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Therapeutics > Immunosuppressants > Flashcards

Immunosuppressants Flashcards

1
Q

Anti-thymocyte globulin
Basiliximab (Simulect)
Alemtuzumab (Campath)
Methylprednisolone

A

Induction immunosuppressants

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2
Q

Which induction immunosuppressant is T cell depleting?

A

Anti-thymocyte globulin

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3
Q

The two anti-thymocyte formulations are:

A

thymoglobulin, atgam

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4
Q

What are the premedications that must be given with anti-thymocyte globulin to prevent cytokine release syndrome?

A

steroids, acetaminophen, diphenhydramine

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5
Q

Which induction immunosuppressant is non-depleting of T cells?

A

Basiliximab

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6
Q

Anti-thymocyte globulin vs. Basiliximab - which immunosuppressant has a duration of T-cell inhibition for 6-12 months and which one for 1 month?

A

Anti-thymocyte globulin - 6-12 months

Basiliximab - 1 month

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7
Q

Basiliximab requires premedications (T/F)

A

False, no cytokine release syndrome is present

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8
Q

Which induction immunosuppressant depletes both B and T cells?

A

Alemtuzumab

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9
Q

Which induction immunosuppressant has a BBW for bone marrow suppression, infusion reactions, and infections?

A

Alemtuzumab

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10
Q

What adverse effect do you have to watch for alemtuzumab?

A

Very resistant infections

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11
Q

Which induction immunosuppressant serves for both induction and a pre-medication agent?

A

Methylprednisolone

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12
Q

Which induction immunosuppressants can also be used for rejection treatment?

A

anti-thymocyte globulin, methylprednisolone

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13
Q

Tacrolimus

Cyclosporine

A

Calcineurin inhibitors (maintenance suppression)

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14
Q

Which CI has lots of DDIs?

A

Tacrolimus

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15
Q

Tacrolimus dosing

A

0.075-0.2 mg/kg/day (either BID or Qday)

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16
Q

Which two formulations are modified cyclosporines?

A

Gengraf, Neoral

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17
Q

Which formulation is non-modified cyclosporine?

A

Sandimmune

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18
Q

Cyclosporine dosing

A

3-10 mg/kg/day BID

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19
Q

The modified cyclosporine formulations have increased absorption compared to non-modified formulation, are less dependent on food, bile acids, etc. (T/F)

A

True

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20
Q

Which CI is 50% more potent?

A

Tacrolimus

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21
Q

Food increases tacrolimus absorption (T/F)

A

False, decreases absorption

22
Q

Mycophenolate

Azathioprine (Imuran)

A

Anti-proliferative agents (maintenance suppression)

23
Q

Mycophenolate mofetil vs. mycophenolic acid - which is a prodrug that theoretically decreases GI side effects?

A

mycophenolic acid

24
Q

Mycophenolate decreases the effectiveness of oral contraceptives (T/F)

A

True

25
Q

Are mycophenolate mofetil and mychophenolic acid interchangeable?

A

False

26
Q

Mycophenolate levels need to be monitored

A

False

27
Q

Mycophenolate is teratogenic (T/F)

A

True

28
Q

Prenisone

A

Steroid (maintenance suppression)

29
Q

Prednisone has long-term adverse effects such as poor wound healing, adrenal suppression, and osteoporosis (T/F)

A

True

30
Q

mTOR inhibitors are considered 2nd line agents if the first line agents produce undesirable nephrotoxic effects (T/F)

A

True

31
Q

mTOR inhibitors have anti-____ properies

A

anti-cancer properties

32
Q

Sirolimus

Everolimus

A

mTOR inhibitors

33
Q

Which mTOR inhibitor is once daily dosing and which is twice daily?

A

Sirolimus - once daily

Everolimus - twice daily

34
Q

mTOR inhibitors are not given right after transplant but ____ months after surgery

A

1-3 months post surgery

35
Q

You need to wait to give mTOR inhibitors because of their BBW of…

A

poor wound healing

36
Q

mTOR inhibitors are also known for causing ___ ulcers

A

oral, recommended to put in applesauce to try and prevent mouth ulcers

37
Q

mTOR inhibitors need daily trough levels because of their long half-lives (T/F)

A

False, they do NOT need daily trough levels because of their long half-lives (take 4-5 days after initiation and/or dose adjustment)

38
Q

mTOR inhibitors can be combined with CI. If a high risk of rejection, tacrolimus is best but it pt is not able to tolerate dose, can lower tacrolimus dose/goal and add mTOR inhibitos (T/F)

A

True, lowers nephrotoxic risk and other side effects

39
Q

This immunosuppressive agent is a selective t-cell co-stimulation blocker that is only approved in kidney transplants

A

belatacept

40
Q

Belatacept’s BBW is the increased risk of post-transplant lymphoproliferative disorder (PTLD) (T/F)

A

True

41
Q

Patients about to take belatacept need to be EBV negative(T/F)

A

False, they must be EBV positive because negative increases the risk of post-transplant lymphoproliferative disorder (PTLD)

42
Q

Belatacept is very well-tolerated (T/F)

A

True

43
Q

Standard maintenance immunosuppression regimen is ____ + _____ +/- ______

A

CNI (tacrolimus) + antimetabolite (mycophenolate) +/- prednisone

44
Q

Alternative maintenance immunosuppression regimen is ___ +/- ____ + _____ + _____

A

CNI (tacrolimus or cyclosporine) +/- antimetabolite (mycophenolate or azathioprine) + mTORin (sirolimus or everolimus) + prednisone

45
Q

Azole antifungals are CYP3A4/PGP inhibitors that increase CNI concentrations (T/F)

A

True

46
Q

Possible post-transplant complications include:

A
  • Infections - due to immunosuppression, threshold for bring pts in for work-up is lower
  • New Onset Diabetes After Transplant (NODA) - most commonly from tacrolimus
  • Cardiovascular complications - risk of metabolic syndrome due to anti-rejection medication
  • Cancer - due to immunosuppression
47
Q

What is more difficult to treat: cellular rejection or antibody mediated rejection?

A

antibody mediated rejection

48
Q 
Treatment for cellular rejection:
Pulse-dose \_\_\_\_\_
Thymoglobulin
Increase \_\_\_\_\_\_ immunosuppression
Consider "restarting" \_\_\_\_ rophylaxis
A

Pulse-dose corticosteroids
Thymoglobulin
Increase maintenance immunosuppression
Consider “restarting” infection prophylaxis

49
Q

Treatment for antibody mediated rejection:
Plasmaphersis
IVIG
Rituximab

A

Plasmaphersis
IVIG
Rituximab

50
Q

Infection prophylaxis includes

A

Valganciclovir - CMV
Bactrim - Pneumocystic Jiroveci Pneumonia + Toxoplasmosis
Fluconazole - “Valley Fever”

51
Q

When should infection prophylaxis be started?

A

Immediately post transplant

Therapeutics (10 decks)

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