ABSITE - transplant

Question 1

mechanism of cyclosporine

Answer 1

binds to cyclophilin A

inhibits calcineurin and IL-2 synthesis

Question 2

mechanism of tacrolimus

Answer 2

binds to FK-506BP

inhibits calcineurin and IL-2 synthesis

Question 3

mechanism of mycophenolate mofetil

Answer 3

antimetabolite
inhibits IMP dehydrogenase
inhibits the enzyme necessary for purine synthesis

Question 4

mechanism of sirolimus

Answer 4

macrolide antibiotic
binds mTOR
blocks IL-2 transduction

Question 5

mechanism of corticosteroids

Answer 5

inhibit IL-2 production
redistribute lymphocytes
block vasodilator production

Question 6

mechanism of azathioprine

Answer 6

converted to 6-mercaptopurine
anti-purine metabolite
interferes with DNA and RNA synthesis
blocks proliferation

Question 7

adverse effects of cyclosporine

Answer 7

nephrotoxicity
hypertension
hyperlipidemia
hirsutism
neurotoxicity (seizures, tremor)
hepatotoxicity
hyperglycemia
gingival hyperplasia

Question 8

adverse effects of tacrolimus

Answer 8

neurotoxicity (seizure, coma)
nephrotoxicity
hypertension
GI toxicity (nausea, diarrhea)
hyperglycemia

Question 9

adverse effects of mycophenolate mofetil

Answer 9

leukopenia
thrombocytopenia
gastritis
GI toxicity

Question 10

adverse effects of sirolimus

Answer 10

thrombocytopenia
neutropenia
hyperlipidemia
vasculitis
NOT nephrotoxic

Question 11

adverse effects of steroids

Answer 11

Cushingoid state
glucose intolerance
osteoporosis
cataracts
myopathy
weight gain

Question 12

adverse effects of azathioprine

Answer 12

bone marrow suppression
pancreatitis
thrombocytopenia
neutropenia
anemia
liver dysfunction
GI upset

Question 13

clinical use of cyclosporine

Answer 13

maintenance

Question 14

clinical use of tacrolimus

Answer 14

maintenance

improved patient and graft survival (liver)

Question 15

clinical use of mycophenolate mofetil

Answer 15

maintenance
primary and rescue therapy (kidney)
may replace azathioprine

Question 16

clinical use of sirolimus

Answer 16

maintenance

may allow early withdrawal of steroids and decreased calcineurin doses

Question 17

clinical use of steroids

Answer 17

induction
maintenance
treatment of acute rejection

Question 18

clinical use of azathioprine

Answer 18

maintenance

Question 19

mechanism of basiliximab/daclizumab

Answer 19

monoclonal antibody
binds CD-25 (IL-2 receptor)
blocks IL-2 induced T-cell activation

Question 20

mechanism of rituximab

Answer 20

binds CD20 on B-cells

blocks B-cell activation

Question 21

mechanism of ATGAM

Answer 21

polyclonal horse antithymocyte immunoglobulin

Question 22

mechanism of thymoglobulin

Answer 22

polyclonal rabbit antithymocyte immunoglobulin

cytolytic- complement dependent opsonization of T cells

Question 23

mechanism of OKT-3

Answer 23

monoclonal murine antibody

binds CD3 on T-cell

Question 24

mechanism of abatacept (Orencia)

Answer 24

fusion of CTLA4 and Fc domain of IgG binds CD80/86 on APC

blocks T-cell activation

Question 25

mechanism of alemtuzumab

Answer 25

humanized rat IgG binds CD-52 on lymphocytes, eosinophils, macrophages targets them for destruction

Question 26

adverse effects of ATGAM

Answer 26

thrombocytopenia leukopenia serum sickness

Question 27

adverse effects of thymoglobulin

Answer 27

``` leukopenia PTLD cytokine release syndrome headache fevers/chills ```

Question 28

adverse effects of OKT-3

Answer 28

pulmonary edema encephalopathy aseptic meningitis nephrotoxicity

Question 29

adverse effects of abatacept

Answer 29

malignancy | increased risk of infections

Question 30

adverse effects of alemtuzumab

Answer 30

arthralgia leukopenia autoimmune disorders fevers/chills

Question 31

adverse effects of basiliximab/daclizumab

Answer 31

noncardiogenic pulmonary edema

Question 32

adverse effects of rituximab

Answer 32

tumor-lysis syndrome hypotension flushing fever

Question 33

clinical use of OKT-3

Answer 33

induction | treatment of acute rejection

Question 34

clinical use of ATGAM

Answer 34

induction | treatment of acute rejection

Question 35

clinical use of thymoglobulin

Answer 35

induction | treatment of acute rejection

Question 36

clinical use of alemtuzumab

Answer 36

induction | treatment of acute rejection

Question 37

clinical use of abatacept

Answer 37

induction | treatment of acute rejection

Question 38

clinical use of basiliximab/daclizumab

Answer 38

induction | treatment of acute rejection

Question 39

medications that potentiate nephrotoxicity of cyclosporine

Answer 39

acyclovir ganciclovir aminoglycosides NSAIDs

Question 40

medications that potentiate nephrotoxicity of tacrolimus

Answer 40

acyclovir ganciclovir aminoglycosides NSAIDs

Question 41

medications that decrease blood levels of mycophenolate mofetil

Answer 41

cholestyramine | antacids

Question 42

medications that potentiate bone marrow suppression of azathioprine

Answer 42

allopurinol | sulfonamides

Question 43

medications that increase blood levels of cyclosporine

Answer 43

P450 inhibitors

Question 44

medications that increase blood levels of tacrolimus

Answer 44

P450 inhibitors

Question 45

medications that decrease blood levels of cyclosporine

Answer 45

P450 inducers

Question 46

medications that decrease blood levels of tacrolimus

Answer 46

P450 inducers