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NAPLEX Review > Transplant > Flashcards

Transplant Flashcards

1
Q

What 2 things are tested before a transplant to assess donor-recipient compatability

A

Human leukocyte antigen (HLA)

ABO blood type

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2
Q

Allograft vs isograft vs autograft

A

Allograft: transplant from one person to another
Isograft: transplant from a genetically identical donor to another
Autograft: transplant from the same patient

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3
Q

How to prevent rejection of a transplanted organ?

A

Immunosuppression

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4
Q

When to induce immunosuppression for a transplant

A

Before the transplant!!!

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5
Q

Antithymocyte Globulin (Atgam, Thymoglobulin) MOA, BBW, SE, notes

A

MOA: binds to antigens on T-lymphocytes (killer cells) and interferes with their function
BBW: anaphylaxis
SE: Infusion-related reactions
Notes: Premedicate (benadryl, APAP and steroids) to lessen infusion-related reactions
Can be used for induction of immunosuppression AND TREATMENT of rejection

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6
Q

Basilizimab MOA

A

MOA: monoclonal antibody that inhibits IL-2 receptor on the surface of activated T-lymphocyte preventing cell-mediated allograft rejection

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7
Q

What medications are clacineurin inhibitors (CNI)

A

Tacrolimus (Prograf)

Cyclosporin (Gengraf, Neoral, Sandimmune)

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8
Q

What medications are Antiproliferative agents

A

Mycophenolate Mofetil (CellCept), Azathioprine

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9
Q

Why is a combination of medications used for maintenance immunosuppression?

A

To lower toxicity risk of the individual immunosuppressants and to reduce the risk of graft rejection

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10
Q

Which systemic steroid is used for maintenance immunosuppression

A

Prednisone

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11
Q

Prednisone MOA, short-term SE, long-term SE

A

MOA: Naturally occurring hormones that prevent or suppress inflammation and humoral immune response
Short term SE: Fluid retention, stomach upset, emotional instability, insomnia, increased appetite, weight gain, acute rise in BP and BG
Long-term SE: Adrenal suppression/Cushing’s syndrome, impaired wound healing, increased BP, diabetes, acne, osteoporosis, impaired growth in children

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12
Q

What antiproliferative agents are used for maintenance immunosuppression?

A

Mycophenolate and azathioprine

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13
Q

Mycophenolate (CellCept, Myfortic) BBW, SE, Notes

A

BBW: Increased risk of infection, increased development of lymphoma and skin malignancies, increased risk of congenital malformations and spontaneous abortions
SE: Diarrhea, GI upset
Notes: REMS drug, decreased efficacy of oral contraceptives

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14
Q

Azathioprine warnings

A

Pts with genetic deficiency of thiopurine methyltransferase (TPMT) are at increased risk for myelosuppression

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15
Q

What medications are Calcineurin inhibitors

A

Tacrolimus (Prograf)

Cyclosporine (Gengraf, Neoral, Sandimmune)

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16
Q

Calcineurin inhibitor MOA

A

Suppress cellular immunity by inhibiting T-lymphocyte activation

17
Q

Tacrolimus BBW, SE, monitoring

A

BBW: Increased susceptibility to infection, lymphoma risk
SE: Increased BP and BG, nephrotoxicity, neurotoxicity, hypo/hyperkalemia, hyperlipidemia, QT prolongation
Monitor: trough levels, serum electrolytes (K, phos, Mg), renal function, LFTs, BP, BG, lipid profile
LOTS of drug interactions

18
Q

Cyclosporine BBW, SE, monitoring, notes

A

BBW: renal impairment, increased risk of lymphoma and other malignancies, increased risk of infection, increased BP
SE: increased BP, nephropathy, hyperkalemia, hypomagnesemia, hirsutism, gingival hyperplasia, edema, increased BG, neurotoxicity, QT prolongation
Monitor: trough level, serum electrolytes, renal function, BP, BG, lipid profile
LOTS of drug interactions

19
Q

What mTOR kinase inhibitors are used to maintain immunosuppression? What is their MOA

A

MOA: inhibit T-lymphocyte activation and proliferation, may be synergistic with CNIs
Everolimus, Sirolimus

20
Q

Everolimus warnings, SE, monitoring, notes

A

Warnings: Hyperlipidemia
SE: peripheral edema, increased BP, do not used within 30 days of transplant d/t risk of thrombosis
Monitoring: trough levels
Notes: LOTS of drug interactions

21
Q

Sirolimus warnings, SE, monitoring, notes

A

Warnings: Impaired wound healing, hyperlipidemia
SE: Irreversible pneumonitis/bronchitis/cough (d/c if this develops), increased BG, peripheral edema
Monitor: trough levels
Notes: LOTS of drug interactions

22
Q

Belatacept MOA, BBW, warnings

A

MOA: Binds CD80 and CD86 to block T-cell costimulation and production of inflammatory mediators
BBW: Increased risk of post-transplant lymphoproliferative disorder (PTLD), use in epstein-barr virus seropositive patients only
Warnings: treat latent TB prior to use

23
Q

Which immunosuppressant should be used in epstein barr virus seropositive patients only?

A

Belatacept

24
Q

What medications are used for induction of immunosuppression?

A

Basilizimab
Antithymocyte globulin in patients at higher risk of rejection
Maintenance drugs at higher doses

25
Q

What medications are used as maintenance immunosuppressants

A

1) Calcineurin inhibitors (CNIs) - primarily tacrolimus
2) Adjuvant medications given with a CNI (antiproliferative agents, mTOR inhibitors, Belatacept)
3) +/- Steroids

26
Q

What transplant medications should not be used with xanthine oxidase inhibitors?

A

Azathioprine b/c it is metabolized by xanthine oxidase

27
Q

S/sx of acute rejection

A

flu-like symptoms (chills, body aches, nausea, cough, SOB

28
Q

Which immunosuppressants can cause

nephrotoxicity

A

Tacrolimus

Cyclosporine

29
Q

Which immunosuppressants can cause

worsening or new onset diabetes

A

Tacrolimus
Steroids
Cyclosporine

30
Q

Which immunosuppressants can cause

worsening lipid parameters

A

mTOR inhibitors
Steroids
Cyclosporine

31
Q

Which immunosuppressants can cause

HTN

A

Steroids
Cyclosporine
Tacrolimus

32
Q

When to give live vaccines in a transplant patient

A

MUST be given before transplant - cannot be given when patient is immunosuppressed after transplant

33
Q

What syndrome can many transplant medications cause?

A

Metabolic syndrome

34
Q

How should Tacrolimus be taken?

A

On an empty stomach every 12 hours

35
Q

With which immunosuppressant medications do you need to avoid grapefruit?

A

Tacrolimus (Progrf)

Cyclosporine

NAPLEX Review (79 decks)

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