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NAPLEX - OUR cards > Transplant > Flashcards

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
Q

Cellcept

A

mycophenolate mofetil

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26
Q

Myfortic

A

mycophenolic acid

27
Q

Cellcept/Myfortic boxed warnings

A

incr risk of infection
incr risk of lymphoma and skin cancers
congenital abnormalties in pregnancy

28
Q

Cellcept/Myfortic side effects

A

diarrhea
GI upset
vomiting
leukopenia

29
Q

Cellcept/Myfortic administration

A

take BID on an empty stomach

30
Q

which form of mycophenolate is available IV?

A

CellCept IV

31
Q

MOA of mycophenolate/azathioprine:

A

inhibit t cell proliferation by altering purine synthesis

32
Q

azathioprine brands

A

Imuran

Azasan

33
Q

azathioprine side effects

A

n/v/d
myelosuppression
rash
incr LFTs

34
Q

azathioprine renal dosing

A

crcl < 50

35
Q

Calcineurin inhibitors MOA

A

inhibit t-lymphocyte activation

36
Q

Tacrolimus brands

A

Prograf (usually given BID)
Astagraf XL
Envarsus XR

37
Q

usual tacrolimus initial dose

A

0.1-0.2 mg/kg/day

38
Q

Tacrolimus side effects

A 
htn
nephrotoxictiy 
hyperglycemia
neurotoxicity
hyperkalemia
hypomagnesemia
QT prolongation
39
Q

what levels of Tacrolimus are measured?

A

trough levels

goal levels vary by pt

40
Q

Tacrolimus metabolism

A

3A4 p-gp substrate

41
Q

Tacrolimus admin with food?

A

Prograf: with or w/o food, but be consistent
Astagraf: qam on empty stomach
Envarsus: qam on empty stomach

42
Q

Prograf PO:IV conversion

A

4:1

IV 1/4 the dose of PO

43
Q

cyclosporine modified brands

A

Neoral

Gengraf

44
Q

cyclosporine non-modified brand

A

Sandimmune

45
Q

Different side effects of cyclosporine

A 
causes hirsutism (tacro causes alopecia)
gingival hyperplasia
46
Q

Sandimmune PO:IV conversion

A

3:1 (PO:IV)

47
Q

what form of cyclosporine has higher bio availability?

A

Modified (neoral and gengraf)

48
Q

Available mTOR inhibitors:

A

everolimus

sirolimus

49
Q

mTOR inhibitors cannot be used with CNIs (t/f):

A

False

can be used together as synergy

50
Q

Everolimus brand

A

Zortress

51
Q

Everolimus side effects

A 
peripheral edema
HTN
constipation
N/v/d
hyperglycemia
52
Q

Everolimus clinical pearl

A

do not use within 30 days of transplant

53
Q

Rapamune

A

sirolimus

54
Q

sirolimus is not recommended in which transplants….

A

liver and lungs

L’s

55
Q

SIrolimus main side effects

A 
Irreversible pneumonitis (d/c immediately if cough develops)
hyperglycemia
56
Q

Nulojix

A

Belatacept

57
Q

belatacept MOA

A

binds to CD80 and 86: block T-cell constimulation and production and production of inflammatory mediators

58
Q

belatacept clinical pearl

A

can only be used in epstein-barr virus (EBV) seropositive pts

increased risk of cancer in pts without immunity to EBV

59
Q

Benefit to giving belatacept

A

less frequent dosing

given q 2 weeks post transplant\
eventually monthly

IV injection

60
Q

1 metabolism pathway for most transplant drugs (tacrolimus, cyclosporine, etc.)

A

CYP 3A4

be aware of 3A4 inducers and inhibitors

61
Q

Main interactions with azathioprine

A

allopurinol: reduce azathioprine dose by 75% if used together
ACEi: do not use together; risk of severe anemia

62
Q

Mycophenolate can decr levels of this class of drugs that some pts might also be taking

A

decr levels of birth control

mycophenolate is CI during pregnancy; woman of childbearing age should be on birth control and use secondary protection

63
Q

Treatment of t-cell (cellular) acute rejection:

A

Usually high-dose steroids

If steroids don’t work: antithymocyte globulin
alemtuzumab (off-label)

64
Q

Treatment or b-cell (humoral or antibody) rejection

A

plasmaphersis +
IVIG +
Rituximab
(in that order)

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