Brainscape's Knowledge GenomeTM

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


See full index

Therapeutics Spring 2015 > Solid Organ Transplantation > Flashcards

Solid Organ Transplantation Flashcards

1
Q

What is the average wait time for a kidney transplant?

A

4 years - long because we have dialysis

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

What is the average wait time for a liver transplant?

A

1 year

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

What is the average wait time for a heart transplant?

A

6 months- more critical

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

What are the 3 kinds of therapy associated with immunosuppression?

A

Induction therapy
Maintenance therapy
Rejection Therapy

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

What is induction therapy?

A

an intense level of immunosuppression at time of transplant

- Can allow delay of nephrotoxic calcineurin inhibitors

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

What is maintenance therapy?

A

Highly individualized therapy

Can be reduced as risk for rejection decreases

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

What is rejection therapy?

A

Used to decrease immune response and prevent allograft damage

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

What are 4 induction therapy agents?

A

Anti-thrombocyte globulin (thymogobulin)
Basiliximab
Alemtuzimab
methylprednisolone

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

What is the brand name of anti-thrombocyte globulin?

A

Thymoglobulin

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

What kind of antibody is thymoglobulin?

A

polyclonal rabbit

Depleting (depletes T cells)

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

What is the mechanism of thymoglobulin?

A

Binds to lymphocytes and causes lysis and depletion of lymphocytes

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

What kind of therapy is thymoglobulin used in?

A

induction and rejection treatment

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

What are some ADE of thymoglobulin?

A 
myelosuppression
anaphylaxis
hypo/hpertension
tachycardia
dyspnea
urticaria 
rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What conditions require dose adjustment for thymoglobulin?

A

thrombocytopenia

leukopenia

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

How do you prevent infusion site reactions?

A

pretreat with acetaminophen, diphenhydramine and steroids

-central line administration/slow infusion rate

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

What are some dosing/administration characteristics of thymoglobulin?

A

IV through central line
Requires 0.22 micron filter
1st dose over 6 hrs, rest over 4hrs

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

What is the brand name of alemtuzumab?

A

Campath

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

What is the mechanism of action of alemtuzumb?

A

Depletes both T and B lymphocytes by binding to CD52 and causing cell lysis

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

What is alemtuzumab’s place in therapy?

A

transplant induction therapy and acute rejection therapy

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

How is alemtuzumab dosed?

A

Single dose at time of transplant (IV)

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

What are some ADEs of alemtuzumb?

A

Infusion related rxns- pretreat

myeosuppression

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

What kind of antibody is alemtuzumab?

A

depleting antibody

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

what kind of antibody is basilixumab?

A

non depleting antibody

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

What is the brand name of basilixumab

A

simulect

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

What is the mechanism of action of basilixumab?

A

IL-2 receptor antagonist by binding to CD25 on T lymphocytes and prevents IL-2 activation and proliferation of t cells.

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

Where is basilixumab’s place in therapy?

A

induction therapy

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

What are some ADEs of basilixumab?

A

not associated with infusion related reactions

hypersensitivity reactions

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

What are some dosing and administration characteristics of basilixumab?

A

2 doses IV, central or peripheral, over 30 min

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

What are 3 types of maintenance immunosuppressants?

A

Calcineurin inhibitors
antiproliferative agents
steroids

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

What kind of maintenance therapy is cyclosporine?

A

calcineurin inhibitor

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

What kind of maintenance therapy is tacrolimus?

A

calcineurin inhibitor

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

What is the mechanism of action of calcineurin inhibitors?

A

Block cell T-cell proliferation by inhaling production of IL-2 and other cytokines

33
Q

What is the place of therapy in calcineurin inhibitors?

A

prevent organ rejection

cornerstone of immunosupression protocols

34
Q

How can cyclosporine be dosed/administered?

A 
IV 1/3 daily dose
cyclosporine - continuous or BID infusion
tacrolimus- continuous infusion
PO- q 12hrs for IR, 24 hrs for ER
SL_ tacrolimus only every 12 hrs
35
Q

How are concentrations of calcineurin inhibitors monitored?

A

trough blood concentrations every 12 hours

- goal dependent on organ, time post transplant, protecols

36
Q

What are the ADEs of calcineurin inhibitors?

A 
dose related nephrotoxicity
electrolyte abnormalities
neurotoxicity- tremors, HA, neuropathy, seizures
Cosmetic effects
metabolic- HTN, HLD, hyperglycemia
37
Q

What kind of cosmetic effects does cyclosporine cause?

A

hirsuitism, ginvival, hyperplasia

38
Q

What kind of cosmetic effect does tacrolimus cause?

A

alopecia

39
Q

What kind of electrolyte abnormalities can tacrolimus cause?

A

hyperkalemia

hypomagnesemia

40
Q

What drugs increase the concentration of calcinurine inhibitors?

A 
Azole antifungals
macrolide antibiotics 
calcium channel blockers
anti-retrovirals
grapefruit juice
*CYP inhibitors
41
Q

What drugs decrease the concentration of calcinurine inhibitors?

