Lippincott Chapter 47: Immunosuppressants

Question 1

47.1 A 45-year-old male who received a renal transplant
3 months previously and is being maintained on
prednisone, cyclosporine, and mycophenolate mofetil
is found to have increased creatinine levels and a
kidney biopsy indicating severe rejection. Which of the
following courses of therapy would be appropriate?
A. Increased dose of prednisone.
B. Hemodialysis.
C. Treatment with rabbit antithymocyte globulin.
D. Treatment with sirolimus.
E. Treatment with azathioprine.

Answer 1

Correct answer = C. This patient is apparently undergoing
an acute rejection of the kidney. The most effective treat-
ment would be administration of an antibody. Increasing the
dose of prednisone may have some effect but would not be
enough to treat the rejection. Sirolimus is used prophylacti-
cally with cyclosporine to prevent renal rejection but is less
effective when an episode is occurring. Furthermore, the
combination of cyclosporine and sirolimus is more nephro-
toxic than cyclosporine alone. Azathioprine has no benefit
over mycophenolate

Question 2

47.2 All of the following are reasonable combinations of
immunosuppressive drugs except:
A. Basiliximab, belatacept, mycophenolate mofetil,
and prednisone.
B. Thymoglobulin, cyclosporine, azathioprine, and
prednisone.
C. Tacrolimus, mycophenolate mofetil, and prednisone.
D. Tacrolimus, cyclosporine, and prednisone.
E. Tacrolimus, sirolimus, and prednisone.

Answer 2

Correct answer = D. Tacrolimus and cyclosporine are both
calcineurin inhibitors and have the same mechanism of
action. Immunosuppressive drug regimens should work
synergistically at different places in the T-cell activation
cascade. Additionally, cyclosporine and tacrolimus are
both extremely nephrotoxic and when used together would
cause harm to the patients.

Question 3

47.3 Which of the following drugs used to prevent allograft
rejection can cause hyperlipidemia?
A. Azathioprine.
B. Basiliximab.
C. Belatacept.
D. Mycophenolate mofetil.
E. Sirolimus.

Answer 3

Correct answer = E. Patients who are receiving sirolimus
can develop elevated cholesterol and triglyceride levels,
which can be controlled by statin therapy. None of the other
agents has this adverse effect.

Question 4

47.4 Which of the following drugs specifically inhibits
calcineurin in the activated T lymphocytes?
A. Basiliximab.
B. Tacrolimus.
C. Prednisone.
D. Sirolimus.
E. Mycophenolate mofetil.

Answer 4

Correct answer = B. Tacrolimus binds to FKBP-12, which,
in turn, inhibits calcineurin and interferes in the cascade
of reactions that synthesize interleukin-2 (IL-2) and lead to
T-lymphocyte proliferation. Although basiliximab also inter-
feres with T-lymphocyte proliferation, it does so by bind-
ing to the CD25 site on the IL-2 receptor. Prednisone can
affect not only T-cell proliferation but also that of B cells
and is, therefore, nonspecific. Sirolimus, while also binding
to FKBP-12, does not inhibit calcineurin. Mycophenolate
mofetil exerts its immunosuppressive action by inhibiting
inosine monophosphate dehydrogenase, thus depriving the
cells of guanosine, a key component of nucleic acids