3 - Mycophenolate Mofetil Flashcards Preview

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Flashcards in 3 - Mycophenolate Mofetil Deck (74):
1

MMF is a prodrug

True

2

The active antimetabolite of MMF is mycophenolic acid

True

3

Mycophenolic acid has antibacterial properties

True

4

Mycophenolic acid has antiviral properties

True

5

Mycophenolic acid has antifungal properties

True

6

Mycophenolic acid has antitumour properties

True

7

Mycophenolic acid has immunosuppressive properties

True

8

MMF has greater bioavailability and tolerability than Mycophenolic acid

True

9

MMF is an ester of mycophenolic acid

True

10

MMF is converted to mycophenolic acid by esterases in the plasma, liver and kidney

True

11

Mycophenolic acid is inactivated in the liver via glucuronidation

True

12

Mycophenolic acid is inactivated in the liver

True

13

Glucuronidation of mycophenolic acid in the liver yields the inactive compound mycophenolic acid glucuronide

True

14

Mycophenolic acid glucuronide (inactive metabolite of mycophenolic acid) is secreted into bile and recycled to the liver via enterohepatic recirculation

True

15

The enterohepatic recirculation of mycophenolic acid glucuronide is vital for maintaining mycophenolic acid serum levels

True

16

Mycophenolic acid glucuronide (inactive metabolite) is converted back to mycophenolic acid by beta-glucuronidase

True

17

The high levels of beta-glucuronidase (to convert mycophenolic acid glucuronide to mycophenolic acid) found in the epidermis accounts for the efficacy of MMF

True

18

The high levels of beta-glucuronidase (to convert mycophenolic acid glucuronide to mycophenolic acid) found in the GI tract accounts for the most common adverse effects of MMF

True

19

The first peak of MMF plasma levels occurs in the first hour

True

20

A second MMF plasma level peak occurs after 6-12 hours due to enterohepatic recirculation of mycophenolic acid glucuronide

True

21

Over 90% of the administered MMF dosage is excreted in urine as mycophenolic acid glucuronide (inactive metabolite)

True

22

Dose reduction of MMF is not necessary in renal impairment

True (renal impairment does not have a significant impact on mycophenolic acid)

23

MMF and mycophenolic acid is bound to serum albumin

True

24

A decrease in MMF dosing may be necessary in situations which alter albumin levels

True (altered albumin levels may occur in liver or renal disease or concomitant use of medications that compete for albumin binding sites)

25

Exposure to increased amounts of unbound mycophenolic acid (active metabolite/drug) may be a predictor of infections

True

26

Exposure to increased amounts of unbound mycophenolic acid (active metabolite/drug) may be a predictor of haematologic toxicity

True

27

Mycophenolic acid inhibits inosine monophosphate dehydrogenase in the de novo purine synthesis pathway

True (just like MTX - an antimetabolite)

28

By inhibiting inosine monophosphate dehydrogenase in the purine synthesis pathway, mycophenolic acid deprives T and B lymphocytes of purine metabolites necessary for growth and replication (hence causes selective immunosuppression)

True

29

The immunosuppressive effects of MMF are related to the effects of purine biosynthesis affecting lymphocytes

True

30

By selectively inhibiting the de novo purine synthesis pathway within activated lymphocytes, MMF targets the lymphocytes most responsible for disease whilst having a minimal effect on other organs and cell types

True

31

MMF also reduces the recruitment of inflammatory cells

True

32

MMF is used off label for dermatologic diseases

True (as a steroid-sparing agent and for severe refractory disease that has failed other treatment regimens)

33

MMF is comparable to other immunosuppressants as a corticosteroid-sparing agent in treatment of Pemphigus

True

34

MMF is not first line treatment in psoriasis

True

35

Azathioprine is associated with a significantly higher rate of elevated LFTs as compared to MMF in the treatment of bullous pemphigoid

True

36

MMF shows promise in the treatment of the associated interstitial lung disease in dermatomyositis

True

37

MMF is efficacious in the treatment of interstitial lung disease associated with diffuse systemic sclerosis, although efficacy is less convincing for cutaneous disease

