Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacotherapy I > Exam 4 Solid Organ Transplantation > Flashcards

Exam 4 Solid Organ Transplantation Flashcards

1
Q

What two depleting antibody products can we use for induction?

A

Rabbit polyclonal antibody (Thymoglobulin) and alemtuzumab (Campath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What two depleting antibody products can we use for induction?

A

Rabbit polyclonal antibody (Thymoglobulin) and alemtuzumab (Campath)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you administer thymoglobulin?

A

Administer with a 0.22 micron filter into a central vein. First dose over 6 hours, subsequent over 4 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are adverse effects of thymoglobulin?

A

Myelosuppression (leukopenia and thrombocytopenia dose adjustments), anaphylaxis, cytokine release syndrome, hypo/hypertension, tachycardia, dyspnea, urticaria, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do we pretreat with when we administer thymoglobulin or alemtuzumab?

A

Acetaminophen, diphenhydramine, and steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the targets of thymoglobulin?

A

Many lymphocyte receptors – results in lysis and depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the target of alemtuzumab?

A

CD52 on T and B lymphocytes (also used for B cell lymphocytic lymphoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you administer alemtuzumab?

A

As a single IV dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What adverse effects are associated with alemtuzumab?

A

Infusion related reactions (cytokine release syndrome, others), myelosuppression (leukopenia, thrombocytopenia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the one induction agent that is nondepleting?

A

Basiliximab (Simulect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the target of basiliximab?

A

The IL-2 receptor (CD25) on activated T cells. Prevents IL-2 mediated activation and proliferation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you administer basiliximab?

A

Two doses IV over 30 minutes (central or peripheral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What adverse effects are associated with basiliximab? What adverse effects are NOT associated with basiliximab?

A

Hypersensitivity reactions could occur. NO infusion related reactions (no cytokine release syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What adverse effects are associated with basiliximab? What adverse effects are NOT associated with basiliximab?

A

Hypersensitivity reactions could occur. NO infusion related reactions (no cytokine release syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What adverse effects are associated with basiliximab? What adverse effects are NOT associated with basiliximab?

A

Hypersensitivity reactions could occur. NO infusion related reactions (no cytokine release syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the three types of drugs that we use in combination for maintenance immunosuppressive therapy?

A

Calcineurin inhibitors, antiproliferative agents, and steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the three types of drugs that we use in combination for maintenance immunosuppressive therapy?

A

Calcineurin inhibitors, antiproliferative agents, and steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do calcineurin inhibitors weaken the immune system?

A

The inhibit production of IL-2 and other cytokines, blocking T-cell proliferation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can you convert dosages of calcineurin inhibitors from oral to IV?

A

IV = 1/3 of daily oral dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which calcineurin inhibitor can be dosed twice daily in addition to continuous infusion?

A

Cyclosporine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How often are PO calcineurin inhibitor doses given?

A

Every 12 hours for IR; every 24 hours for ER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which calcineurin inhibitor can be given sublingually by pouring capsule contents under the tongue?

A

Tacrolimus – q 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should you draw a patient’s blood to monitor calcineurin inhibitor concentrations?

A

In the trough right before the next dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What electrolyte abnormalities can be caused by tacrolimus?

A

Hyperkalemia and hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a primary reason we might try to hold back on calcineurin inhibitors?

A

Nephrotoxicity – dose and duration related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a primary reason we might try to hold back on calcineurin inhibitors?

A

Nephrotoxicity – dose and duration related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What metabolic side effects are associated with calcineurin inhibitors?

A

HTN, HLD, hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What neurogenic side effects can be seen sometimes with calcineurin inhibitors?

A

Tremors, HA, neuropathy in palms/soles, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What cosmetic effects might become an adherence issue with cyclosporine? With tacrolimus?

A

Cyclosporine – gingival hyperplasia, hirsuitism (lots of hair)
Tacrolimus – alopecia (hair loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Name three drug classes that might increase serum levels of calcineurin inhibitors by inhibiting CYP enzymes.

A

Azole antifungals, macrolide antibiotics, calcium channel blockers, antiretrovirals, grapefruit juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Name four drugs that might decrease calcineurin inhibitor serum concentrations by inducing CYP enzymes.

A

Antiepileptics (phenytoin, phenobartibal), antibiotics for TB (rifampin, rifabutin), St. Johns Wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What courses of action can you take if a patient is on drugs that interact with calcineurin inhibitors?

A

Avoid combination, empirically increase or decrease calcineurin inhibitor dose, or monitor serum concentrations more closely and adjust as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the three most commonly used antiproliferative agents?

