Transplant

Question 1

CellCept indication / MOA

Answer 1

Transplant - renal, heart and liver transplant rejection prophylaxis
Antiproliferative agent - inhibits DNA replication and suppress B- and T-cell proliferation

Question 2

CellCept generic

Answer 2

Mycophenolate Mofetil

Question 3

CellCept dosing

Answer 3

Given PO usually twice daily
Max adult dosage: 3 grams per day
Max adolsecent and infant dosage: 2 grams per day

Question 4

CellCept - pearls

Answer 4

Available as a 500 mg tablet and a 250 mg capsule - pay attention with additive dosing!
Powder for suspension - discard any unused portion 60 days after reconstitution, so do NOT dispense more than a 56 days supply (accredo reconstitutes)

Question 5

Sandimmune indication / MOA

Answer 5

Transplant - renal, heart and liver transplant
Calcineurin Inhibitor - suppresses the activation of T lymphocytes by inhibiting the production of cytokines (first phase of T-cell activation)

Question 6

Sandimmune generic

Answer 6

cyclosporine NON-modified

Cannot be used interchangeably with cyclosporine modified!

Question 7

Sandimmune dosing

Answer 7

Dosed PO usually twice daily

dosing based on trough levels

Question 8

Sandimmune pearls

Answer 8

always check DAW and history to confirm modified / non-modified
Solution expires 60 days after opened - enter this in the directions
All directions for solution should start with “Dilute and drink” - to make more palatable, should be diluted with orange or apple juice at room temperature in a glass container

North Carolina law - refilled using only the same product by the same manufacturer last dispensed unless the prescriber is notified prior to dispensing and the prescriber and the patient give consent to the dispensing of another mfr’s product

Question 9

Neoral indication / MOA

Answer 9

Transplant - renal, heart and liver transplant
Calcineurin Inhibitor - suppresses the activation of T lymphocytes by inhibiting the production of cytokines (first phase of T-cell activation)

Question 10

Neoral generic

Answer 10

Cylosporine modified

Cannot be used interchangeably with cyclosporine non-modified!

Question 11

Neoral dosing

Answer 11

Dosed PO usually twice daily
dosing based on trough levels
Generic: 25 mg, 50 mg and 100 mg caps
Brand: 25 mg and 100 mg caps

Question 12

Neoral pearls

Answer 12

always check DAW and history to confirm modified / non-modified
Solution expires 60 days after opened - enter this in the directions
All directions for solution should start with “Dilute and drink” - to make more palatable, should be diluted with orange or apple juice at room temperature in a glass container

North Carolina law - refilled using only the same product by the same manufacturer last dispensed unless the prescriber is notified prior to dispensing and the prescriber and the patient give consent to the dispensing of another mfr’s product

Question 13

Imuran indication / MOA

Answer 13

transplant - renal

Antiproliferative agent - inhibits DNA replication and suppresses B- and T- cell proliferation

Question 14

Imuran generic / alternate brands and available forms

Answer 14

azathioprine 50 mg tablets
Imuran 50 mg tablets
Azasan 75 mg and 100 mg tablets

Question 15

Imuran dosing

Answer 15

1 mg to 30 mg/kg once daily
max adult dose in 3 mg to 5 mg/kg/day
adolescents and children - safety and efficacy not established. doses of 1-2 mg/kg/day PO for renal transplant have been used

Question 16

Imuran pearls

Answer 16

Azasan (75 mg and 100 mg) is brand only
if patient is splitting tablets and it’s a ned med, need to set up a contact to make sure MDO wants patient to split tabs and set up ODT for consult to counsel patient on risk of splitting tablets
According to guidelines, an antiproliferative agent such as azatioprine is to be used for initial maintenance immunosuppression with a calcinurin inhibitor such as tacrolimus plus or minus corticosteroid - mycophenolate is suggested to the be first-line antiproliferative agent!

Question 17

Myfortic indication / MOA

Answer 17

Renal, heart and liver transplant

antiproliferative agent - inhibits DNA replication and suppresses B- and T- cell proliferation

Question 18

Myfortic generic

Answer 18

mycophenolic acid / mycophenolate sodium

NOT interchangable with CellCept

Question 19

Myfortic dosing

Answer 19

Adults: 720 mg BID

max dose 1440 mg/day for anyone with BSA greater than 1.19

Question 20

Myfortic pearls

Answer 20

transition from CellCept to Myfortic

cellcept 250 mg = myfortic 180 mg