Want to support the channel? Be a patron at:
/ lymed Welcome to LY Med, where I go over everything you need to know for the USMLE STEP 1, with new videos every day.
Follow along with First Aid, or with my notes which can be found here: www.dropbox.co...
This video will be on transplant reactions and transplant pharmacology. We start with a talk about adverse transplant rejections. There are different types, which include:
1) Hyper acute rejection: rejection within minutes due to preformed antibodies against the transplant. Damage to the endothelium of the transplant leads to thrombosis and necrosis of the transplant tissue.
2) Acute: in weeks-months. This is non-preformed antibodies against the transplant and is less severe. This leads to vasculitis. Treatment is with immunosuppresants.
3) Chronic rejection: long term inflammation leads to fibrosis and narrowing of the vessels. This can lead to Bronchiolitis obliterans in the lungs, atherosclerosis in the heart, nephropathy of the kidneys, jaundice and hepatomegaly in liver transplants.
4) Graft vs host disease (GVHD): here the transplant is attacking the host. Signs include rash, jaundice, and hepatosplenomegaly. Sometimes, you want graft vs tumor effect in bone marrow transplant in leukemic patients.
Our last topic will be on immunosuppressive drugs. Pharm starts with a quick recap of the T cell, how it activates, and the importance of IL-2. Drugs include:
Calcineurin inhibitors:
1) Cyclosporine: this binds a chaperone protein called cyclophilin which interferes with calcineurin.
2) Tacrolimus: this binds to FKBP (FK506) which also interferes with calcineurin. Both of these drugs are nephrotoxic, but cyclosporin also has gingival hyperplasia and hirsutism.
Now some other drugs:
3) Sirolimus: this also likes to bind FKBP, but the FKBP that it binds interferes with mTOR. Side effect is pancytopenia
4) IL-2 receptor monoclonal antibody - blocks interleukin 2 and stops transcription.
Done!
Негізгі бет USMLE Immunology 6: Transplant Rejection and Immunosuppresion Pharmacology
Пікірлер: 19