A

Mycophenolate mofetil, mycophenolate sodium, and azathioprine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the target of the antiproliferative agents?

A

IMPDH, to decrease lymphocyte proliferation by decreasing nucleotide synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which drug has better graft survival rates–mycophenolate or azathioprine?

A

Mycophenolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which type of mycophenolate can be dosed IV?

A

Mycophenolate mofetil. Mycophenolate sodium is only PO because it is the enteric coated version.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the conversion between mycophenolate sodium and mycophenolate mofetil?

A

720mg mycophenolate sodium = 1000mg mycophenolate mofetil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What dose adjustment do you have to make for the antiproliferative agents to switch IV and PO?

A

No dose adjustment – same IV and PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What adverse effects are associated with the antiproliferative agents (mycophenolate and azathioprine)?

A

Nausea, vomiting, diarrhea, anemia, leukopenia, and thrombocytopenia (bone marrow suppression)
Azathioprine only – hepatotoxicity, pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What adverse effects are associated with the antiproliferative agents (mycophenolate and azathioprine)?

A

Nausea, vomiting, diarrhea, anemia, leukopenia, and thrombocytopenia (bone marrow suppression)
Azathioprine only – hepatotoxicity, pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does mycophenolate have a REMS program for?

A

To screen for pregnancy – potentially teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What major interaction is there between an antiproliferative agent and anti-gout agent?

A

Azathioprine and allopurinol interact – allopurinol inhibits an enzyme that metabolizes azathioprine, leading to increased active metabolites and risk of bone marrow suppression.
Empirically reduce dose of azathioprine by 50-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What two corticosteroids do we primarily use for maintenance therapy?

A

Methylprednisolone (IV) tapered to prednisone (PO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What adverse effects from corticosteroids do we worry about?

A

HTN, HLD, hyperglycemia, osteoporosis, insomnia, mood swings, fat redistribution, thin skin, cataracts, increased appetite, weight gain, hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What mTOR inhibitors can we potentially use in place of calcineurin inhibitors for maintenance immunosuppression to avoid nephrotoxicity?

A

Sirolimus (Rapamune) and everolimus (Zortress).

46
Q

How do mTOR inhibitors affect the immune system?

A

They inhibit response to IL-2 and the progression of the cell cycle.

47
Q

Which mTOR inhibitor is dosed once a day? Twice a day?

A

Sirolimus is qd; everolimus is BID. Both PO although liquids available.

48
Q

How do you determine the dose of mTOR inhibitors for a patient?

A

Go off of their trough serum concentrations.

49
Q

How do you determine the dose of mTOR inhibitors for a patient?

A

Go off of their trough serum concentrations.

50
Q

What adverse effects are seen with mTOR inhibitors?

A

Myelosuppression, HLD, high triglycerides, delayed wound healing (dont use right after surgery!), mouth ulcers, pneumonitis, rash, acne, diarrhea, arthralgia, proteinuria (monitor)
Same D-D interactions as CNIs

51
Q

What costimulation blocker can we use instead of the calcineurin inhibitors?

A

Belatacept (Nulojix)

52
Q

What does belatacept bind to?

A

CD80 and 86 on APCs, blocking the costimulatory signal

53
Q

How is belatacept administered?

A

IV over 30 minutes. Dosed 10mg/kg weekly twice then biweekly until 16 weeks, then monthly.

54
Q

What adverse effects do we worry about with belatacept?

A

Anemia, leukopenia, GI, fever, HA, HTN, potassium abnormalities, peripheral edema, cough, post-transplant lymphoproliferative disorder (PTLD) and progressive multifocal leukoencephalopathy (PML)
REMS program for PTLD and PML. (pts get these with others too though)

55
Q

What cations interact with mycophenolate?

A

Iron, magnesium, aluminum. Also cholestyramine. Decrease absorption of mycophenolate – separate administration by 2-4 hours.

56
Q

What types of rejection generally occur in the first three months after transplant?

A

Acute cellular and antibody-mediated (vascular or humoral rejection)

57
Q

What is the goal of therapy for drugs used in a rejection?

A

To minimize the immune response and prevent irreversible damage to the allograft

58
Q

What is the goal of therapy for drugs used in a rejection?

A

To minimize the immune response and prevent irreversible damage to the allograft

59
Q

For what situation is IV immunoglobulin used?

A

Transplant rejection

60
Q

For what situation are IV immunoglobulin, rituximab, and depleting antibodies all used?