True

38

Peptic ulcer disease is a relative contraindication of MMF

True

39

Cholestyramine (interferes with enterohepatic recirculation) is relatively contraindicated with MMF

True

40

Concomitant administration of Azathioprine with MMF increases risk of bone marrow suppression

True

41

The risk of MMF in causing lymphoproliferative disorders and NMSCs is unclear

True

42

The risk of malignancy associated with MMF (lymphoproliferative disorders and NMSCs) likely relates to the effects of cumulative immunosuppression from multiple drugs rather than an MMF specific effect

True

43

GI symptoms are most common with MMF

True

44

GI symptoms associated with MMF are dose related

True

45

Adverse GI effects associated with MMF improve over time

True

46

Administration of MMF with food and BD or TDS dosing improves GI tolerability

True

47

MMF is not hepatotoxic although elevated transaminases have been reported

True (the significance of the elevated transaminases is unclear)

48

MMF can cause elevated transaminases

True (though significance is unclear)

49

MMF is less hepatotoxic than Azathioprine

True

50

MMF does not cause nephrotoxicity

True

51

Haematologic toxicity associated with MMF is dose-dependant

True

52

The haematologic toxicity associated with MMF is rapidly reversible with cessation of therapy

True

53

Risk of Infections with MMF are more common in transplant patients used as anti-rejection treatment

True

54

Progressive multifocal leukoencephalopathy was associated in patients on MMF with transplanted organs and long-standing SLE on concomitant immunosuppression

True

55

The role of MMF to the development of progressive multifocal leukoencephalopathy is unclear

True (occurred in transplant patients and SLE patients already at increased risk for this condition)

56

Fetal malformations are associated with MMF (teratogenic)

True

57

Antacids and PPIs reduce serum levels of mycophenolic acid

True (MMF requires gastric acidity for conversion to the active metabolite mycophenolic acid)

58

Oral iron supplementation does not affect serum MMF levels

True (although it is advisable to give MMF 1 hour before iron containing products)

59

Salicylic acid competes with mycophenolic acid for albumin binding sites and can increase the free active fraction of mycophenolic acid

True

60

Phenytoin competes with mycophenolic acid for albumin binding sites and can increase the free active fraction of mycophenolic acid and vice versa increase free phenytoin levels

True

61

Xanthine bronchodilators (theophylline) compete with mycophenolic acid for albumin binding sites and can increase the free active fraction of mycophenolic acid and vice versa increase free levels of theophylline

True

62

Antivirals (acyclovir, ganciclovir, valganciclovir) inhibit renal tubular secretion of mycophenolic acid and thus increase the serum levels of mycophenolic acid

True (caution with co-administration especially in renal impairment)

63

There is a potential risk of neutropenia with both valacyclovir and MMF

True

64

There is a risk of decreased serum levels of levonorgestrel (progestin component of OCP) with Co-administration with MMF

True

65

Co-administration of MMF does not affect the serum levels of desogestrel, gestodene and ethinyl oestradiol

True (in contrast to levonorgestrel, levels of these do not appear to be affected by MMF although caution is still advised)

66

Live vaccines are contraindicated in patients on MMF

True (risk of reduced immunologic response or increased risk of disseminated viral infection)

67

MMF may increase levels of Cyclosporine

True

68

Antibacterials may reduce serum levels of mycophenolic acid because of reduced enterohepatic recirculation

True (multiple classes including metronidazole, cephalosporins, aminoglycosides, macrolides, etc)


69

Bile acid sequestrants I.e. Cholestyramine reduces the enterohepatic recirculation of mycophenolic acid glucuronide (hence reduce serum levels of mycophenolic acid)

True

70

Probenecid competes with mycophenolic acid for renal tubular secretion and thus increase the serum levels of mycophenolic acid

True

71

Concomitant use of MMF and narcotics may increase risk of seizures

True

72

MMF has been linked to rising Hep C viral titres and Hep C induced acute hepatitis

True (although MMF is safe to use in patients infected with Hep B and C)

73

MMF has been associated with reactivation of latent TB

True

74

MMF may cause genitourinary symptoms I.e. Urgency, frequency, dysuria

True