This Might Be Why No One Takes Me Seriously In PBL

Tacrolimus

Our 20 year old patient from South of the Border
Had a lupus-related kidney disorder
Her husband donated one of his two
Because, as we all know, one kidney will do

The transplant went fine, at least right at first,
Her worrisome creatinine safely reversed
And after one week she left on prednisone
Her immune system would leave her new kidney alone

And from our deep bag of medical tricks,
We also pulled out FK-506.
(It’s an immunosuppressive, and most of the time it’s
Simply referred to as old tacrolimus,)

Our patient was like, “What is this new med?
Can you tell me about it?” And here’s what we said.
Tacro’s a drug in the macrolide group
You take it by mouth; it comes out in your poop.

It’s used to stop transplanted organ rejection
(Though for vitiligo and atopic dermatitis it’s also a selection.)
For liver, kidney, and heart transplant it’s employed
And as Protopic topically eczema gets destroyed.

It’s produced by a species of the strep bacteria
And we don’t use it under certain criteria.
For instance, it’s not good to drink grape fruit juice
If you’re pregnant or breast-feeding please do not use.

Likewise in cancer it’s contra-indicated
In liver failure and infection it should not be instated.
The jury is out on whether it’s linked to cancer
Unfortunately we’re waiting on trials for an answer.

It can lead to neural problems and hypertension,
And cholelithiasis can cause apprehension.
It can be neurotoxic and raise your blood glucose
Its serum level can be erratic so watch this drug muy close!

Ironically, it’s also a bit nephrotoxic
But when rejection begins, it summarily blocks it.
Cyclosporine is used along similar lines
They both block T cells, inhibit cytokines.

They both bind to proteins in the cytosol
And then TCR activation does nothing at all.
Because your T cells offer no more protection
We need to watch for opportunistic infection.

If the side effects are bad, please let us know fast
We hope you feel renally better at last.