Transplant Flashcards
AD is a 36 y/o female who recently underwent a liver transplant. Her maintenance immunosuppression included tacrolimus, which she taked every day at 8:00 and 20:00. She’s due to have her tacrolimus level checked today. When would be an appropriate time to draw the tacrolimus level?
a. 12:00
b. 8:30
c. 17:00
d. 10:00
e. 7:30
e
Tacrolimus, as well as other transplant meds, require a trough level for monitoring. This should be drawn just before a dose (usually within 30 minutes of the next dose).
A 64 y/o man underwent kidney transplantation 1 year ago. He takes several immunosuppressive meds including azathioprine, sirolimus, and prednisone for maintenance therapy. Which type of vaccine should be avoided in this patient?
a. Pneumococcal vaccines
b. Live vaccines
c. Subcutaneous vaccines
d. Polysaccharide vaccines
e. Conjugate vaccines
b
Which of the following meds can worsen or cause new-onset diabetes?
a. Azathioprine
b. Cyclosporine
c. Tacrolimus
d. Prednisone
e. Antithymocyte Globulin
b, c, d
A 62 y/o female is admitted to the hospital for an unrelated living-donor kidney transplant. She has a hx of ESRD d/t diabetic nephropathy and has received hemodialysis for the last 2 years. The transplant surgery is performed without complication, and the pt demonstrates good urine output afterward. To help prevent rejection, she’s started on maintenance immunosuppressants. Which of the following meds inhibit T-lymphocyte and B-lymphocyte proliferation by altering nucleotide (purine) synthesis?
a. Belatacept
b. Mycophenolate
c. Prednisone
d. Sirolimus
e. Tacrolimus
b
Which of the following is a BBW of mycophenolate?
a. Decreased fertility in men and women
b. Increased risk of serotonin syndrome
c. Increased risk of psychiatric effects, including suicidal thoughts
d. Risk of fetal harm when administered to a pregnant woman
e. Risk of adrenal suppression with long-term use
d
Mycophenolate has a BBW for increased risk of congenital malformations and spontaneous abortions when used in a pregnant woman. Mycophenolate also decreases the efficacy of PO contraceptives, making this risk higher. Other BBWs include infection risk and risk of lymphoma and skin malignancies.
When is induction immunosuppression given?
a. At the time of transplant
b. When the pt is put on the transplant list
c. Up to 1 year after transplant
d. Indefinitely after transplant
e. Shortly after transplant
a
Induction immunosuppression is given just before or at the time of transplant to prevent acute rejection during the early post-transplant period.
A 32 y/o white female with a hx of T1DM and diabetic nephropathy received a kidney transplant. The pt has been prescribed cyclosporine. Which of the following statements regarding cyclosporine solution is correct?
a. It can’t be diluted with orange juice or apple juice
b. It shouldn’t be administered from a plastic or styrofoam cup
c. It should be stored in the fridge
d. This med can be mixed with grapefruit juice
e. The med should be shaken well before use
b
Which of the following drugs are used for chronic maintenance in transplant recipients?
a. Azathioprine
b. Antithymocyte globulin
c. Everolimus
d. Steroids
e. Tacrolimus
f. Cyclosporine
a, c, d, e, f
Antithymocyte globulin is used for induction, not for maintenance.
Tacrolimus and cyclosporine aren’t used together because of the risk of this additive toxicity:
a. Peripheral edema
b. Gastric perforation
c. Hepatotoxicity
d. Nephrotoxicity
e. Neuropathy
d
Drugs with the same MOA are generally not used together. The use of mycophenolate or another adjuvant allows lower doses of the calcineurin inhibitor, and this lowers the risk of nephrotoxicity. It is still a major risk.
Which of the following should be tested for prior to using belatacept (Nulojix) as maintenance immunosuppression for a pt?
a. HLA-B*1502 allele
b. CYP2C19 deficiency
c. CXCR4 co-receptor
d. Immunity to Epstein-Barr Virus
e. Thiopurine methyltransferase deficiency
d
Belatacept is an infusion given in a medical office. It’s only used in pts with immunity to the Epstein-Barr virus (must be seropositive) d/t a risk for post-transplant lymphoproliferative disorder (PTLD).
A pt picks up an Rx from the pharmacy for tacrolimus capsules to be taken BID. Counseling should include all of the following points:
a. The 2 doses should be taken 12 hours apart.
b. The med is absorbed best when taken on an empty stomach.
c. Monitor BP during tx.
d. Monitor for signs and symptoms of infection during tx.
e. Separate administration from other meds by at least 2 hours.
a, b, c, d
LM is taking azathioprine and several other immunosuppressants to prevent rejection of a lung transplant. Which med interacts with azathioprine?
a. Torsemide
b. Allopurinol
c. Levothyroxine
d. Phenytoin
e. Rifampin
b
Allopurinol will significantly increase the serum concentration of azathioprine. If the pt requires allopurinol therapy, the dose of azathioprine is reduced by 75%.
How does Myfortic differ from CellCept?
a. There’s no difference; CellCept and Myfortic can be used interchangeably
b. Myfortic is a schedule V controlled substance
c. Myfortic is enteric-coated to decrease side effects
d. Myfortic capsules should be stored in the fridge
e. Myfortic is an IV formulation
c
Both are dosed BID and taken on an empty stomach, but Myfortic is a delayed-release tablet that was formulated to decrease diarrhea.
Which of the following is an induction immunosuppressant given prior to transplant to prevent acute rejection?
a. Adalimumab (Humira)
b. Bevacizumab (Avastin)
c. Sirolimus (Rapamune)
d. Basiliximab (Simulect)
e. Cyclosporine (Neoral)
d
Humira and Avastin aren’t used for transplant rejection. Other options are used for maintenance immunosuppression.
