Brainscape's Knowledge GenomeTM

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


See full index

P&T Block 5 Renal > L65 > Flashcards

L65 Flashcards

1
Q

What are the 3 signals required for activation of T cells by APCs?

A 
APC gets antigen -> draining LN
1. MHC2 + TCR (CD4)
MHC 1 + Tc (CD8)
2. Costim B7 on APC + CD28 on T cell
3. T cell produce IL2 that act paracrine to turn it on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the purpose of induction chemotherapy for transplant?

A

Reduce acute rejection

Deplete T cell so can’t respond to the donor antigens

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

What are the 2 induction agents that deplete T cells?

A

ATG = anti-thymocyte globulin

Alemtuzumab

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

What is the induction agent that does not deplete T cells?

A

Basiliximab - Ab vs IL 2 receptor

No signal 3 for T cell activation

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

What are the 2 toxicities of ATG therapy?

A

TCP
Leukopenia
AKA drop platelets and T cells… duh… common SE to all these drugs
So you’re watching for infection - prophylactic antibiotics

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

What are your 2 drugs of choice for initial immuno-suppression in setting of transplant?

A

Calcineurin inhibitors
1. Cyclosporine
2. Tacrolimus
Mechanism = prevent IL 2 transcription

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

Toxicity of both calcineurin inhibitors

A

Nephrotox - if use this for immune suppression in transplant of other organs, develop CKD over time
↑K
↓Mg + PO4
Thrombotic microangiopathy

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

2 SE tacrolimus

A

Alopecia - can’t tack on that lost hair!

**Post-transplant diabetes

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

SE cyclosporine

A

Gingival hyperplasia

↑ hair - male pattern

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

What is the normal fxn of calcineurin?

A

TCR gets bound - activates calcineurin to turn NFAT-P = NFAT

NFAT required for IL2 transcription

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

Architecture changes to kidney on calcineurin inhibitors

A

Stripes of fibrosis

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

Mechanism of anti-metabolite agents

A

Inhibit T cell prolif by blocking nucleotide synthesis

Aka stop G1 -> S progression (after IL2 binds - activates TOR - then would normally undergo cell cycle)

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

What are the 2 anti-metabolites you need to know? What is the difference in their mechanism?

A

Azathioprine = “azothio-purine” = X purine recycling/synthesis
vs
Mycophenolate mofetil = MMF = inhibits de novo purine synthesis

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

Why do you avoid azathioprine in gout patients?

A

Azathioprine is broken down by xanthine oxidase
Your gout pt is probably on ALLOPURINOL = xanthine oxidase inhibitor to ↓uric acid levels
Gout pts can’t breakdown azathiprine = ↑SEs

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

Biggest SE/concern with azathioprine

A

Sensitize to UV radiation

↑↑risk skin cancer

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

Mechanism of glucocorticoids for immune suppression

A

XNfKB - X IL2

↓T + B cell production

17
Q

SE glucocorticoids

A

**Osteoporosis
**Diabetes (hyperglycemia)
AVN
Cushing features: central obesity, muscle breakdown
Cataracts
HTN

18
Q

What is steroid withdrawl vs avoidance?

A

It is easier to pull pts off steroids who have been on them short term
If you have long term users, higher change of rejection if take off glucocorticoids

19
Q

What is the mechanism of mTOR inhibitors?

A

Block T cell response to binding IL 2 (aka progressing into cell cycle)

20
Q

2 mTOR inhibitors

A

Sirolimus = rapamycin

Everolimus

21
Q

SE sirolimus

A

**Delayed wound healing - not right after OR
Insulin resistance
↑Cholesterol
TCP, leukopenia, anemia…

22
Q

Mechanism of belatacept

A

Block costim via CD28 (2nd signal)

23
Q

SE belatacept

A

↑post-transplant lymphoma - esp CNS lymphoma

Not going to give to a sero-neg EBV pt

24
Q

Initial immune suppression regimen in adult kidney transplant pts

A

Tacrolimus = calcineurin I
+
MMR = mTOR block

25
Q

Induction agent used at time of kidney transplant

A

T cell depleters: ATG or Alemtuzumab

26
Q

How are the calcineurin Is broken down - which enzyme? Which drugs would ↑ vs ↓ their metabolism?

A 
Tacrolimus + cyclosporine via CYP3A4 in liver 
Drugs that ↓enzyme = ↑immune suppression
1. CCBs = dilitizaem, verapamil
2. Azoles
3. Antibiotics - mycins
Drugs that ↑enzyme = ↓IS *worry about rejection*
1. Rifampin (rifle)
2. Phenytoin (seizures)
3. Phenobarbital (barbituate)
4. St. John's Wart
27
Q

How treat rejection?

A

Intensify IS:
+ Prednisone
Thymoglobulin
IVIg if Ab mediated rejection

28
Q

Treat transplant pt with CMV infection

A

Present w/ flu-like symptoms
Stop anti-prolif agent
Immune system will take care of it

29
Q

Treat BK/JC virus in transplant pt

A

Presentation of BK is asymptomatic - watch Cr for ↑
Prevention = monitoring
↓IS

30
Q

Which drugs do you use in pregnancy for IS?

A

Cyclosporine/tacrolimus
Azathiprine
Prednisone

31
Q

Drug that causes pneumonitis

A

Sirolimus (X mTOR)

32
Q

Drug that causes vision changes

A

Cataracts = glucocorticoids

33
Q

Drug class most likely to cause neutropenia/leukopenia

A

All but esp anti-metabolites

- Azathiopurine

34
Q

Drug that causes proteinuria + oral ulcers

A

Sirolimus (X mTOR)

P&T Block 5 Renal (30 decks)

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