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NAPLEX 21 > Transplant > Flashcards

Transplant Flashcards

1
Q

People with which type of blood are considered universal donors?

A

Type O

but can only receive type O blood

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2
Q

People with Type A blood will react against what types of blood?

A

Type B and Type AB

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3
Q

People with Type B blood will react against what types of blood?

A

Type A, Type AB

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4
Q

Prior to any transplant, tissue typing or crossmatching is performed to assess donor-receipt compatibility for _______ and ________

A

human leukocyte antigen (HLA) and ABO blood group

a mismatch would lead to acute rejection

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5
Q

An _____ is the transplant of an organ or tissue from one individual to another of the same species with a different genotype

A

allograft; can also be called an allogenic transplant or homograft

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6
Q

A transplanted organ from a genetically identical donor (such as a twin) is called an ____

A

isograft

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7
Q

A transplant in the same patient from one site to another

A

autograft - termed autologous transplant

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8
Q

Induction immunosuppression is given BEFORE or at the time of transplant to …

A

prevent acute rejection during the early post-transplant period

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9
Q

What does induction immunosuppression consist of?

A

a short course of effective IV medication, either a biological drug or monoclonal antibody sometimes combined with high dose IV steroids

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10
Q

What is the most commonly used induction drug?

A

an interleukin2 receptor antagonist - basiliximab

expressed on activated t-lymphocytes and is a critical pathway for activating t lymphocytes to attack and reject the organ

ONLY used for prevention

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11
Q

Patients at a higher risk of rejection can receive…

A

antithymocyte globulin

these drugs are made by injecting human T lymphocytes into animals and then back to humans

*used for both induction and treatment of rejection

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12
Q

This drug is off-label but can be used for induction

A

alemtuzumab

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13
Q

Induction immunosuppression is not required if the transplant is from…

A

an identical twin

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14
Q

Brand: Atgam - equine
Brand: Thymoglobulin - rabbit

A

Generic: antithymocyte Globulin

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15
Q

This drug has a boxed warning for anaphylaxis

A

antithymocyte Globulin

*premedicate (Benadryl, Tylenol, steroids) to lessen infusion-related reactions

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16
Q

Brand: Simulect

A

Generic: basiliximab (IL2 receptor antagonist)

well tolerated

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17
Q

Maintenance immunosuppression is generally provided by the combination of:

A

a calcineurin inhibitor (CNI) +

an anti proliferative agent +/-

Steroids

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18
Q

Why do we use multiple mechanisms through different drug classes?

A

to both lower toxicity risk of the individual immunosuppressants and to reduce the risk of graft rejection

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19
Q

Systemic steroids used

A

Prednisone typically

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20
Q

What drug?

short-term effects include: fluid retention, stomach upset, emotional instability, insomnia, inc appetite, weight gain, acute rib ein blood glucose, and blood pressure

Long term side effects: adrenal suppression/cushing’s, impaired wound healing, inc BP, DM, acne, osteoporosis, impaired growth in children

A

prednisone

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21
Q

These drugs inhibit t lymphocyte proliferation by altering purine synthesis

A

anti proliferative agents

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22
Q

What types of drugs are mycophenolate mofetil, and mycophenolic acid, and azathioprine?

A

anti proliferative agents

S/e: diarrhea, GI upset

NOT INTERCHANGEABLE

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23
Q

Brand: CellCept

A

generic: mycophenolate mofetil

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24
Q

Brand: Myfortic

A

Generic: mycophenolic acid

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25
Q

What is the boxed warning for mycophenolate mofetil, and mycophenolic acid?

A

inc risk of infection, inc development of lymphoma and skin malignancies, inc risk of congenital malformations and spontaneous abortions

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26
Q

mycophenolate mofetil, and mycophenolic acid - which is enteric coated to decrease diarrhea?

A

mycophenolic acid

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27
Q

mycophenolate mofetil, and mycophenolic acid - which is stable in D5W only?

A

mycophenolate mofetil

*these drugs decrease oral contraceptives!

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28
Q

Brand: Azasan, Imuran

A

generic: azathioprine

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29
Q

This drug has warnings for patients with genetic deficiency of thipurine methyltransferase (TPMT_ are at high risk for myleosuppression

A

azathioprine

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30
Q

This drug works by suppressing cellular immunity by inhibiting T lymphocyte activation

A

calcineurin inhibitors

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31
Q

What is an example of a calcineurin inhibitor?

A

tacrolimus, cyclosporine

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32
Q

Brand: Prograf

A

generic: tacrolimus

33
Q

This drug has a boxed warning for increase susceptibility to infection, lymphoma

s/e: inc BP, nephrotoxicity, inc BG, neurotoxicity, hyperkalemia, hyperlipidemia, QT Prolongation

A

tacrolimus

numerous drug interactions too!!! CYP450 3A4 and P-gp substrate

34
Q

What labs need to be monitored with tacrolimus?

A

trough levels

serum electrolytes: K, Phos, Mg; renal function, LFTs, BP, BG, lipid profile

35
Q

Can you interchange XL to IR for tacrolimus?

A

NO!

36
Q

Tacrlimus - IV is administered as a continuous infusion in a what container?

A

non-PVC

37
Q

Brand: Gengraf, Neoral (modified); Sandimmune (non-modified)

A

generic: cyclosporine

38
Q

This drug has boxed warnings for: renal impairment, inc risk of lymphoma, skin cancer, inc risk of infection, inc BP

A

cyclosporine

39
Q

can the non-modified be interchanged with the modified?

