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NAPLEX Special Populations > Transplant > Flashcards

Transplant Flashcards

1
Q

Why can’t basiliximab (Simulect) be used as a treatment for organ rejection?

A
  • Basiliximab is an interleukin-2 (IL-2) receptor (expressed on activated T-cells and is a critical pathyway for activting T-cells to attack and reject the organ) antagonist.
  • Does not deplete immature T-cells.
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2
Q

Antithymocyte Globulin MOA

Atgam (equine), Thymoglobulin (rabbit)

A

Bind to antigens on T-cell and causing T-cell depletion of both mature and immature T-cells.

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3
Q

Which immusuppressant can be used for both induction and treatment of organ rejection?

A

Antithymocyte Globulin

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4
Q

Antithymocyte globulins are indicated in patients who are

A

at higher risk of rejection

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5
Q

Which immunosuppressant requires premedication?

A

Antithymocyte globulins

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6
Q

Calcineurin Inhibitor MOA

Tacrolimus (Prograf), Cyclosporine (Gengraf, Neoral, Sandimmune)

A

Suppress cellular immunity by inhibiting T-cell activation.

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7
Q

Which medication is an alternative treatment option if patients experience significant side effects such as nephrotoxicity from a calcineurin inhibitor?

A

Belatacept
Use in EBV seropositive patients only

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8
Q

Belatacept MOA

A

Inhibits T-cell activation and production of inflammatory mediators by binding to CD80 and CD86 on antigen presenting cells, blocking costimulation with CD28 on T-cells.

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9
Q

Which medication is used as an alternative to antiproliferative agent?

A

mTOR kinase inhibitors

Everolimus, Sirolimus

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10
Q

Mammalian target of rapamycin (mTOR) kinase inhibitor MOA

A

Inhibit T-cell activation/proliferation.

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11
Q

Antiproliferative Agent MOA

Mycophenolate Mofetil (CellCept), Mycophenolic Acid (Myfortic), Azathioprine

A

Inhibit T- and B-cell proliferation by altering purine nucleotide synthesis.

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12
Q

Common side effects of both tacrolimus and cyclosporine

A
  • Hyperkalemia
  • Hypomagnesemia
  • Hypertension
  • Hyperlipidemia
  • Hyperglycemia
  • Infections
  • Nephrotoxicity
  • Neurotoxicity
  • QT prolongation
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13
Q

Unique side effects of cyclosporine

A
  • Gingival hyperplasia
  • Hirsutism
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14
Q

Unique side effects of tacrolimus

A

Alopecia

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15
Q

Can you exchange Sandimmune with Neoral without prescriber’s approval?

A

No
* Non-modified (Sandimmune) formulation and modified (Neoral and Gengraf) formulation are not AB-rated.
* Modified formulation has greater bioavailability compared to the non-modified formulation.

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16
Q

Calcineurin inhibitor drug interactions

A
  • Cyclosporine and tacrolimus are substrates of CYP3A4 and P-gp
  • Cyclosporine is also an inhibitor of CYP3A4

Avoid grapefruit

17
Q

Which immunosuppressant requires non-PVC bag and tubing for IV administration?

A
  • Tacrolimus
  • Cyclosporine
18
Q

Which immunosuppressant requires genetic testing for TPMT prior to initiation?

A

Azathioprine

Patients w/ genetic deficiency of TPMT are at increased risk for myelosuppression

19
Q

Which immunosuppresants are only available through REMS program?

A
  • Mycophenolate mofetil
  • Mycophenolic acid
20
Q

Which immunosuppresants can decrease efficacy of oral contraceptives?

A
  • Mycophenolate mofetil
  • Mycophenolic acid
21
Q

Unique side effects of antiproliferative agents

A
  • Diarrhea
  • GI upset
22
Q

Common side effects of mTOR kinase inhibitors

Everolimus, Sirolimus

A
  • Metabolic syndrome (hyperlipidemia, hyperglycemia, hypertension)
  • Imapired wound healing
  • Peripheral edema
23
Q

mTOR kinase inhibitor drug interactions

A

Everolimus and sirolimus are substrates of CYP3A4 and P-gp

24
Q

What test should be done prior to the initiation of belatacept?

25
Q

Which medication is an alternative treatment option to myophenolate mofetil if the patient wants to become pregnant?

A

Azathioprine

26
Q

List the induction immunosuppressants

A
  • Basiliximab
  • Antithymocyte globulin
  • High-dose IV steroids
27
Q

List the maintenance immunosuppressants

A
  • Calcineurin inhibitors
  • Adjuvant medications given with a CNI: antiproliferative agents or mTOR inhibitors
  • Steroids at lower or tapering doses
28
Q

Do not use azathioprine with

A

xanthine oxidase inhibitors (allopurinol, febuxostat)

29
Q

Which maintenance immunosuppressants have the highest incidence of nephrotoxicity?

A
  • Tacrolimus
  • Cyclosporine
30
Q

Which maintenance immunosuppressants have the highest incidence of worsening or new-onset diabetes?

A
  • Tacrolimus
  • Cyclosporine
  • Steroids
31
Q

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

A
  • mTOR inhibitors
  • Steroids
  • Cyclosporine
32
Q

Which maintenance immunosuppressants have the highest incidence of hypertension?

A
  • Tacrolimus
  • Cyclosporine
  • Steroids

NAPLEX Special Populations (5 decks)

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