Brainscape's Knowledge GenomeTM

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


See full index

Naplex > Transplant > Flashcards

Transplant Flashcards

1
Q

List the type of blood groups

A
  • Type A
  • Type B
  • Type AB
  • Type O
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the blood type of a person to be considered “universal donor”? Why?

A
  • Type O
  • Type O blood does not cause an immune response when received by people with type A, B or AB blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T/F: People with type O blood will react against type A, B or AB blood so they can only receive type O

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

What is the blood type of a person to be considered “universal receiver”? Why?

A
  • Type AB
  • Type AB blood does not react against type A, B or AB blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

People with type A blood will react against __ or __ blood

Fill in the blanks

A
  1. Type B
  2. Type AB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

People with type B blood will react against __ or __ blood

Fill in the blanks

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

Why tissue typing or crossmatching is performed prior to any transplant?

A
  • To assess donor-recipient compatibility for human leukocyte antigen (HLA) and ABO blood group
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define allograft, isograft and autograft

A

Allograft (AKA homograft)
* Transplant of an organ or tissue from one individual to another

Isograft
* Transplanted organ from a genetically identical donor, such as an identical twin

Autograft
* Transplant in the same patient, from one site to another (e.g., autologous stem cell transplant or skin grafting)

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

When and why induction immunosuppression is given?

A
  • It is given before or at the time of transplant to prevent acute rejection during the early post-transplant period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name the commonly used induction drug

A
  • Basiliximab an interleukin-2 (IL-2) receptor antagonist
  • Only used for prevention. It is not used to treat rejection

IL-2 receptor on activated T-lymphocytes is critical for organ rejection

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

What is alternative to basiliximab? Why is it used?

A
  • Antithymocyte globulin
  • Used for patients with higher risk of rejection as they deplete both mature and immature T-lymphocytes, therefore can be used for both induction and treatment

These drugs are made by injecting human T-lymphocytes into animals and administering the purified antibodies that animals made back into humans

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

Antithymocyte globulin - MOA, brand/generic and SEs

A

MOA:
* Binds to antigens on T-lymphocytes (killer cells) and interferes with their function

Brand/Generic:
* Atgam - Equine
* Thymoglobulin - Rabbit

SEs:
* Infusion-related reactions - fever, chills, pruritus, rash, low BP (particularly common with first dose)

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

How to lessen infusion-related reactions when antithymocyte globulins are used?

A
  • Premedicate with diphenhydramine, acetaminophen and steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Basiliximab - MOA

A

Interleukin-2 (IL-2) receptor antagonist:

  • Chimeric (murine/human) monoclonal antibody that inhibits the IL-2 receptor on the surface of activated T-lymphocytes, preventing cell-mediated allograft rejection

Basiliximab (Simulect)

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

What is the combination of maintenance immunosuppression? Why used?

A
  • Calcineurin inhibitor (CNI) - Tacrolimus is first line
  • Antiproliferative agent - Mycophenolate is first line
  • With or without steroids (typically prednisone) - if low immunological risk, it can be discontinued

– Supressing the immune system by multiple mechanisms through different drug classes is designed to lower toxicity and reduce the risk of graft rejection

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

Systemic steroids - MOA, short/long-term side effects

A

MOA:
* Naturally occuring hormones that prevent or suppress inflammation and humoral immune response

Short-term side effects:
* Fluid retention, upset stomach, emotional instability, insomnia, increased appetite, weight gain, acute rise in BG and BP

Long-term side effects:
* Adrenal supression/Cushing’s syndrome, impaired wound healing, increased BP, diabetes, acne, osteoporosis, impaired growth in children

Typically prednisone is used in this case

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

Antiproliferative agents - MOA, brand/generic, BWs, SEs

A

MOA:
* Inhibit T-lymphocyte proliferation by altering purine synthesis

Brand/Generic:
* Mycophenolate Mofetil (CellCept) - IV only stable in D5W

  • Mycophenolic Acid (Myfortic) - enteric coated to ↓ diarrhea
  • Not interchangeable due to absorption differences
  • Both ↓ efficacy of oral contraceptives

Boxed Warnigs:
* Increased risk of infection
* Increased development of lymphoma and skin malignancies
* Increased risk of congenital malformations and spontaneous abortions when used in pregnancy

Side Effects:
* Diarrhea, GI upset

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

Azathioprine - Warnings

A
  • Patients with genetic deficiency of thiopurine methyltransferase (TPMT) are at increased risk for myelosuppression

Also an antiproliferative agent
Brand names: Azasan, Imuran

19
Q

Calcineurin Inhibitor - MOA, BWs, SEs, monitoring parameters for tacrolimus

A

Tacrolimus (Prograf):
* Do not interchange XL to IR

  • IV administered as a continuous infusion; must use non-PVC bag
  • Take every 12 hours on an empty stomach
  • Avoid alcohol as this is CYP450 3A4 an P-gp substrate

MOA:
* Suppress cellular immunity by inhibiting T-lymphocyte activation

Boxed Warnings:
* ↑ susceptibility to infection; possible development of lymphoma

Side Effects:
* ↑BP, ↑BG, nephrotoxicity, neurotoxicity, hyperkalemia, hyperlipidemia, QT prolongation

Monitoring:
* Specific through level
* Serum electrolytes (K, Phos and Mg), renal fx, LFTs, BP, BG, lipid profile

20
Q

Calcineurin Inhibitor - BWs, SEs, monitoring parameters for cyclosporine and restasis

A
  1. Restasis drops for dry eye
  2. Cyclosporine
    * Modified: Gengraf, Neoral
    * Non-modified: Sandimmune
    * Gengraf/Neoral has greater bioavailability compared to Sandimmune and cannot be used interchangeably

