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NAPLEX 25 > Chapter 56: Transplant > Flashcards

Chapter 56: Transplant Flashcards

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1
Q

Transplant of an organ or tissue from one individual to another

A

Allograft

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2
Q

Transplant from a genetically identical donor (such as an identical twin) is called

A

Isograft

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3
Q

Transplant in the same patient, from one site to another (e.g., stem cell or skin grafting)

A

Autograft

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4
Q

What is performed prior to any transplant?

A

Tissue typing or crossmatching is performed to assess donor-recipient compatibility.

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5
Q

What are the two compatibility factors assessed in transplant compatibility?

A

HLA and ABO blood group.

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6
Q

Which blood type is universal receiver?

A

AB

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7
Q

Which blood type is universal donor?

A

O

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8
Q

What are two boxed warnings for all transplant medications?

A
  • Infection risk
  • Cancer risk
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9
Q

_____ immunosuppression is given before or at the time of transplant to ______

A

Induction
to prevent acute rejection during the early post-transplant period

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10
Q

Most commonly used induction drug

A

Basiliximab

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11
Q

Basiliximab drug class

A

IL-2 receptor antagonist

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12
Q

Patients at higher risk of rejection can receive which drug class?

A

antithymocyte globulin

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13
Q

What stages of transplant can antithymocyte globulins be used for?

A

Induction and treatment of rejection.

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14
Q

What are the brand names of antithymocyte globulin?

A

Atgam (equine), Thymoglobulin (rabbit)

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15
Q

What is the mechanism of action (MOA) of antithymocyte globulin?

A

Binds to T-lymphocytes and interferes with their function

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16
Q

What is the boxed warning for antithymocyte globulin?

A

Anaphylaxis

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17
Q

What are the side effects of antithymocyte globulin?

A

Infusion-related reactions (premedicate)

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18
Q

What is maintenance immunosuppression generally provided by?

A

A combination of a calcineurin inhibitor and an antiproliferative agent with or without steroids

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19
Q

What is the first line calcineurin inhibitor (CNI)?

A

Tacrolimus

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20
Q

What is the first line antiproliferative agent?

A

Mycophenolate

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21
Q

What are the benefits of suppressing the immune system via multiple mechanisms?

A
  • It lowers the toxicity risk of individual immunosuppressants.
  • It reduces the risk of graft rejection.
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22
Q

What are the modified brand names of Cyclosporine?

A

Gengraf, Neoral

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23
Q

What is the non-modified brand name of Cyclosporine?

A

Sandimmune

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24
Q

What are the modified brand names of Cyclosporine?

