Solid Organ Transplant

Backbone maintenance immunosuppression

Calcineurin inhibitors
Antimetabolites
Corticosteroids

Non-backbone maintenance immunosuppression

mTOR inhibtors
Co-stimulation blockers

Corticosteroids

Dexamethasone
Methylprednisolone
Prednisone

Corticosteroids Side effects

Short term: Mood changes, hyperglycemia, hypertension
Long-term: osteoporosis, adrenal insufficiency,

Calcineurin inhibitors

Tacrolimus
Cyclosporine

What side effects tacrolimus has a higher risk of

Hyperglycemia, Neurotoxicity, Electrolyte abnormalities,

What side effects cyclosporine has a higher risk of

Nephrotoxicity

Both tacrolimus & cyclosporine have an equal risk of

HTN

Tacrolimus unique side effects

Alpoecia

Cyclosporine unique side effects

Hirsutism, HL, gingival hyperplasia, hyperuricemia

Antimetabolites

Mycophenolate
Azathiopurine

Mycophenolate Drug interactions

Antaicde, H2RAs, PPI
Iron supplements
Cholestyramine
Oral contraceptives

Mycophenolate ADR

GI side effects- take with food
Myelosuppresion: leuokopenia, anemia, thrombocytopenia

Mycophenolate teratogenicity

Spontaneous abortions, anamolaies, if pregnancy desired seitch to azathiopurine

Azathiopurine drug interactions

6-mercaptopurine
Allopurinal/febuxostat

Azathiopurine ADRs

GI side effects
myelosuppresion
Pancreatitis
Hepatotoxicity

mTOR inhibitors

Sirolimus
Everolimus

Sirolimus & Everolimus ADRs

Edema
Anemia
impiared wound healing
proteinuria
hyperlipidemia

Sirolimus only side effects

Interstitial lung disease

Co-Stimulation Blockers

Belatacept

Belatacept BBW

Postmytansplant lymphoproliferativr disorder

ONLY GIVE IFEPSTEIN BARR VIRUS SEROPOSITIVE

Belatacept side effects

GI upset
HTN
Edema
Anemia
Leukopenia

Preffered agents in HTN

CCB or BB

NOT ACE/ARB

Preffered agents in hyperlipidemia

Pravastatin, Rosuvastatin

Preffered agent in New onset diabetes after transplant

Insulin

What drugs are 3A4 inhibtors and increase tacrolimus levels

Amiodarone
Azole antifungals
Diltiazem
Grapfefruit juice
Macrolide antibiotics
Ritonavir

What drugs are 3A4 indicers and decrease tacrolimus levels

Carbamazepine
Phenytoin
Phenobarbital
Rifampin
St. Johns Wort

Understand the role of the clinical pharmacist in solid organ transplantation

→Therapeutic drug monitoring
→Adverse drug reaction management
→Drug interaction management
→Patient Education