Transplant Flashcards
Which of the following are correct brand names for everolimus? (Select ALL that apply.)
Answer
A Afinitor B Rapamune C Zortress D Myfortic E Nulojix
A
Afinitor
C
Zortress
SJ, a 54 year-old African American male, presented with severe hypertension and renal failure. SJ underwent a renal transplant and was discharged on tacrolimus and prednisolone. SJ developed seizures from the use of tacrolimus and was changed to cyclosporine. Which of the following side effects are likely with cyclosporine therapy?
Answer
A Elevated blood glucose B Nephrotoxicity C QT-prolongation D Alopecia E Hypotension
A Elevated blood glucose B Nephrotoxicity C QT-prolongation
Incorrect
Renal dysfunction and hypertension are the most common concerns with the use of cyclosporine. Drug interactions are a significant concern.
A pharmacist will counsel a patient beginning CellCept therapy. Which of the following counseling points are correct regarding mycophenolate? (Select ALL that apply.)
Answer
A
Take with a high fat meal.
B
Do not take antacids or multivitamins at the same time. These need to be separated by at least two hours. Do not take with Questran or Welchol.
C
If the patient cannot tolerate the medicine on an empty stomach, he/she can take with a light meal if less than 300 calories.
D
If you miss a dose and remember within 4 hours of the scheduled time, take the does. If > 4 hours, skip that dose.
E
If the patient is unable to swallow the Cellcept capsule, it can be opened and the contents sprinkled on applesauce.
B
Do not take antacids or multivitamins at the same time. These need to be separated by at least two hours. Do not take with Questran or Welchol.
D
If you miss a dose and remember within 4 hours of the scheduled time, take the does. If > 4 hours, skip that dose.
Incorrect
If the patient is not able to swallow tablets or capsules, the healthcare provider can prescribe an oral suspension. Do not open CellCept capsules.
A female patient with end stage renal disease secondary to hypertension has been using Fosamax, erythropoietin, cholecalciferol, cyclosporine, Coreg, prednisone and hydrocodone. Since the patient began taking this regimen she developed hypertension. Which of the medications could be contributing to increased blood pressure levels?
Answer
A
Prednisone, erythropoietin, alendronate, hydrocodone
B
Prednisone, erythropoietin, alendronate, cyclosporine
C
Prednisone, cyclosporine, hydrocodone
D
Prednisone, cyclosporine, cholecalciferol
E
Prednisone, cyclosporine, erythropoietin
E
Prednisone, cyclosporine, erythropoietin
Which types of cancer are normally suppressed by a healthy immune system, and are therefore higher risk in transplant patients who are receiving strong immunosuppressant drugs?
Answer
A Lymphoma, osteosarcoma B Prostate cancer, breast cancer, cervical cancer C Osteosarcoma, melanoma D Melanoma, lymphoma E Liver cancer Correct In addition to the cancer risk, the skin of patients taking transplant drugs will burn more easily. Transplant recipients need to protect their skin from the sun.
D
Melanoma, lymphoma
Correct
In addition to the cancer risk, the skin of patients taking transplant drugs will burn more easily. Transplant recipients need to protect their skin from the sun.
All of the following warnings apply to mycophenolate except:
Answer
A
Patients receiving immunosuppressive regimens involving combinations of drugs, including CellCept, are at increased risk of developing lymphomas and other malignancies, particularly of the skin.
B
Mycophenolate can decrease efficacy of oral contraceptives.
C
Oversuppression of the immune system can also increase susceptibility to infection, including opportunistic infections, fatal infections and sepsis.
D
Patients using mycophenolate should be monitored for symptoms of leukocytosis.
E
This drug is Pregnancy Category D and can cause fetal harm when administered to a pregnant woman.
D
Patients using mycophenolate should be monitored for symptoms of leukocytosis.
Incorrect
Monitor patients for leukopenia (low white blood cell counts) not leukocytosis (high white blood cell counts). Symptoms of infection could indicate a low white blood cell count. Patients should be seen right away if they experience symptoms of infection: fever, chills, sore throat, cough or unexplained bruising or bleeding.
JJ is taking Myfortic to prevent organ rejection of a kidney transplant. Which of the following statements regarding Myfortic is correct?
Answer
A
CellCept and Myfortic can be used interchangeably.
B
This medication is safe to take during pregnancy.
C
Mycophenolic acid is Myfortic.