A

Transplant rejection

61
Q

What two viruses do we screen for and treat prophylactically in transplant patients?

A

CMV (cytomegalovirus) and herpes simplex virus

62
Q

What two viruses do we screen for and treat prophylactically in transplant patients?

A

CMV (cytomegalovirus) and herpes simplex virus

63
Q

What two conditions would put a patient at medium risk for CMV infection?

A

+/+ or -/+ (basically if the recipient is positive it is medium risk)

64
Q

What three antivirals can we use to prevent CMV?

A

Valganciclovir (Valcyte), ganciclovir (Cytovene), and acyclovir (Zovirax)

65
Q

What three PO antivirals can we use to prevent CMV?

A

Valganciclovir (Valcyte), ganciclovir (Cytovene), and acyclovir (Zovirax)
Duration dependent on risk – 3-6 months usually
Adjust dose for renal dysfunction

66
Q

What two antivirals can we use to treat CMV?

A

Valganciclovir at higher dose or IV ganciclovir
IVIg may be added
Minimum 2 weeks therapy
Adjust dose for renal dysfunction

67
Q

What bacterial infection do we try to prevent in transplant patients?

A

Pneumocystis pneumonia (will present with respiratory symptoms and fever)

68
Q

Name the drug of choice for preventing pneumocystis pneumonia infection and a backup option in case they are allergic to sulfa. What do we do for treatment?

A

Sulfamethoxazole/trimethoprim (Bactrim DS)
Backup: Dapsone, pentamidine, atovaquone
Treatment – same except higher dosages and different dosage forms.

69
Q

Name the drug of choice for preventing pneumocystis pneumonia infection and a backup option in case they are allergic to sulfa. What do we do for treatment?

A

Sulfamethoxazole/trimethoprim (Bactrim DS)
Backup: Dapsone, pentamidine, atovaquone
Treatment – same except higher dosages and different dosage forms.

70
Q

What is the ideal diagnostic test to check for herpes simplex virus?

A

HSV DNA by PCR

71
Q

What do we check to determine the risk of herpes simplex infection in a transplant patient?

A

Serostatus of recipient

72
Q

True or false: The agents we use to prevent CMV are the same as the agents we use to prevent herpes simplex virus infection.

A

True – both can be prevented with valganciclovir, ganciclovir, and acyclovir

73
Q

True or false: The agents we use to treat CMV are the same ones we use to treat herpes simplex virus.

A

False – we use acyclovir, famciclovir, or valacyclovir to treat herpes simplex, but only valganciclovir or gancyclovir for CMV (look for “gan” in the ones to treat CMV)

74
Q

True or false: The agents we use to treat CMV are the same ones we use to treat herpes simplex virus.

A

False – we use acyclovir, famciclovir, or valacyclovir to treat herpes simplex, but only valganciclovir or gancyclovir for CMV (look for “gan” in the ones to treat CMV)

75
Q

What is the most common invasive fungal infection in solid organ transplantation?

A

Candida

76
Q

What symptoms should clue you to look for candida infection?

A

Candidemia, UTIs, pulmonary symptoms.

77
Q

What symptoms should clue you to look for candida infection?

A

Candidemia, UTIs, pulmonary symptoms.

78
Q

What symptoms should clue you to look for candida infection?

A

Candidemia, UTIs, pulmonary symptoms.

79
Q

What is one big issue with prophylactically giving agents against candida?

A

Most antifungals have drug interactions with immunosuppressants. Prophylaxis is controversial, but 14 days at least if it is done.

80
Q

Name three drugs we can use to treat candida.

A

Fluconazole, itraconazole, voriconazole, posaconazole, capsofungin, micafungin, amphotericin B, anidalafungin

81
Q

Name three drugs we can use to treat candida.

A

Fluconazole, itraconazole, voriconazole, posaconazole, capsofungin, micafungin, amphotericin B, anidalafungin

82
Q

What viral infection can be a problem in kidney transplant recipients, but is not treated prophylactiacally?

A

BK virus

83
Q

Which tract does BK virus lie dormant in after childhood infection?

A

Genitourinary tract

84
Q

How do we screen for BK virus?

A

Test urine or blood for BK by PCR; biopsy for nephropathy detection. Sccreen routinely!! Monthly or every other month for the first year, especially kidney transplant.

85
Q

What agents can we add to treat BK virus?

A

Leflunomide, ciprofloxacin, IVIG

86
Q

What agents can we add to treat BK virus?

A

Leflunomide, ciprofloxacin, IVIG

87
Q

What vaccinations are acceptable pre-transplant?

