin is bile dependent and tacolimus is not
what are some of the drugs that can decreas the blood levels of tacrolimus and cyclosporin
carbamazepine, phenytoin, nafcillin, primidone, octreotide, rifampin, and phenobarb
binders: antacids,resins, and sodium bicarb.
what is the dose for cyclosporin
IV drip 2-3mg/kg/day
oral 8mg/kg/day q12hrs
IV to Oral:  1:3
what is the tacrolimus dosing
oral: .05-.1mg/kg/day
oral to IV:     1:4
what is AZA
purine antalogue
interfere with DNA and RNa synthesis
use for provention
MMF
  • decrease antibody formation
  • block denovo purine formation
  • uses for prevention and rescue
  • more likely to CMV
HOW is CMV bad
it can cause rejections its self and can lead to more infections
AZA drug interactons
allopurinol, succinylcholine, pancuronium, warfarin,
MMF drug interactions
antacids and cholysteramine
AZA dosing
1-2mg/kg/day
MMF dosing
cellcept: 1-1.5 gm/q12 hrs
decrease or seperate dose if not tolerated well
Sirolimus
TOR inhibitor
blocks translation
inhibits Bcell proliferation
stops IL2,6,10
sirolimus dosing
1-2mg QD
basiliximab
monoclonal antibody used forhigh risk induction patients. but it is garbage. binds to CD25 of the IL2
basiliximab dosing
20 mg IV on days 0 and 4 post op
OKT3
binds to CD3 receptor on the Tcell. used for steroid rejection in rescue
what do you have to do before you give OKT3
premedicate the patient with tylenol, benadryl, and methylprednisone. also ganciclovir to protect against CMV
thymoglobulin and Atgam
works on peripheral Tcells
used for high risk induction patients and steroid resistant rescue
premedicate with tylenol, benadryl, methylprednisone and ganciclovir
thymoglobulin dosing
.5-1.5 mg/kg/day for 7-14 days through a centtral line over 4-6 hrs
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