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Board Study Topics > 00 Immunosuppressants > Flashcards

00 Immunosuppressants Flashcards

1
Q

What is the generic name of Simulect?

A

Basiliximab (approved for renal transplant induction therapy)

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2
Q

What are the most common ADRs with Simulect?

A

GI!!! HTN, edema. Electrolyte abnormalities. HA, insomnia, tremor. Anemia

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3
Q

What is the generic name of Atgam?

A

Anti-Thymocyte Globulin, equine (polyclonal antibody)

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4
Q

What is the generic name of Thymoglobulin?

A

Anti-Thymocyte Globulin, rabbit (polyclonal antibody)

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5
Q

How does the dosing differ between Atgam and Thymoglobulin?

A

Atgam: 15mg/kg/day x14 days.
Thymoglobulin: 1.5mg/kg/day x 14 days

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6
Q

What do you need to remember when giving Polyclonal antibodies?

A

Always give first dose in monitored setting d/t risk for anaphylaxis. Pre-medicate with Benadryl and Tylenol

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7
Q

What classes of medications are primarily used for maintenance therapy?

A

Calcineurin inhibitors (cyclosporine, tacrolimus). mTOR inhibitors (sirolimus)

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8
Q

What are the typical maintenance therapy regimens?

A

Cyclosporine based (+steroid + MMF or sirolimus). Tacrolimus based (+steroid + MMF or sirolimus). Sirolimus based (+ steroid + MMF). DO NOT combine two CNIs, two mTOR inhibitors, or two purine antagonists

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9
Q

What is the BBW for oral CNI (Calcineurin inhibitor)?

A

Increased risk of infection. May be associated with the development of malignancy, including lymphoma and skin cancer

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10
Q

What is the generic name of Sandimmune?

A

Cyclosporine (non-modified)

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11
Q

What is the generic name of Neoral/Gengraf?

A

Cyclosporine (modified or microemulsion). Not interchangeable with the non-modified version

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12
Q

What is the BBW associated with Cyclosporine?

A

HTN, nephrotoxicity

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13
Q

What is the generic name of Prograf?

A

Tacrolimus (CNI)

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14
Q

What is the BBW associated with Prograf?

A

For Prograf XL only: Increased mortality in female liver transplant recipients

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15
Q

What are the common CNI side effects?

A

Nephrotoxicity! Hyperglycemia, HTN, Hyperlipidemia

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16
Q

What are the target Cyclosporine trough levels?

A

100-400

17
Q

What are the target Tacrolimus trough levels?

A

5-20

18
Q

What do you need to monitor for CNI’s?

A

Renal function (CrCl)

19
Q

What is the generic name of Rapamune?

A

Sirolimus (mTOR inhibitor)

20
Q

What is the BBW associated with Rapamune (Sirolimus)?

A

Not recommended for liver transplant d/t increased risk of fatal hepatic artery thrombosis. Not recommended for lung transplant d/t increased risk of bronchial anastomotic dehiscence

21
Q

What do you need to monitor with Rapamune (Sirolimus)?

A

Lipid panel, reduce dose in hepatic impairment

22
Q

What is the generic name of Zortress?

A

Everolimus (mTOR inhibitor)

23
Q

What are the BBWs associated with Zortress (Everolimus)?

A

Increased risk of renal arterial and venous thrombosis; may result in graft loss. Increased mortality (usually associated with infections) after heart transplant; use in heart transplant is not recommended. Increased risk for nephrotoxicity in renal transplantation; avoid standard dose of cyclosporine in combination with everolimus

24
Q

What are the corticosteroids used for immunosuppression?

A

Prednisone, Methylprednisolone. Usually a part of most immunosuppressive regimens

25
Q

What is the generic name of Cellcept?

A

Mycophenolate mofetil (Purine Antagonists)

26
Q

What is the generic name of Myfortic?

A

Mycophenolic acid (Purine Antagonist)

27
Q

What is the generic name of Imuran?

A

Azathiprine (Purine Antagonist)

28
Q

What is the most common ADR with Cellcept (MMF)?

A

GI!!!

29
Q

What is a big DDI to look out for with Imuran (Azathioprine)?

A

DDI with allopurinol and febuxostat. Prevents metabolism of 6-MP, leads to increased levels and risk for toxicities

30
Q

What is the BBW associated with Cellcept (MMF)?

A

Teratogenicity

31
Q

What is the generic name of Nulojix?

A

Belatacept. ONLY USED in patients who are EBV (+)

32
Q

What counseling needs to be done when they start immunosuppression?

A

Compliance! Avoid NSAIDs, grapefruit juice. Always use sun protection

Board Study Topics (38 decks)

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