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PHRM 865 Therapeutics > Exam 6 - Solid Organ Transplants Arora > Flashcards

Exam 6 - Solid Organ Transplants Arora Flashcards

(52 cards)

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1
Q

transplant of tissue from 1 part of the body to another

a. autotransplantation
b. allotransplantation
c. xenotransplantation
d. orthotopic
e. heterotopic

A

a. autotransplantation

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2
Q

Transplant of tissue from 1 person to another person

a. autotransplantation
b. allotransplantation
c. xenotransplantation
d. orthotopic
e. heterotopic

A

b. allotransplantation

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3
Q

Transplant of tissue from a different species

a. autotransplantation
b. allotransplantation
c. xenotransplantation
d. orthotopic
e. heterotopic

A

c. xenotransplantation

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4
Q

Transplanted into recipient in the same place (ex. heart, lung)

a. autotransplantation
b. allotransplantation
c. xenotransplantation
d. orthotopic
e. heterotopic

A

d. orthotopic

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5
Q

Transplanted into recipient in a different place (ex. kidney)

a. autotransplantation
b. allotransplantation
c. xenotransplantation
d. orthotopic
e. heterotopic

A

e. heterotopic

(leave 2 kidneys in and add another)

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6
Q

two types of deceased organ donors

A

-deceased by brain death (DBD)
-deceased by circulatory death (DCD)

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7
Q

T or F: HLA antibodies occur naturally

A

F (formed in response to non-self HLA exposure)

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8
Q

positive crossmatch (XM) indicates pre-formed DSA present -> ____ risk of rejection

a. low
b. high

A

b. high

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9
Q

which of the following has the HIGHEST risk of transplant rejection?

a. liver
b. kidney, pancreas
c. heart
d. small bowel, lung

A

d. small bowel, lung

(risk inc with more lymphoid tissue)

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10
Q

which of the following has the LOWEST risk of transplant rejection?

a. liver
b. kidney, pancreas
c. heart
d. small bowel, lung

A

a. liver

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11
Q

T or F: African Americans have a lower risk of transplant rejection than caucasians

A

F

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12
Q

African Americans are rapid metabolizers of _______ -> much higher dose requirements (the blank is a drug)

A

tacrolimus

(so they may benefit from Envarsus, which is a prolonged tacrolimus)

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13
Q

two types of allograft rejection

A

-TCMR (T-cell mediated rejection)
-AMR (antibody mediated rejection)

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14
Q

immunosuppression induction agents:
rabbit/horse antithymocyte globulin

a. polyclonal antibodies
b. monoclonal antibodies
c. IL-2a receptor antagonists

A

a. polyclonal antibodies

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15
Q

immunosuppression induction agents:
alemtuzumab

a. polyclonal antibodies
b. monoclonal antibodies
c. IL-2a receptor antagonists

A

b. monoclonal antibodies

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16
Q

immunosuppression induction agents:
Basiliximab

a. polyclonal antibodies
b. monoclonal antibodies
c. IL-2a receptor antagonists

A

c. IL-2a receptor antagonists

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17
Q

how long does rabbit antithymocyte globulin lymphocyte depletion persist?

a. 7 days
b. 30 days
c. 1 month
d. 3 months

A

d. 3 months

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18
Q

which of the following is FALSE about rabbit antithymocyte globulin?

a. thymoglobulin dose is 1-1.5 IV mg/kg/day
b. oral only
c. leukopenia, thrombocytopenia are dose limiting SE
d. can premedicate with diphenhydramine or acetaminophen to prevent fever/chills

A

b. oral only

(IV)

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19
Q

which of the following is FALSE about alemtuzumab?

a. humanized anti-CD52 mAb
b. leads to profound depletion of T cells for up to 12 months
c. liver transplant only
d. one time dose
e. premedicate with diphenhydramine and acetaminophen to prevent infusion-related

A

c. liver transplant only

(kidney)

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20
Q

which of the following is FALSE about basiliximab?

a. profound depletion of T cells
b. no pre-medications needed
c. used for induction only
d. mAb against CD25

A

a. profound depletion of T cells

(non-lymphodepleting)

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21
Q

which of the following is NON-lymphodepleting?

a. thymoglobulin
b. alemtuzumab
c. basiliximab

Study These Flashcards
A

c. basiliximab

(we don’t want lymphodepletion to bring cancer back)

22
Q

TH is a 58 yo AA M with ESRD 2/2 T2DM who presents for a living related kidney transplant (LRKT) from his son. He has been anuric for 2 months and has been tolerating HD MWF. Patient denies any recent fevers, chills, N/V/D/C, abdominal pain, or other complaints today. PMHx includes CKD, HTN, gout, diabetic neuropathy, and previous melanoma (treated 2010)

What would be an appropriate induction agent for this patient?

A. Alemtuzumab
B. Thymoglobulin
C. Basiliximab

Study These Flashcards
A

C. Basiliximab

(previous melanoma, don’t want malignancy to come back

23
Q

current cornerstone of immunosuppression

a. calcineurin inhibitors
b. mTOR inhibitors
c. corticosteroids
d. antimetabolites

Study These Flashcards
A

a. calcineurin inhibitors

(c. is the “original” cornerstone)

24
Q

which formulation of tacrolimus has more potential benefits, immediate-release or extended-release?