A

Gengraf, Neoral

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25
What is the non-modified brand name of Cyclosporine?
Sandimmune
26
What are the black box warnings (BW) for Cyclosporine?
Renal impairment, increased risk of lymphoma and other malignancies, including skin cancer, increased risk of infection, can increase BP; modified has 20-50% greater bioavailability compared to non-modified.
27
Can modified and non-modified Cyclosporine be interchanged?
No, they cannot be interchanged. ## Footnote True
28
What are the side effects of Cyclosporine?
Increased BP, hyperlipidemia, hyperkalemia, hypomagnesemia, hirsutism, gingival hyperplasia, neurotoxicity, hyperuricemia.
29
What should be monitored for Cyclosporine?
Trough levels, serum electrolytes, renal function, blood pressure, blood glucose, lipid profile
30
What type of inhibitor is Cyclosporine?
Cyclosporine is a 3A4 inhibitor ## Footnote Cyclosporine is also a 3A4 & P-gp substrate.
31
From what should Cyclosporine oral liquid not be administered?
Cyclosporine oral liquid should not be administered from a plastic or styrofoam cup.
32
What is the brand name of Tacrolimus?
Prograf
33
What is the mechanism of action (MOA) of Tacrolimus?
Inhibits T-lymphocyte activation
34
What are the boxed warnings for Tacrolimus?
Increased susceptibility to infection, possible development of lymphoma
35
What are the side effects of Tacrolimus?
Increased BP, nephrotoxicity, increased BG, neurotoxicity, hyperkalemia, hyperlipidemia, QT prolongation
36
What should be monitored in patients taking Tacrolimus?
Trough levels, serum electrolytes (K, phos, Mg), renal function, LFTs, BP, blood glucose, lipid profile
37
In what type of container is IV Tacrolimus administered?
Non-PVC
38
What type of substrate is Tacrolimus?
3A4 & P-gp
39
What is a warning associated with Azathioprine?
Patients with genetic deficiency of TMPT are at high risk for myelosuppression and may require lower dose.
40
Mycophenolate mofetil brand name
CellCept
41
Mycophenolic acid brand name
Myfortic
42
Mycophenolate boxed warnings
Increased risk of infection, increased development of lymphoma and skin malignancies, increased risk of congenital malformations and spontaneous abortions when used during pregnancy
43
Mycophenolate side effects
Diarrhea, GI upset
44
T/F: CellCept and Myfortic are NOT interchangeable
True
45
Which brand of mycophenolate is enteric coated to decrease diarrhea
Myfortic
46
CellCept IV is stable in ____ only
D5W
47
Mycophenolate decreases efficacy of
oral contraceptives
48
What is the mechanism of action of mTOR kinase inhibitors?
Inhibit T-lymphocyte activation & proliferation
49
List mTOR kinase inhibitors?
* Everolimus * Sirolimus
50
What is a warning associated with mTOR kinase inhibitors?
* Hyperlipidemia * impaired wound healing
51
What are the side effects of mTOR kinase inhibitors?
Peripheral edema, increased BP and BG do not use within 30 days of transplant d/t increased risk of renal and hepatic artery thrombosis
52
Which mTOR kinase inhibitors should do not use within 30 days of transplant? Why?
Everolimus, d/t increased risk of renal and hepatic artery thrombosis
53
What should be monitored in patients taking mTOR kinase inhibitors ?
Trough levels
54
What type of substrate are mTOR kinase inhibitors ?
3A4
55
What is the mechanism of action (MOA) of Belatacept?
Belatacept binds to CD80 & CD86 to block T-cell costimulation and production of inflammatory mediators.
56
What is the black box warning (BW) for belatacept?
Belatacept has an increased risk of post-transplant lymphoproliferative disorder (PTLD) with the highest risk in recipients without immunity to Epstein-Barr virus. Use in EBV seropositive patients only.
57
What warnings are associated with belatacept?
Belatacept has an increased risk of TB. Test for latent TB prior to initiation and treat latent TB prior to use.
58
Which drug classes are used for maintenance therapy in transplant?
1. CNIs (tacrolimus primarily or cyclosporine), 2. adjuvant therapy (antiproliferative agents like mycophenolate or azathioprine, mTOR inhibitors like everolimus or sirolimus, or belatacept), and 3. steroids.
59
Azathioprine should be avoided with which drug class?
Xanthine oxidase inhibitors (allopurinol or febuxostat).
60
What should be avoided with both cyclosporine and tacrolimus?
Grapefruit juice and St. John’s Wort
61
What should be cautioned with additive drugs that worsen what condition with mTOR inhibitors, steroids, and cyclosporine?
lipids
62
Caution with additive drugs that raise ____ with tacrolimus, steroids, cyclosporine & mTOR inhibitors
Caution with additive drugs that raise levels with tacrolimus, steroids, cyclosporine & mTOR inhibitors.
63
Caution with additive drugs that raise ____ with tacrolimus, steroids, & cyclosporine
Caution with additive drugs that raise levels with tacrolimus, steroids, & cyclosporine.
64
Which maintenance immunosuppressants have the highest incidence of nephrotoxicity?
Tacrolimus and cyclosporine.
65
Which maintenance immunosuppressants have the highest incidence of worsening or new onset diabetes?
Tacrolimus, steroids, and cyclosporine.
66
Which maintenance immunosuppressant has the highest incidence of worsening lipid parameters?
mTOR inhibitors
67
Which maintenance immunosuppressants have the highest incidence of HTN?
steroids, cyclosporine, and tacrolimus
68
What mechanisms cause acute rejection of a transplanted organ?
T-cell (cellular) or B-cell (humoral or antibody) mediated mechanisms.
69
How can you distinguish the type of acute rejection of an organ?
via biopsy
70
What is the initial approach for acute rejection?
administering high-dose steroids
71
Which cancer is most common with transplant?
Skin
72
Inactivated vaccines can be given post-transplant after how many months?
3-6
73
Which vaccines cannot be given after transplant?
Live
74
Which vaccines are important for transplant recipients?
Influenza in adults 19+ years Pneumococcal in adults 19+ years (PCV13 first then PPSV23 at least 8 weeks later) Varicella pre-transplant Hep B
75
What is a counseling point for all immunosuppressants?
Take medication exactly as prescribed and stay consistent on how you take your medication.
76
Tacrolimus should be taken every ___ hours.
12
77
Tacrolimus should be taken (with/without) food for best absorption.
without

NAPLEX 25 (63 decks)

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