A 
phenytoin
phenobarbital 
rifampin
rifabutin
St. John's Wort
42
Q

Which CYP enzyme metabolizes calcineurin inhibitors?

A

CYP3A4

43
Q

Which drug class does mycophenolate mofetil belong too?

A

antiproliferative agents

44
Q

what is the brand name of mycophenolate mofetil?

A

CellCept

45
Q

what class of drugs does mycophenolte sodium belong too?

A

antiproliferative agents

46
Q

what is the brand name of mycophenolate sodium?

A

Myfortic

47
Q

What class of drugs does azthioprine belong too?

A

antiproliferative agents

48
Q

what is the brand name of azthioprine?

A

Imuran

49
Q

what is the dosing and administration of mycophenolate mofetil?

A

same IV and PO q 12hrs

50
Q

What is the dosing and administration of mycophenolate sodium?

A

Only PO q 12 hrs

51
Q

What is the dose conversion betweek myco. mofetil and myco. sodium?

A

720 mg sodium = 1000 mg mofetil

52
Q

What is the dosing and admin of azathioprione?

A

same dose IV and PO q 24 hrs

53
Q

What are the ADEs of antiproliferative agents?

A

N/V, diarrhea, abdominal pain

anemia, leukopenia, thrombocytopenia

54
Q

What are ADEs of azathioprine specifically?

A

hepatotoxicity, pancreatitis

55
Q

How can we deal with GI side effects of antiproliferatives?

A

reduce dose, divide doses, take with food, start low and increase dose as needed

56
Q

Which antiproloferative has a REMS program?

A

mycophenolate

for pregnancy

57
Q

What are some drug interactions with mycophenolate?

A

iron, Mg, Al, Cholestyramine
all decrease the absorption of mycophenolate
separate by 2-4 hours

58
Q

What are some drug interactions with azathioprine?

A

Allopurinol
inhibits xanthine oxidase (used in azthioprine metabolism)
increases risk of bone marrow suppression

59
Q

By how much does azathioprine need to be increased or reduced by when taking concurrently with allopurinol?

A

Reduce by 50-75%

60
Q

What are the two corticosteroids used in immunosupression therapy?

A

methylprednisolone -Solu-Medrol

prednisone- Deltasone

61
Q

What is the mechanism of action of steroids?

A

block cytokine activation and interfere with cell migration, recognition and has cytotoxic effector mechanisms

62
Q

What is the dosing/admin of steroids?

A

usually begins IV methylpred then tapered to PO prednisone then tapered to minimally effective dose

63
Q

What are the metabolic ADEs of corticosteroids?

A

HTN
HLD
hyperglycemia
osteoporosis

64
Q

What are some cosmetic ADEs of corticosteroids?

A 
moon face
buffalo hump
thin skin
cataracts
increased appetite
weight gain
hirsutism
65
Q

What are the psychological effects of corticosteroids?

A

insomnia

mood swings

66
Q

What drug class does sirolimus belong too?

A

rapamycin inhibitors

67
Q

what drug class does everolimus belong too?

A

rapamycin inhibitors

68
Q

What is the mechanism of rapamycin inhibitors?

A

inhibits the cellular response to IL-2 and progression of the cell cylce

69
Q

What is the place in therapy of rapamycin inhibitors?

A

in place of CNI to decrease nephrotoxicity

slow progression of vasculopathy after heart transplant

70
Q

What are the dosing/admin of sirolimus?

A

QD dosing
May or may not use a loading dose
Only PO
Dose based on serum concentrations - 24 hr trough

71
Q

What is the dosing/admin of everolimus?

A

BID dosing
only PO
dose based on serum concentrations- 24 hr trough

72
Q

What are some ADEs of rapamycin inhibitors?

A 
myelosuppression
hypercholesterolemia
hypertriglyceridemia
delayed wound healing
mouth ulcers 
reversible interstitial pneumonitis
rash/acne/diarrhea/arthralgia
proteinuria
73
Q

What class of drugs does Belatacept (Nulojix) belong too?

A

costimulation blocker

74
Q

What is the mechanism of action of belatacept?

A

binds to CD80/86 pm APC cells blocking CD28 costimulation of T cells

75
Q

When is belatacept used in therapy?

A

prevent rejection of kidney in patients who are positive for EBV
replace CNI in conjunction with an antiproliferative and steroids

76
Q

What is the dosing/admin of belatacept?

A

Initially- 10mg/kg IV day of transplant prior to surgery, on day 5, and end of weeks 2, 4, 8, 12
Maintenance- 5mg/kg at end of week 16 and q 4 weeks IV over 30 min

77
Q

What are the ADEs of costimulation blockers?

A 
Anemia, leukopenia
N/V, diarrhea, constipation
peripheral edema
fever, cough, HA
HTN
Hyperkalemia, hypokalemia
infection
malignancy
78
Q

What are the 4 kinds of rejection?

A

hyperacute
acute cellular
antibody mediated
chronic

Therapeutics Spring 2015 (12 decks)

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