Study These Flashcards
A

extended-release

( lower overall drug dose, improved adherence, less peak effects = reduced ADE, less swings/variability in trough concentrations)

25
which CNI is metabolized by P-glycoprotein and has a highly variable half-life? a. cyclosporine b. tacrolimus
a. cyclosporine (tacrolimus is preferred)
26
which drug has the following SE? (in red on his slide) -HTN -Hypercholesterolemia -Hypertriglyceridemia -Gingival hyperplasia -Hirsutism a. cyclosporine b. tacrolimus
a. cyclosporine
27
which drug has the following SE? (in red on his slide) -HTN -Hypercholesterolemia -Hypertriglyceridemia -Gingival hyperplasia -Hirsutism a. cyclosporine b. tacrolimus c. azathioprine d. sirolimus
a. cyclosporine
28
which drug has the following SE? (in red on his slide) -Neurotoxicity, insomnia, tremor, dizziness -Hyperglycemia; post-transplant DM -Alopecia a. cyclosporine b. tacrolimus c. azathioprine d. sirolimus
b. tacrolimus
29
_______ dysfunction leads to alterations in CNI PK a. ocular b. endothelial c. renal d. liver
d. liver (c. does not affect CNI PK)
30
LS is a 52 yo white F with ESLD 2/2 NASH cirrhosis s/p orthotopic liver transplant (OLT) 4 months ago. She was recently admitted to the hospital and diagnosed with pneumonia and oral candidiasis (thrush), for which she was prescribed antibiotics. Patient now returns to clinic for her follow-up. She notes a new fine hand tremor and her FK level is supra-therapeutic. Which of the following medications may be contributing to her elevated levels? A. Fluconazole B. Azithromycin C. Levofloxacin D. None of the above
A. Fluconazole (thrush)
31
MOA of azathioprine
purine analog; leads to inhibition of immune cell proliferation (there is more on the slide)
32
azathioprine main AE (2 in red; slide 58)
-GI: abdominal pain, N/V, diarrhea, dyspepsia -bone marrow suppression: agranulocytosis, macrocytic anemia, leukopenia, neutropenia, thrombocytopenia
33
azathioprine main drug interaction to know a. mycophenolic acid b. atorvastatin c. allopurinol d. levofloxacin
c. allopurinol (reduce AZA by 50-75%)
34
mycophenolic acid is the most commonly used adjuct agent with _____
CNIs
35
mycophenolate mofetil, MMF vs mycophenolate sodium, MPS dosing conversion
MMF 250 mg = MPS 180 mg IV:PO 1:1
36
mycophenolic acid requires how many forms of birth control in women of child-bearing age?
2 forms (it is teratogenic)
37
mycophenolic acid has an interaction with other myelosuppressive drugs such as: (2; slide 61)
-valganciclovir -sirolimus
38
mTOR inhibitors metabolism
CYP3A4 and PgP
39
which of the following is TRUE about mTOR inhibitors? a. sirolimus is approved for both kidney and liver transplant rejection prophylaxis b. everolimus is approved for only liver transplant rejection prophylaxis c. everolimus is dosed once daily d. dose limiting SE include hyperlipidemia and impaired wound healing
d. dose limiting SE include hyperlipidemia and impaired wound healing (a. is just kidney; b. is kidney and liver; c. is BID)
40
why are mTOR inhibitors not used immediately post-transplant?
due to impaired wound healing
41
which of the following is FALSE about corticosteroids? a. Used for maintenance immunosuppression b. Can cause hypoglycemia and hypotension c. Some transplant centers utilize early steroid withdrawal or steroid-free regimens d. ADE related to both avg dose and cumulative duration of use
b. Can cause hypoglycemia and hypotension (hyperglycemia and hypertension)
42
which drug is a T-cell Co-stimulation Blocker? a. belatacept b. tacrolimus c. mycophenolate d. azathioprine
a. belatacept (b. is CNI; c. and d. are antimetabolites)
43
belatacept has a relative contraindication for use in _____ tranplant
liver
44
which of the following is TRUE about belatacept? a. IV only b. routinely q2 weeks at an infusion clinic c. used as a replacement or adjunct to corticosteroids d. CI in EBV seropositive patients
a. IV only (b. is q4 weeks; c. is CNIs; d. is seronegative)
45
most common triple drug regimen
tacrolimus mycophenolate prednisone
46
mild-moderate acute cellular rejection (ACR) a. methylprednisolone 250-1000 mg IV x 3-5 days b. rabbit anithymocyte globulin 1.5 mg/kg/day IV x 6-7 days c. alemtuzumab d. steroids +/- rituximab +/- IVIG
a. methylprednisolone 250-1000 mg IV x 3-5 days (high-dose steroids)
47
moderate-severe or steroid-resistant acute cellular rejection (ACR); NON-refractory a. methylprednisolone 250-1000 mg IV x 3-5 days b. rabbit antithymocyte globulin 1.5 mg/kg/day IV x 6-7 days c. alemtuzumab d. steroids +/- rituximab +/- IVIG
b. rabbit antithymocyte globulin 1.5 mg/kg/day IV x 6-7 days
48
moderate-severe or steroid-resistant acute cellular rejection (ACR); Refractory a. methylprednisolone 250-1000 mg IV x 3-5 days b. rabbit anithymocyte globulin 1.5 mg/kg/day IV x 6-7 days c. alemtuzumab d. steroids +/- rituximab +/- IVIG
c. alemtuzumab
49
antibody mediated rejection (AMR) a. methylprednisolone 250-1000 mg IV x 3-5 days b. rabbit anithymocyte globulin 1.5 mg/kg/day IV x 6-7 days c. alemtuzumab d. steroids +/- rituximab +/- IVIG
d. steroids +/- rituximab +/- IVIG (plasmaphoresis often performed in conjunction)
50
intravenous immune globulin (IVIG) indication (2; slide 88)
-desensitization protocols in solid organ transplant -tx of antibody-mediated rejection
51
drug for fungal opportunistic infection prophylaxis (in red; slide 97)
posaconazole
52
aspergillus infection is most common in _____ transplant pts
lung

PHRM 865 Therapeutics (32 decks)

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