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NAPLEX 2023 > Chapter 56: Transplant > Flashcards

Chapter 56: Transplant Flashcards

1
Q

Prior to any transplant, tissue typing or crossmatching is performed to assess donor-recipient compatibility for

A

HLA and ABO blood group

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2
Q

Transplant of an organ or tissue from one individual to another

A

allograft

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3
Q

Transplant from a genetically identical donor (such as an identical twin) is called

A

isograft

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4
Q

Transplant in the same patient, from one site to another (e.g., stem cell or skin grafting)

A

Autograft

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5
Q

____ immunosuppression is given before or at the time of transplant to ____

A

Induction
to prevent acute rejection during the early post-transplant period

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6
Q

Most commonly used induction drug

A

Basiliximab

induction ONLY, not rejection

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7
Q

Basiliximab drug class

A

IL-2 receptor antagonist

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8
Q

Patients at higher risk of rejection can receive which drug class

A

antithymocyte globulin

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9
Q

antithymocyte globulins can be used for which stages of transplant

A

induction and treatment or rejection

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10
Q

antithymocyte globulin brand names

A

Atgam (equine)
Thymoglobulin (rabbit)

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11
Q

antithymocyte globulin MOA

A

binds to T-lymphocytes and interferes with their function

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12
Q

antithymocyte globulin boxed warning

A

anaphylaxis

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13
Q

antithymocyte globulin side effects

A

infusion-related reactions (premedicate)

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14
Q

What is the first line calcineurin inhibitor (CNI)

A

Tacrolimus

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15
Q

What is the first line antiproliferative agent

A

Mycophenolate

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16
Q

Suppressing the immune system via multiple mechanisms through different drug classes has what 2 benefits

A

lowers toxicity risk of individual immunosuppressants and reduces risk of graft rejection

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17
Q

Mycophenolate mofetil brand name

A

CellCept

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18
Q

Mycophenolic acid brand name

A

Myfortic

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19
Q

Mycophenolate boxed warnings

A

Increased risk of infection, increased development of lymphoma and skin malignancies, increased risk of congenital malformations and spontaneous abortions when used during pregnancy

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20
Q

Mycophenolate side effects

A

Diarrhea, GI upset

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21
Q

T/F: CellCept and Myfortic are NOT interchangeable

A

True

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22
Q

Conversion from CellCept to Myfortic

A

CellCept 500 mg = Myfortic 360 mg

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23
Q

Which brand of mycophenolate is enteric coated to decrease diarrhea

A

Myfortic

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24
Q

CellCept IV is stable in ____ only

A

D5W

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25
Q

Mycophenolate decreases efficacy of

A

oral contraceptives

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26
Q

Azathioprine warning

A

Patients with genetic deficiency of TMPT are at high risk for myelosuppression and may require lower dose

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27
Q

Tacrolimus drug class

A

Calcineurin inhibitor

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28
Q

Tacrolimus brand name

A

Prograf

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29
Q

Tacrolimus MOA

A

inhibits T-lymphocyte activation

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30
Q

Tacrolimus boxed warnings

A

Increased susceptibility to infection, possible development of lymphoma

31
Q

Tacrolimus side effects

A

Increased BP, nephrotoxicity, increased BG, neurotoxicity, hyperkalemia, hyperlipidemia, QT prolongation, alopecia

32
Q

Tacrolimus monitoring

A

Trough levels, serum electrolytes (K, phos, Mg), renal function, LFTs, BP, blood glucose, lipid profile

33
Q

IV Tacrolimus is administered as a continuous infusion in a ____ container

A

non-PVC

34
Q

Tacrolimus is a ______ & ______ substrate

A

3A4 & P-gp

35
Q

Cyclosporine modified brand names

A

Gengraf, Neoral

36
Q

Cyclosporine non-modified brand name

A

Sandimmune

37
Q

Cyclosporine BW

A

renal impairment, increased risk of lymphoma and other malignancies, including skin cancer, increased risk of infection, can increase BP; modified has 20-50% greater bioavailability compared to non-modified

38
Q

T/F: modified & non-modified Cyclosporine cannot be interchanged

A

true

39
Q

Cyclosporine SE

A

Increased BP, nephropathy, hyperkalemia, hypomagnesemia, hirsutism, gingival hyperplasia, edema, increased BG, neurotoxicity, QT prolongation

