Immune system + transplantation

Question 1

Examples of calcineurin inhibitors

Answer 1

ciclosporin and tacrlimus

Question 2

What is azathioprine metabolised to?

Answer 2

Mercaptopurine

Question 3

If allopurinol is given alongside azathioprine what needs to be considered?

Answer 3

Dose reduction of Azathioprine

Question 4

What disease is ciclosporine used prophylactically for?

Answer 4

graft vs host disease

Question 5

Neurotoxicity, cardiomyopathy and disturbance to glucose metabolism is associated with whihc calcineurin inhibitor?

Answer 5

tacrolimus

Question 6

What needs to be prescribed prior to adminstration of antithymocyte immunoglobulin?

Answer 6

pre-treatment with paracetamol, anti histamine and corticosteroid

Question 7

If a patient has absent TMPT activity, can they have azathioprine?

Answer 7

No - contraindicated

Question 8

3 main side effects of azathioprine

Answer 8

1. Hypersensitivity reactions - malaise, fever, vommiting diarrhoea
2. Neutropenia + thrombocytopenia - dose dependent
3. nausea - managed by dividing doses, giving after food + antiemetics

Question 9

What pre treament screening is required before starting azathioprine?

Answer 9

TPMT

Question 10

If a patient has reduced TPMT activity, what is the risk?

Answer 10

myleosuppression

Question 11

Monitoring requirements for Azathioprine

Answer 11

FBC weekly for first 4 weeks then 3 monthly

Question 12

MHRA warning regarding ciclosporin

Answer 12

Must be prescribed by brand name

Question 13

Can a patient with uncontrolled HTN + active infection have ciclosporin?

Answer 13

no - contra indicated

Question 14

Side effects of ciclosporin

Answer 14

Gingival hyperplasia, headaches, apetite decreaase, hyperglycaemiahyperlipidemia, HTN,

Question 15

Monitoring requirements for ciclosporin

Answer 15

1. ciclosporin level (trough)
2. BP,
3. renal function
4. LFT
5. serum potassium
6. serum magnesium
7. lipids - baseline and at 1 month

Question 16

What should patients be counselled on regarding their skin when on sicrolimus

Answer 16

void excessive exposure to UV light

Question 17

What is the MHRA warning regarding Tacrolimus?

Answer 17

prescribe and dispense as brand name only

Question 18

Adoport, prograf, capexion and tacni are what form of tacrolimus capsules?

Answer 18

Immediate release BD capsules

Question 19

Advagraf is what form of tacrolimus medication

Answer 19

Modified release taken OM

Question 20

True or false - tacrolimus can cause QT prolongation?

Answer 20

true

Question 21

Why is echocardiography needed for patients on tacrolimus?

Answer 21

risk of cardiomyopathy

Question 22

Belimumab has an MHRA warning about what?

Answer 22

increased risk of serious psychiatirc events

Question 23

What is the contraceptive advice regarding mycophenolate?

Answer 23

mycophenolate is genotoxic - females need pregancy to be ruled out before treatment. 2 tests required 8-10 days apart. Women need at least 1 form of contraception and for 6 weeks on discontinuation

Question 24

Monitoring requirement for mycophenolate

Answer 24

FBC for 4 weeks then twice a month for 2 months then every month for the first year

Question 25

Low levels of what vitamin are a risk factor for developing MS?

Answer 25

vitamin D

Question 26

What medication is sometimes used to treat fatigue associated with MS?

Answer 26

Amantadine

Question 27

What is the first line treatment of Oscillopsia in MS?

Answer 27

Gabapentin

Question 28

What should patients receive prior to anti lymphocyte antibodies?

Answer 28

pre medication to reduce risk of infusion related side effects

Question 29

If a patient is prescribed Alemtuzumab, what condition do they requrie prophylaxis medication for?

Answer 29

Herpes infection

Question 30

Nataliumab is associated with what neurological condition?

Answer 30

PML - progressive multi focal leukonencepthalopathy MRI required before initiation

Question 31

What food interaction should patients be aware of with ciclosporin?

Answer 31

Pomelo/grapefruit juice - increases Ciclosporin levels | Purple grape juice decreases levels

Question 32

How often dose ciclosporin levels need to be taken?

Answer 32

Every weel until stable for 6 weeks then monthly

Question 33

What is a risk when a patients cholesterol is < 3 and they are on ciclosporin

Answer 33

toxicity

Question 34

What is the MHRA warning associated with giving Bevacizumab and Sunitinib?

Answer 34

Risk of ONJ

Question 35

What should be measured if hypogammaglobinaemia is suspected following mycophenolate use?

Answer 35

serum immunoglobulin

Question 36

Men must use a condom for how many days after completing mycophenolate course?

Answer 36

90 days

Question 37

EGFR inhibitors have an MHRA warning about what?

Answer 37

serious cases of keratitis and ulcerative keratitis

Question 38

Brand name for Trastuzumab

Answer 38

Herceptin

Question 39

What is the main risk with herceptin therapy

Answer 39

Cardiotoxic - need to monitor function before and during treatment

Question 40

What hepatic condition can RTX reactivate

Answer 40

Hep B