A

NO! modified has 20-50% greater bioavailability compared to non-modified

40
Q

This drug’s side effect profile: inc BP, nephropathy, hyperkalemia, hypo magnesia, hirsutism, gingival hyperplasia, edema, inc BG, neurotoxicity, QT Prolongation

A

cyclosporine

41
Q

What labs need to be monitored with cyclosporine?

A

trough levels, serum electrolytes (K, Mg), renal function, BP, BG, lipid profile

42
Q

What drug can you not administer from a plastic or styrofoam cup?

A

cyclosporine

43
Q

What drops can be used for dry eyes?

A

Restasis

44
Q

This drug class inhibit T lymphocyte activation and proliferation, may be synergistic with CNIs

A

mammalian target of rapamycin (mTOR) kinase inhibitors

45
Q

Everolimus
Sirolimus

are examples of what drug class?

A

mTOR kinase inhibitors

46
Q

This mTOR drug can cause peripheral edema, inc BP, and should not be used within 30 days of transplant

A

everolimus

many D/I – 3A4 substrate

47
Q

Brand: Zortress

A

generic: everolimus

48
Q

Brand: Rapamune

A

generic: sirolimus

49
Q

This mTOR drug has warnings for impaired wound healing, hyperlipidemia and side effects are extensive:

irreversible pneumonitis, bronchitis, cough (d/e therapy If this develops), inc BG, peripheral edema

A

sirolimus

D/I – 3A4 substrate

50
Q

Sirolimus - are tablets and oral solution bioequivalent?

A

no!!!

51
Q

This drug binds to CD80 and CD86 to block T cell costimulation and production of inflammatory mediators

A

belatacept

52
Q

Brand: Nulojix

A

generic: belatacept

53
Q

This drug has a boxed warning for increase risk of post-transplant lymphoproliferative disorder (PTLD); use in EBV seropositive patients ONLY

A

belatacept

54
Q

What patients do you use belatacept in?

A

Those that are EBV seropositive!!!

55
Q

This drug has an inc risk of OI, sepsis, and or fatal infection, inc risk of TB… test for latent TB prior to initiation and TREAT latent TB prior to use

A

belatacept

56
Q

What are options for induction immunosuppressants?

A
  • basiliximab
  • antithymocyte globulin in patients at higher risk of rejection
  • maintenance drugs at higher doses
57
Q

What are maintenance immunosuppressants?

A
  • CNIs – tacrlimus > cyclosporine
  • adjuvant medications given with a CNI
    - anti proliferative agents (mycophenolate or azathioprine)
    - mTOR inhibitors (everolimus or sirolimus)
    - belatacept
  • steroids
58
Q

Azathioprine is metabolized by xanthine oxidase. Avoid with which drugs?

A

allopurinol or febuxostat

59
Q

Which drug can dec OC?

A

mycophenolate

60
Q

Avoid grapefruit juice and st john’s wort with either…

A

CNI

61
Q

Caution with additive drugs that are nephrotoxic with

A

tacrolimus and cyclosporine

62
Q

Caution with additive drugs that raise blood glucose with

A

tacrolimus

steroids

cyclosporine

mTOR inhibitors

63
Q

Caution with additive drugs that worsen lipids with

A

mTOR inhibitors

steroids

cyclosporine

64
Q

caution with additive drugs that raise bP with

A

steroids

cyclosporine

tacrolimus

65
Q

What are the three monitoring questions?

A

Is it a sx of drug toxicity, organ rejection, or infection?

66
Q

What are the common symptoms of acute rejection?

A

flu-like symptoms (chills, body aches, nausea, cough, SOB) & organ specific symptoms

67
Q

Which maintenance immunosuppressants have the highest incidence of: nephrotoxicity

A

tacrolimus and cyclosporine

68
Q

Which maintenance immunosuppressants have the highest incidence of: worsening or new diabetes

A

tacrolimus, steroids, and cyclosporine

69
Q

Which maintenance immunosuppressants have the highest incidence of: worsening lipid parameters

A

mTOR inhibitors, steroids, cyclosporine

70
Q

Which maintenance immunosuppressants have the highest incidence of: hypertension

A

steroids, cyclosporine, and tacrolimus

71
Q

ALL transplant recipients must self monitor for symptoms of

A

infection!

Fever of 100.5/38C or higher, chills

cough, more sputum or change in color of sputum, sore throat

pain with passing urine ear or sinus pain

mouth sores or a wound that does not heal

72
Q

Acute rejection of the transplanted organ arises from either

A

T cells (cellular) or B cell (humoral or antibody) mediated mechanisms

both can occur simulataneously !! biopsy needs to be done

73
Q

What is the initial approach to acute rejection?

A

high-dose steroids

74
Q

For _____ rejection, the steroids and increased levels of maintenance immunosuppression are adequate to treat the rejection

A

cellular

[[[humoral rejection is way more complicated… need to remove antibodies and administer IVIG]]]

75
Q

For steroid-resistant rejection, administration of ____ is the next step

A

antithymocte globulin; another option is off-label use of alemtuzumab

76
Q

Can live vaccines be given post-transplant?

A

no!

77
Q

Required vaccines are given pre-transplant if not up to date. Inactivated vaccines can be given post-transplant after ____ months.

Live vaccines cannot be give post transplant

A

3-6m

78
Q

What are important vaccines for transplant patients?

A

flu annually

pneumococcal in adults >19y (PCV13 first if not received, PPSV23 at least 8 weeks later); subsequent doses of 23 should be in 5 years

Varicella vaccine (pre-transplant)

79
Q

Tacrolimus is taken every ___ hours

A

12

and taken on an empty stomach! however, consistency is most important w or without food

NAPLEX 21 (60 decks)

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