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Transplant Flashcards

1
Q

Test that are performed in the donor and recipient before transplant is performed

A

Human leukocyte antigen (HLA)

and ABO blood group

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2
Q

Allograft

A

transplant of an organ or tissue from one individual to another with a different genotype

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3
Q

Which blood type is the universal donor?

A

Type O

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4
Q

Hyperacute rejections

A

Happens w/in hours
Usually in the operating room
organ must be removed ASAP

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5
Q

Induction immunotherapy consist of….

A 
IV agent (biologic or monocloncal antibody)
sometimes combined w/ high-dose IV steroids
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6
Q

Organ transplant complications

A

CVD (drugs cause metabolic syndrome)
Cancer
Incr risk of infection

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7
Q

What cancer is more common in transplant pts?

A

Skin cancer
wear sunscreen daily
calcineurin inhibitors also cause photosensitiviy

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8
Q

General symptoms of acute rejection:

A 
chills
body aches
nausea
cough
SOB

flu like symptoms

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9
Q

transplant drugs that can cause nephrotoxicity

A

tacrolimus

cyclosporine

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10
Q

transplant drugs that can cause worsening/new onset diabetes

A

tacrolimus
cyclosporin
steroids

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11
Q

transplant drugs that cause hypertension

A

steroids
cyclosporine
tacrolimus

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12
Q

Can live vaccines be given to transplant pts??

A

HELL NO

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13
Q

Transplant pts are at increased risk for varicella, should they receive the vaccine?

A

They should receive it prior to transplant only

varicella vaccine is live

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14
Q

Pneumococcal vaccine recommendations

A

for adults 19 and older:

PCV13 fisrt
PPSV23 (at least 8 weeks later)

then PPSV23 every 5 years per most facilities

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15
Q

MOA of antithymocyte globulin

A

bind to antigens on T-lymphocytes (killer cells)

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16
Q

antithymocyte globulin brand names

A

ATGAM (made from horses)

Thymoglobulin (made from Rabbit)

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17
Q

antithymocyte globulin side effects

A

infusion-related reactions (fever, chills, rash, hypotension)
leukopenia
thromobocytopenia

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18
Q

Meds used to pre-medicate for antithymocyte globulin infusion reaction:

A

Benadyrl
APAP
Steroids

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19
Q

basiliximab MOA

A

IL-2 receptor antagonist

binds to IL-2 receptors on activated t-lymphocytes

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20
Q

basiliximab brand

A

Simulect

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21
Q

basiliximab and antithymocyte globulin can both be used to treat organ rejection (t/f)

A

False

Only antithymocyte globulin can be used for rejection treatment

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22
Q

Preferred induction agent

A

basiliximab (better side effect profile)

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23
Q

basiliximab dosing

A

20 mg IV post-op day 1

repeat dose 4 days after transplant

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24
Q

Drugs used for maintenance therapy:

A 
Steroids (prednisone)
Antiproliferative agents (mycopehnolate)
Calineurin inhibitors (tacrolimus)
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25
Cellcept
mycophenolate mofetil
26
Myfortic
mycophenolic acid
27
Cellcept/Myfortic boxed warnings
incr risk of infection incr risk of lymphoma and skin cancers congenital abnormalties in pregnancy
28
Cellcept/Myfortic side effects
diarrhea GI upset vomiting leukopenia
29
Cellcept/Myfortic administration
take BID on an empty stomach
30
which form of mycophenolate is available IV?
CellCept IV
31
MOA of mycophenolate/azathioprine:
inhibit t cell proliferation by altering purine synthesis
32
azathioprine brands
Imuran | Azasan
33
azathioprine side effects
n/v/d myelosuppression rash incr LFTs
34
azathioprine renal dosing
crcl < 50
35
Calcineurin inhibitors MOA
inhibit t-lymphocyte activation
36
Tacrolimus brands
Prograf (usually given BID) Astagraf XL Envarsus XR
37
usual tacrolimus initial dose
0.1-0.2 mg/kg/day
38
Tacrolimus side effects
``` htn nephrotoxictiy hyperglycemia neurotoxicity hyperkalemia hypomagnesemia QT prolongation ```
39
what levels of Tacrolimus are measured?
trough levels | goal levels vary by pt
40
Tacrolimus metabolism
3A4 p-gp substrate
41
Tacrolimus admin with food?
Prograf: with or w/o food, but be consistent Astagraf: qam on empty stomach Envarsus: qam on empty stomach
42
Prograf PO:IV conversion
4:1 | IV 1/4 the dose of PO
43
cyclosporine modified brands
Neoral | Gengraf
44
cyclosporine non-modified brand
Sandimmune
45
Different side effects of cyclosporine
``` causes hirsutism (tacro causes alopecia) gingival hyperplasia ```
46
Sandimmune PO:IV conversion
3:1 (PO:IV)
47
what form of cyclosporine has higher bio availability?
Modified (neoral and gengraf)
48
Available mTOR inhibitors:
everolimus | sirolimus
49
mTOR inhibitors cannot be used with CNIs (t/f):
False | can be used together as synergy
50
Everolimus brand
Zortress
51
Everolimus side effects
``` peripheral edema HTN constipation N/v/d hyperglycemia ```
52
Everolimus clinical pearl
do not use within 30 days of transplant
53
Rapamune
sirolimus
54
sirolimus is not recommended in which transplants....
liver and lungs L's
55
SIrolimus main side effects
``` Irreversible pneumonitis (d/c immediately if cough develops) hyperglycemia ```
56
Nulojix
Belatacept
57
belatacept MOA
binds to CD80 and 86: block T-cell constimulation and production and production of inflammatory mediators
58
belatacept clinical pearl
can only be used in epstein-barr virus (EBV) seropositive pts increased risk of cancer in pts without immunity to EBV
59
Benefit to giving belatacept
less frequent dosing given q 2 weeks post transplant\ eventually monthly IV injection
60
#1 metabolism pathway for most transplant drugs (tacrolimus, cyclosporine, etc.)
CYP 3A4 be aware of 3A4 inducers and inhibitors
61
Main interactions with azathioprine
allopurinol: reduce azathioprine dose by 75% if used together ACEi: do not use together; risk of severe anemia
62
Mycophenolate can decr levels of this class of drugs that some pts might also be taking
decr levels of birth control mycophenolate is CI during pregnancy; woman of childbearing age should be on birth control and use secondary protection
63
Treatment of t-cell (cellular) acute rejection:
Usually high-dose steroids If steroids don't work: antithymocyte globulin alemtuzumab (off-label)
64
Treatment or b-cell (humoral or antibody) rejection
plasmaphersis + IVIG + Rituximab (in that order)

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