A

All – try to complete vaccination series and boosters early in disease and before transplant

88
Q

What vaccinations are acceptable post-transplant?

A

Annual injected influenza vaccine, pneumococcal vaccine

NOT MMR, varicella, or nasal influenza

89
Q

What vaccinations are acceptable post-transplant?

A

Annual injected influenza vaccine, pneumococcal vaccine

NOT MMR, varicella, or nasal influenza

90
Q

What medications can contribute to HLD post transplant?

A

Cyclosporine, tacrolimus, sirolimus, and prednisone

91
Q

What can HLD post transplant do?

A

Cause cardiovascular diseases and aid chronic allograft rejection

92
Q

What do we do to treat post-transplant HLD?

A

Statins, lifestyle modifications, immunosuppressant adjustment
MONITOR: myopathy and drug interactions

93
Q

What causes contribute to post-transplant HTN?

A

Steroids, calcineurin inhibitors, kidney dysfunction, vascular compromise

94
Q

What do we do for post-transplant HTN?

A

Home monitoring! Lifestyle modifications, immunosuppression switch (cyclosporine to tacrolimus), antihypertensive meds (NOT ACE/ARB/CCBs like diltiazem, verapamil –> hyperkalemia risk)

95
Q

What antidiabetic drug should be avoided in new-onset diabetes after transplantation?

A

Metformin – raises serum creatinine.

96
Q

How can we treat post-transplant new onset diabetes?

A

Same as regular diabetes – monitor HgbA1C q3mos, lifestyle modifications, oral meds and/or insulin, modify immunosuppressants.

97
Q

What can we do for post-transplant patients who develop gout?

A

Increase steroid doses, give colchicine especially if already issues with mycophenolate, AVOID NSAIDS (nephrotoxicity), give allopurinol, febuxostat (watch azathioprine interaction)
Adjust doses for renal function

98
Q

What causes contribute to the development of post-transplant osteoporosis?

A

Calcineurin inhibitors, steroids, kidney and other organ dysfunction, age, post-menopausal, others

99
Q

How can we treat post-transplant osteoporosis?

A

Assess pre-transplant, exercise, calcium and vitamin D supplements, bisphosphonates (consider kidney function!), immunosuppressant modifications.

100
Q

How can we treat post-transplant osteoporosis?

A

Assess pre-transplant, exercise, calcium and vitamin D supplements, bisphosphonates (consider kidney function!), immunosuppressant modifications.

101
Q

What tweak can we make to immunosuppressant drugs to lower the chances of post-transplant malignancy? What is another big prevention strategy?

A

Change from a CNI to sirolimus b/c antineoplastic properties.
Surveillance and prevention key!! suncreen, smoking cessation, etc.

102
Q

What tweak can we make to immunosuppressant drugs to lower the chances of post-transplant malignancy? What is another big prevention strategy?

A

Change from a CNI to sirolimus b/c antineoplastic properties.
Surveillance and prevention key!! suncreen, smoking cessation, etc.

103
Q

What virus is associated with post-transplant lymphoproliferative disorder (PTLD)?

A

Epstein-Barr virus

104
Q

What virus is associated with post-transplant lymphoproliferative disorder (PTLD)? What induction agent?

A

Epstein-Barr virus and polyclonal anti-lymphocyte antibodies are both associated with PTLD
Highest rate in first year post-transplant

105
Q

What is the biggest prevention strategy for PTLD? What is another unusual cancer option?

A

Minimize immunosuppression, can use rituximab (anti B cell antibody).
Also surgical resection, local irradiation, and chemotherapy

106
Q

Besides PTLD, what type cancer is more common in transplant patients?

A

Skin cancer – basal cell, squamous cell, Merkel cell, Kaposi’s, and melanoma all more common.
(Sirolimus decreases incidence!)

107
Q

As pharmacists, what are two big things we can do for transplant patients?

A

Identify and address nonadherence risk factors; provide updated medications lists to every patient

108
Q

As pharmacists, what are two big things we can do for transplant patients?

A

Identify and address nonadherence risk factors + provide updated medications lists to every patient

109
Q

As pharmacists, what are two big things we can do for transplant patients?

A

Identify and address nonadherence risk factors + provide updated medications lists to every patient

110
Q

What three classes of OTCs are we cautious about in transplant patients?

A

NSAIDS – decreased kidney blood flow
Decongestants – increased blood pressure, effect on kidneys and cardiovascular system
Herbals – increased or decreased CNI or mTOR serum concentration

Pharmacotherapy I (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions