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Renal/Resp > Renal Pharm pt2 > Flashcards

Renal Pharm pt2 Flashcards

1
Q

pharmacokinetics predisolone

A

action take >8hours

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2
Q

benefits of mTOR inhibitor sirolimus over calcineurin inhibitors Cyclosporine, tacrolimus

A

prophylaxis against cellular jrection

less vasoconstriction

no acute/chronic renal insuffciency

down regu of TGF-B+ PDGF > less interstial fibrosis

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3
Q

interleukin 2 receptor abx

A

daclizumab (95% human)

Basiliximab (75% human)

alemtuzmab (humanized)

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4
Q

drug interaction sirolimus

A

CYP3A4 inducers - Rifampin

CYP450 inhibitors - itraconazole, ketoconazole

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5
Q

___- may potentiate adverse events with calcineurin inhibitors

A

prednisolone

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6
Q

indications belatacept

A

renal transplant for patients seropos for ebstein Barr

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7
Q

indicated drug class in membranous nephropathy

A

ACEi, ARB

cotricosteroids, immunosuppresants

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8
Q

monitoring needed for mycophenolate mofetile

A

CBC to monitor hematologic side effects

GI side effects common when dose >1g bid > reduce dose

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9
Q

pharmacokinetics and side effects belatacept

A

long half life - 8-10-days

hypersensitivity

lymphoproliferative if no prior exposure to ebstein barr

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10
Q

pharmacokinetics taccrolimus

A

or or IV

more water soluble than cyclosporine

variable half -lfie

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11
Q

pharmacokinetics basiliximab

A

long half life (1 week)

given prior to surgery and 4 days following

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12
Q

3 path ot immunosuppression

A

Calcineurin

Mtor Pathway

Cell cycle pathway (antimetabolites)

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12
Q

calcineurin inhibitors

A

cyclosporine

tacrolimus

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12
Q

side effects cyclosporin

A

nephrotoxicity - vasoconstrition, induce TGFB, fibrosis+atrophy)

HTN+fluid retension

Hepatic dysfunction

tremor, headache, fatigue

Hypertrichosis (hair growth)

gum hypertrophy

hyperlipidemia, hyopmagnesmia, hypokalemia

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12
Q

pharmacokinetics mycophenolate mofetil

A

oral or IV

liver metab

long half-life - 18 hours

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12
Q

interaction with mycophenolate mofetil

Rifampin, phenobarbital, phenytoin

A

decrease MPA levels

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12
Q

interaction with mycophenolate mofetil

corticosteroids, cyclosporine

A

decrease MPA levels

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12
Q

indicated drug class in IgA nephropathy

A

ACEi

corticosteroids or immunosuppresents

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12
Q

indicated drug clase in focal segmental glomerulosclerosis

A

ACEi

corticosteroids, immunosuppresants

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13
Q

monitoring needed for azathioprine

A

complete blood count to monitor hematologic side effects

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15
Q

side effects sirolimus

A

Edema, ascities

tachycardia, HTN

hyperlipidemia, hypokalemia, hypophos

Rash

Lymphocele > can cause ereteric compression in transplant

16
Q

mTOR inhibitor

A

sirolimus

17
Q

death post kidney transplant causes

A

Infection

CVD

Malignancy

18
Q

issue with antiacids in calcineurin inhibitors

A

mg and aluminum antiacids inhibit abs

should wait until 2hrs after calcineurin inhibitor dose

20
Q

interaction with mycophenolate mofetil

antacids, cholstyramine, sevelamer, feso4

A

decrease MPA levels

21
Q

indicated drug class in Neprhotic syndrome

A

ACEi, ARB

24
Q

pharmacokinetics sirolimus

A

oral

abs modulated by p-glycoproteins

metabolized by CYP450

very long half life (60hours)

25
Q

higher impact on lipid levels, cyclosporine or tacrolimus?

A

cyclosporine greater

26
Q

risk of HMG-CoA reductase inhibitors (statins) with calcineurin inhibitors (Tacrolimus, cyclosporine)

A

increased risk of rhabdomyolysis

bone marrow suppression

27
Q

costimulator Cd80 and Cd86 blocker

A

belatacept

29
Q

side effects tacrolimus

A

pleual effusion

cardial effusion

cardiomyopathy in children

30
Q

mechanism calcineurin inhibitors (Cyclosporine + tacrolimus)

A

bind to cyclphilin (cyclosporine) or FBKP12 (tacrolimus)

complex binds and inhibits calcineurin

inhibits transcription of Il-2 > inhibit Tcell activation and prolif

31
Q

therapeutic action prednisolone

A

inhibit proinflam like NF-kB

activate anti-inflam genes via histone acetlyation

reduce T-cell prolif and increase Tcell apop

reduce Tcell activation, b-cell pro-lif

32
Q

mechanism+metabolism azathioprine

methotrexate

cyclophosphamide

A

metabolized to 6mercaptopurine>TIMP in liver

TIMP decreases synthesis of DNA precursors

block CD28 costim of Tcells

33
Q

pharmacokinetics Azathioprine

A

oral

short half life (3-5 hours)

metabolized to TIMP in liver

34
Q

mechanism of aaction sirolimus

A

binds FKBP12 > mdoulates activity of mTOR

inhibits IL-2 induced cell progression from G1 to S phase

35
Q

drug interactions azathioprine

A

allopurinol > decrease 6 mercaptopurine metabolism,

must reduce azathioprine dose by 75% if used together

36
Q

antiproliferative antimetabolitte

A

mycopehnolate mofetil

37
Q

side effects azathioprine

A

bonemarrow supression, leucopenia, thrombocytopenia

hypersensitivity reactions

opportunistic infection

alopecia

small risk of lymphomas

38
Q

side effects mycophenolate mofetil

A

leucopenai, thrombocytopenia, anemia

HTN edema, tachycardia (electrolytes)

dypsnea, cough

opportunistic infections

lymphoproliferative disease

skin cancer

39
Q

purine analogs antiproliferative agents

block CD28 co-stimulation of Tcells

A

Azothioprine

cyclophosphamide

methotrexate

40
Q

drug interactions cyclosporing

A

nephrotoxic drugs - NSAIDs, aminoglycosides, antimicrobials

**CYP3A3 inducers - **phenytoin, carbamazepine

**CPY450 inhibitors **- erythromycin, ketoconazole

41
Q

side effects basiliximab

A

hypersensitivity reactions

42
Q

critical consideration with induction agents in kidney rejections

A

check fluid volume status

43
Q

pharmocokinetics cyclosporine

A

or or IV

concentrates in liver, kidney, spleen, marrow

metabolized by CYP3A4 in liver

27 hour halflife

45
Q

interaction with mycophenolate mofetil

tacrolimus, sirolimus

A

no change in MPA levels

46
Q

induction agents to combat kidney transplant rejection

A

muronomab

anti-thymocyte globulin (deplete circulating lymphocytes)

daclizumab (IL-2 receptor)

basiliximab (IL-2 receptor)

alemtuzumab (IL-2 receptor)

FTY-720 - lymphocyte homing

47
Q

side effects prednisolone

A

acne

cushings face

hirsutism

mood disorder

HTN, glucose intolerance

cataracts

osteoporosis

growth retardation

48
Q

indicated drug class in lupus nepritis

A

class V corticosteroids

49
Q

mechanism mycophenolate mofetil

A

competive/reversible inhibition of IMPDH > rate limiting de-novo purine synth

lymphocytes dependent on denove pathway > inhibits B and T lymphocyte prolif

Renal/Resp (43 decks)

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