D
Myfortic capsules should be stored in the refrigerator.
E
Myfortic cannot be used with tacrolimus.
C
Mycophenolic acid is Myfortic.
Mycophenolic Acid (Myfortic) cannot be interchanged with CellCept. They are both dosed twice daily, and taken on an empty stomach, but Myfortic has delayed release and was formulated to decrease diarrhea.
Choose the correct statement/s regarding cyclosporine formulations: (Select ALL that apply.)
Answer
A
Sandimmune can be interchanged with Neoral but not with Gengraf.
B
Cyclosporine is available as Neoral capsules, which have improved absorption.
C
A formulation of cyclosporine is available to treat excessive lacrimation.
D
A formulation of cyclosporine called Restasis is available to treat dry eyes; if used, the patient must be diligent to avoid contamination due to eye infection risk.
E
Cylosporine (and tacrolimus) require monitoring of the trough levels.
B
Cyclosporine is available as Neoral capsules, which have improved absorption.
D
A formulation of cyclosporine called Restasis is available to treat dry eyes; if used, the patient must be diligent to avoid contamination due to eye infection risk.
E
Cylosporine (and tacrolimus) require monitoring of the trough levels.
Incorrect
Neoral capsules have better absorption; they are not interchangeable with Sandimmune. Sandimmune cannot be interchanged with other formulations.
A 55 year-old female patient received a kidney transplant. She required tacrolimus for chronic immunosuppression. The tacrolimus trough blood levels remained stable over several years. In the fourth year after transplant the patient expired from complications of an acute graft rejection. The hospital pharmacist reviewed the bag of medicines brought in from the home and found the following products: DHEA, women’s multivitamin, B vitamin complex and St. John’s Wort. What is the likely explanation for the acute graft rejection?
Answer
A
St. John’s Wort increased levels of cyclosporine due to enzyme inhibition.
B
St. John’s Wort decreased levels of cyclosporine due to enzyme induction.
C
St. John’s Wort decreased levels of cyclosporine due to enzyme inhibition.
D
DHEA increased levels of cyclosporine.
E
St. John’s Wort increased levels of cyclosporine due to enzyme induction.
B
St. John’s Wort decreased levels of cyclosporine due to enzyme induction.
Incorrect
St. John’s Wort induces many enzymes and cannot be used with transplant drugs, birth control pills, and other CYP 450 and p-glycoprotein efflux transporter substrates.
A transplant recipient is receiving the maintenance agent belatacept (Nulojix). Which statements concerning belatacept are correct? (Select ALL that apply.)
Answer
A
A silicone-free disposable syringe comes with the drug.
B
Nulojix is available in oral formulation only.
C
Post-transplant lymphoproliferative disorder (PTLD), a condition that can happen when lymphocytes grow out of control due to immunesuppression, can occur with use of belatacept and is a boxed warning for the drug.
D
Patients must have immunity to Epstein Bar Virus (seropositive) to receive belatacept; patients without immunity are at higher risk for PTLD.
E
Patients self-administer Nulojix.
A silicone-free disposable syringe comes with the drug.
C
Post-transplant lymphoproliferative disorder (PTLD), a condition that can happen when lymphocytes grow out of control due to immunesuppression, can occur with use of belatacept and is a boxed warning for the drug.
D
Patients must have immunity to Epstein Bar Virus (seropositive) to receive belatacept; patients without immunity are at higher risk for PTLD.
Incorrect
Belatacept (Nulojix) is an infusion given in a medical office, using the silicone-free disposal syringe that comes with the drug.
A 32 year-old white female with a history of type 1 diabetes and diabetic nephropathy received a kidney transplant. The patient has been prescribed cyclosporine. Which of the following statements regarding cyclosporine solution is correct?
Answer
A
It can be diluted with orange juice or apple juice.
B
It should be administered from a plastic or styrofoam cup.
C
It should be stored in the refrigerator.
D
This medication can also be mixed with grapefruit juice.
E
It is not hepatically metabolized.
A
It can be diluted with orange juice or apple juice.
Correct
Instruct patients to take the prescribed amount of the cyclosporine oral solution from the container using the dosing syringe supplied and transfer the solution to a glass of orange or apple juice, which is preferably at room temperature. Stir well and drink all at once. Do not allow diluted oral solution to stand before drinking. Use a glass container (not plastic). Rinse the glass with more liquid to ensure that the total dose is consumed.
