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Pharm Exam 3 > Transplant Drugs > Flashcards

Transplant Drugs Flashcards

1
Q

What are the 3 drugs of triple maintenance therapy? (name drug type not specifics)

A
  1. Anti-metabolite.
  2. Calcineurin Inhibitor
  3. Prednisone
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2
Q

what is the main anti-metabolite drug used w/ triple therapy?

A

mycophenolate

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3
Q

what is the main calcineurin Inhibitor drug used w/ triple therapy?

A

tacrolimus

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4
Q

Is Azathioprine a prodrug?

A

yes

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5
Q

what does azathioprine get converted into?

A

6 MP

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6
Q

MOA of azathioprine

A

decrease B and T lymphocytes, decrease IG synthesis, decrease IL-2 secretion

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7
Q

what happens if you have a generic alteration of TPMT?

A

you can’t degrade 6MP causing increased immunosuppression (pt would need lower aza dose)

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8
Q

what often blocks XO in the azathioprine/6MP pathway?

A

gout medications, causing increased concentration of 6MP and increased immunosupression

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9
Q

what allele for azathioprine requires dose reduction?

A

heterozygous for non-functional allele

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10
Q

what allele type can you not give azathioprine?

A

homozygous for non-functional allele

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11
Q

what drugs should be avoided w/ azathioprine use?

A

ACEI
allopurinol/febuxostat
Aminosalicylates

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12
Q

what happens if you give ACEI + Azathioprine?

A

anemia

severe leukopenia

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13
Q

what happens if you give Allopurional/febuxo + azathiroprine?

A

inhibition of XO leads to increase myelosuppression risk

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14
Q

what happens if you give aminosalicylates + azathioprine?

A

inhibition of TPMT leads to increase myelosuppression risk

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15
Q

ADR of azathioprine?

A 
N/V
Hepatotoxic
Pancreatitis
Myelosupression (bac & viral)
Malignancy
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16
Q

what cancer are azathioprine pts @ risk for?

A

Skin SCC

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17
Q

what pts have increase risk of malignant dz?

A

renal transplant pts

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18
Q

Mechanism of Mycophenolate

A

decrease B & T cell proliferation

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19
Q

indications of Mycophenolate use

A

transplants
auto-immune dz pts
GVHD

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20
Q

what can decrease absorption of mycophenolate?

A

Fe
antacids
cholestyramine

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21
Q

if you decrease the absorption of mycophenolate what happens?

A

increased risk of REJECTION

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22
Q

ADR of mycophenolate

A

N/V/D/abd cramp
myelosuppression
miscarriage & birth defects

23
Q

Cyclosporine MOA

A

decrease production/release of IL-1 and inhibits IL-2 induced activation of resting T lymphocytes

24
Q

indications for cyclosporine

A

transplant
auto-immune dz: RA, psoriasis, IBD
ophthalmic emulsion

25
Q

what ophthalmic condition does cyclosporine tx?

A

keratoconjunctivitis sicca-associated ocular inflammation (aka helps increase tear production)

26
Q

drug interactions of cyclosporine?

A

*nephrotox with other nephrotoxic drugs (gentamicin)

pGp & 3A4 substrate (also inhibits 3A4)

27
Q

ADR of cyclosporine?

A 
nephrotoxic--AKI (most significant ADR)
HTN
neurotoxic
PTDM
Increase lipids & uric acid
myelosuppression
gingival` hyperplasia
hirsutism
N/V/D
28
Q

Tacrolimus stands for what?

A

tsukuba macrolide immunosupressant

29
Q

MOA of tacrolimus

A

binds to immunophillin to modulate T cells

30
Q

indications of tacrolimus PO

A

transplant

ulcerative colitis

31
Q

indications of tacrolimus topical

A

mod/severe atopic dermatitis

32
Q

drugs interactions of tacrolimus?

A

*nephrotox with other nephrotoxic drugs (gentamicin)

pGp & 3A4 substrate (also inhibits 3A4)

33
Q

ADR of tacrolimus

A

similar to cyclosporine

34
Q

what ADR occurs more with tacrolimus vs cyclosporine?

A

PTDM

35
Q

what ADR occurs less with tacrolimus vs cyclosprine?

A

every other ADR is less w/ tacrolimus

36
Q

what is prednisone converted to?

A

predisolone

37
Q

drug interactions of prednisone?

A

antagonistes anti DM meds

38
Q

ADRS of acute use of prednisone

A

insomnia
nervousness
increase appetite
hyperglycemia

39
Q

ADRs of chronic use of prednisone

A 
hirsutism
cataract
fat redistribution*
fluid retention
osteoporosis/AVN*
poor would healing
HPA-axis suppression/growth impression*
myopathy
*= M/C ADR
40
Q

what type of myopathy do pts taking prednisone get?

A

proxmial muscle weakness w/o myalgis or tenderness

41
Q

what part of the body gets weakness 1st?

A

LE

42
Q

how severe is the muscle weakness associated with prednisone?

A

affects ADLs

43
Q

what dose makes the myopathy of prednisone uncommon?

A

<10mg/d

44
Q

what dose makes myopathies of prednisone v’ common?

A

> 40mg-60mg/d for more than 1 month

45
Q

what kind of a drug is sirolimus/rapamycin?

A

MTOR inhibitor

46
Q

MOA of sirolimus/rapamycin

A

inhibit MTOR to then suppress cytokine driven T cell proliferation

47
Q

what can siroliumus replace in triple therapy?

A

anti-metabolite or calcineurin inhibitor

48
Q

main thing to monitor w/ sirolimus/rapamycin

A

BP

49
Q

drug interactions of sirolimus/rapamycin

A

Cyp3A4 substrate and pgp

50
Q

ADR of sirolimus/rapamycin

A 
HA
tremor
HTN
edema
PTDM
renal dysfunction
51
Q

MOA of belatacept

A

T cell costimulation blocker

inhibits production of cytokines

52
Q

use of belatacept

A

renal transplant in pts who are EBV serotype +

53
Q

ADR of belatacept

A 
leukopenia
anemia
N/V/D
increase malignancy risk 
PT lymphoproliferative disorder (PTLD)

Pharm Exam 3 (2 decks)

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