Boxed Warnings:
* Renal impairment

  • ↑ risk of lymphoma and other malignancies, including skin cancer,
  • ↑ risk of infection
  • ↑BP

Side Effects:
* ↑BP,↑BG, nephropathy, hyperkalemia, hypomagnesemia, hirsutism, gingival hyperplasia, edema, neurotoxocity, QT prolongation

Monitoring:
* Through levels

  • Serum electrolytes (K and Mg), renal fx, BP, BG, lipid profile
  • Do not administer oral liquid from a plastic or styrofoam cup
  • Numerous DIs; this is a CYP3A4 inhibitor NS CYP3A4 and P-gp substrate
21
Q

Everolimus - MOA, warnings, SEs, Monitoring

A

MOA:
* Mammalian target of rapamycin (mTOR) kinase inhibitor - Inhibit T-lymphocyte activation and proliferation; may be synergistic with CNIs

Warnings:
* Hyperlipidemia

Side Effects:
* Peripheral edema,
* ↑BP
* Risk of renal and hepatic artery thrombosis (do not use within 30 days of transplant)

Monitoring:
Through levels, Numerous DIs: this is CYP3A4 substrate

Brand name: Zortress

22
Q

Sirolimus - MOA, warnings, SEs, monitoring

A

MOA: Same with mTOR kinase inhibitors

Warnings:
* Impaired wound healing, hyperlipidemia

Side Effects:
* Irreversible pneumonitis/bronchitis/cough (discontinue therapy if this develops), ↑BG, peripheral edema

Monitoring:
* Through levels

  • Tablets and oral solution are nor bioequivalent
  • Numerous DIs: this is CYP3A4 substrate

Brand name: Rapamune

23
Q

Belatacept - MOA, BWs, warnings

A

MOA:
* Binds to CD80 and CD86 to block T-cell costimulation and production of inflammatory mediators

Warnings:
* Treat latent TB prior to use

Brand name: Nulojix

24
Q

What decreases CNI concentration?

Tacrolimus, Cyclosporin

A
  • Tacrolimus and cyclosporin are CYP3A4 and P-gp substrates
  • Cyclosporin inhibits CYP3A4
  • Inducers of either enzyme (e.g., carbamazepine, nafcillin, rifampin) decrease CNI concentration
25
Q

What increases CNI concentration?

Tacrolimus, Cyclosporin

A
  • Inhibitors of CYP3A4 and P-gb increase the CNI concentration (e.g., azole antifungals, diltiazem, erythromycin)
26
Q

What should be avoided when using azathioprine?

A
  • Xanthine oxidase inhibitors (allopurinol or febuxostat)
27
Q

T/F: Avoid grapefruit juice or St. John’s wort with either CNI

A
  • True
28
Q

Caution with additive drugs that raise __ with tacrolimus, steroids, cyclosporineand the mTOR inhibitors

Fill in the blank

A
  • Blood glucose
29
Q

Caution with additive drugs that are __ with tacrolimus and cyclosporin

Fill in the blank

A
  • Nephrotoxic
30
Q

Caution with additive drugs that worsen __ with the mTOR inhibitors, steroids and cyclosporine

Fill in the blank

A
  • Lipids
31
Q

Caution with additive drugs that raise __ with steroids, cyclosporine and tacrolimus

A
  • Blood pressure
32
Q

T/F: Mycophenolate can decrease levels of hormonal contraceptives

A
  • True
33
Q

What are highest incidence of adverse effects of cyclosporin and tacrolimus?

A
  • Nephrotoxicity
  • Worsening or new-onset of diabetes
  • HTN
34
Q

What are highest incidence of adverse effects of steroids?

A
  • Worsening or new-onset of diabetes
  • HTN
35
Q

What are highest incidence of adverse effects of mTOR inhibitors?

A
  • Worsening lipid panels
36
Q

What are symptoms of infection?

A
  • Fever of 100.4 F (38 C) or higher (lower if elderly, chills
  • Cough, more sputum or change in color of sputum, sore throat
  • Pain with passing urine, ear or sinus pain
  • Mouth sores or wound that does not heal

All transplant recipients must self-monitor for these symptoms

37
Q

How is acute rejection of the transplanted organ arises?

A
  • Arises from either T-cell (cellular) or B-cell (humoral or antibody) mediated mechanisms
  • Distinguishing the type of rejection is determined via biopsy
38
Q

What is the initial approach to treat acute cellular rejection (ACR)?

A
  • The administration of high-dose steroids and increased levels of maintenance immunosuppression
39
Q

How are opportunistic infections caused?

A
  • Caused by organisms that are everywhere in the environment rarely cause disease in patients with a functional immune system (immunocompetent)
  • Prophylaxis is essential
40
Q

__ cancer is common after a transplant. __ must be used routinely

Fill in the blanks

A
  • Skin
  • Sunscreen
41
Q

T/F: Many medications that are used to prevent rejectioncan cause metabolic syndrome. These patients are among the highest risk for CVD

A
  • True
42
Q

T/F: Live vaccines can be given post-transplant

A
  • False
43
Q

T/F: Inactivated vaccines can be given post-transplant after 3-6 months

A
  • True
44
Q

What are the important vaccines for transplant recipients?

A

Influenza (inactivated, not live) anually

Pneumococcal vaccine in adults >= 19 years
* PCV13 first (if never received)

  • PPSV23 at lleast 8 weeks later
  • Subsequent doses of PPSV23 for adults at higher risk (5 years after the first PPSV23 dose)

Varicella vaccine
* Vaccine pre-transplant

  • Vaccinate close contacts
  • If a vaccinated household contact develops a rash, they are considered contagious, and must avoid contact with the transplant recipient and contact physician
    • If the transplant patient develops a rash, they need to be seen right away

Naplex (20 decks)

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