9. Management Of Immune-mediated Toxicites

Question 1

What is TRUE about drug allergy and pseudoallergy?
A. Drug allergy is more severe and life threatening
B. Both are lgE mediated reactions
C. Treatment is the same for both
D. Histmine release is involved in allergy but not pseudoallergy

Answer 1

Ans: C
A. Pseudoallergy can be as serious as drug allergies
B. pseudoallergy directly release cytokines (not IgE)
D. Some pseudoallergy involve histamine

Question 2

Severe cutaneous adverse reactions (SCAR)
A. Can be life threatening
B. Consist of DRESS, SJS, and TENS
C Are known to be caused by allopurinol, carbamazepine, and sulfonamides
D. All of the above

Answer 2

Ans: D

Question 3

What type of immune-mediated hypersensitivity causes systemic lupus erythematosus symptoms like
inflammation?
A. Type l immediate hypersensitivity

B.Type ll antibody mediated disease

C. Type Il immune complex-mediated disease
D. Type IV T cell-mediated disease

Answer 3

C, antibodies and antigen complex

Question 4

Which of the following individuals would be at the HIGHEST risk for developing SLE?
20-year-old African American female
25-year-old White female
30-year-old Hispanic male
40-year-old Asian male

Answer 4

20-year-old African American female

Question 5

A 35-year-old woman who wants to have a baby in the future is found to have SLE. Which of the following
drugs has the greatest potential to adversely affect fertility?
Azathioprine
Hydroxychloroquine
Mycophenolate mofetil
Cyclophosphamide

Answer 5

Ans: Cyclophosphamide - affects fertility

• Mycophenolate mofetil is teratogenic at 1st trimester, can use in 2nd, 3rd trimester

Question 6

Which of the following is NOT true regarding induction immunosuppression strategies?
A. They are used in patients at high risk of rejection
B. They are used to delay the initiation of nephrotoxic medications
C. They refer to the use of antibody agents
D. They include calcineurin inhibitors

Answer 6

D. CCI is for immunosuppression maintenance, which are nephrotoxic

Question 7

Which of the following immunosuppressive medications is most likely to have increased AUC during
treatment of esophageal candidiasis infection with fluconazole?

Cyclosporine
Prednisone
Mycophenolate
Belatacept

Answer 7

Cyclosporine - cyp3A4 inhibitor

Question 8

A 32-year-old male received a kidney transplant 3 weeks ago. He presents to clinic with a blood pressure of
160/98 and HR 62. SCr 97umol/L. Currently taking tacrolimus and mycophenolate. Choose the most
appropriate antihypertensive agent to initiate?

Diltiazem
Amlodipine
Lisinopril
Metoprolol

Answer 8

Amlodipine - DHP CCB (no nephrotoxicity)

Diltiazem, Metoprolol - not FL for HTN
Lisinopril - nephrotoxicity
Metoprolol - not FL

Question 9

What causes a delayed immune response?

Answer 9

IgM,IgG, Tcell-mediated

Question 10

Name the 5 Immunosuppression Maintenance Drug classes

Answer 10

Calcineurin inhibitors
- Tacrolimus, cyclosporins
Antimetabolites
- Mycophenolate, azathioprine
Corticosteroids
mTOR inhibitors
- Sirolimus, everolimus
Biologics
-Adalimumab, Belatacept

Question 11

Common combination of immunosuppressive Maintenance drugs

Answer 11

CCI+ GC + Mycophenolate

Question 12

______ and ________ should not be used together due to nephrotoxicity

Answer 12

CCI, mTOR inhibitors

Question 13

Name 2 Calcineurin inhibitors used in immunosuppression maintenance

Answer 13

Tacrolimus, cyclosporins

Question 14

Name 2 Antimetabolites

Answer 14

Mycophenolate, azathioprine

Question 15

Name 2 mTOR inhibitors

Answer 15

Sirolimus, everolimus

Question 16

Name 2 biologics used in immunosuppression maintenance

Answer 16

Adalimumab, Belatacept

Question 17

Name 2 classes of drugs used in immunosuppression induction

Answer 17

Lymphocyte-depleting agents
- Antithymocyte globulin
- Alemtuzumab (off-label)

Immune Modulators
- Basiliximab

Question 18

Name 2 lymphocyte-depleting agents

Answer 18

Antithymocyte globulin, Alemtuzumab (off-label)

Question 19

Name 1 Immune Modulators

Answer 19

Basiliximab