40
Q

Cyclosporine monitoring

A

Trough levels, serum electrolytes, renal fxn, BP, BG, lipid profile

41
Q

Cyclosporine is a ___ inhibitor and ___ & ___ substrate

A

3A4 inhibitor
3A4 & P-gp substrate

42
Q

Cyclosporine oral liquid should not be administered from

A

a plastic or styrofoam cup

43
Q

mTOR kinase inhibitor MOA

A

inhibit T-lymphocyte activation & proliferation

44
Q

Everolimus warning

A

hyperlipidemia, impaired wound healing

45
Q

Everolimus side effects

A

Peripheral edema, increased BP, do not use within 30 days of transplant d/t increased risk of renal and hepatic artery thrombosis

46
Q

Everolimus and sirolimus monitoring

A

Trough levels

47
Q

Everolimus and sirolimus are substrates of ___

A

3A4 and pgp

48
Q

Sirolimus warnings

A

impaired wound healing, hyperlipidemia

49
Q

Sirolimus SE

A

irreversible pneumonitis/bronchitis/cough (d/c therapy if this develops), increased BG, peripheral edema

50
Q

T/F: Sirolimus tablets and oral solution are bioequivalent

A

false, not bioequivalent

51
Q

Belatacept MOA

A

binds to CD80 & CD86 to block T-cell costimulstion with CD28 and production of inflammatory mediators

52
Q

Belatacept BW

A

increased risk of post-transplant lymphoproliferative disorder (PTLD) with highest risk in recipients without immunity to Epstein-Barr virus. Use in EBV seropositive patients only

53
Q

Belatacept warings

A

Increased risk of TB - test for latent TB prior to initiation and treat latent TB prior to use
remember balatacept has the word lat in it for latent

54
Q

Which drug classes are used for maintenance therapy in transplant

A
  • CNIs (tacrolimus primarily or cyclosporine)
  • Adjuvant therapy given with CNI (antiproliferative agents like mycophenolate or azathioprine, mTOR inhibitors like everlolimus or sirolimus, or belatacept)
  • Steroids
55
Q

Azathioprine should be avoided with which drug class

what should you do if using these drugs?

A

Xanthine oxidase inhibitors (allopurinol or febuxostat)
do not use with febuxostat
decrease dose by 75% if starting allopurinol

56
Q

____ & ____ should be avoided with both cyclosporine and tacrolimus

A

Grapefruit juice and St. John’s Wort

57
Q

Caution with additive drugs that worsen ____ with the mTOR inhibitors, steroids and cyclosporine

A

lipids

58
Q

Caution with additive drugs that raise ____ with tacrolimus, steroids, cyclosporine & mTOR inhibitors

A

BG

59
Q

Caution with additive drugs that raise ____ with tacrolimus, steroids, & cyclosporine

A

BP

60
Q

Which maintenance immunosuppressants have the highest incidence of nephrotoxicity

A

tacrolimus and cyclospsorine

61
Q

Which maintenance immunosuppressants have the highest incidence of worsening or new onset diabetes

A

tacrolimus, steroids and cyclosporine

62
Q

Which maintenance immunosuppressant has the highest incidence of worsening lipid parameters

A

mTOR inhibitors

63
Q

Which maintenance immunosuppressants have the highest incidence of HTN

A

steroids, cyclosporine, and tacrolimus

64
Q

Acute rejection of the transplanted organ arises from either ___ or ___ mediated mechanisms

A

T-cell (cellular) or B-cell (humoral or antibody)

65
Q

How can you distinguish the type of acute rejection of an organ

A

via biopsy

66
Q

Initial approach for acute rejection

A

administering high-dose steroids

67
Q

Which cancer is most common with transplant

A

Skin

68
Q

Inactivated vaccines can be given post-transplant after how many months

A

3-6

69
Q

Which vaccines cannot be given after transplant

A

live

70
Q

Which vaccines are important for transplant recipients

A
  • Influenza in adults 19+ years
  • Pneumococcal in adults 19+ years (PCV13 first then PPSV23 at least 8 weeks later
  • Varicella pre-transplant
71
Q

Counseling point for ALL immunosuppressants

A

Take medication exactly as prescribed and stay consistent on how you take your medication

72
Q

Tacrolimus should be taken every ___ hours

A

12

tacro 12

73
Q

Tacrolimus should be taken (with/without) food for best absorption

A

without

NAPLEX 2023 (88 decks)

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