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Immunotherapy Flashcards

(60 cards)

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1
Q

too little therapy

A

rejection

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2
Q

too much therapy

A

opportunistic infection

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3
Q

therapy stages

A

induction maintenance rejection

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4
Q

standard regimen

A

TAC + MMF or EC-MPS + Prednisone

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5
Q

secondary acquired immunodeficiencies

A

increase typical and opportunistic infections and cancers

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6
Q

what class needs TDM

A

CNI

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7
Q

Prograf

A

Tacrolimus IR BID DAW

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8
Q

Asatgraf XL

A

Tacolimus ER

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9
Q

Envarsus

A

Tacrolimus ER

70% of IR daily dose

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10
Q

Neoral

A

modified cyclosporine BID

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11
Q

Gengraf

A

modified CYA

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12
Q

Neoral and Gengraf are bioevquivalents and are interchangeable

A

true

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13
Q

Prograf is interchangeable with other TAC generics

A

false

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14
Q

Prograf and Astagraf are equivalent and interchangeable

A

false

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15
Q

Astagraf to Prograf compairson

A

1 mg ER : 1 mg IR

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16
Q

Sandimmune

A

non modified CYA

qd and not interchangeable

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17
Q

CYA AEs

A 
hyperlipidemia 
nephrotoxicity
tremor, HA
HTN
hyperglycemia
gingival hyperplasia
hirsutism
d/v
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18
Q

TAC AEs

A 
N/D
nephrotoxicity
tremor, HA
Insomnia
Hyperglycemia
Hyperlipidemia
HTN
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19
Q

DDI that inhibit CYP3A4

A 
-azole antifungals
antivirals (-VIR)
CCB - diltiazem and verapamil
gastric acid suppressors
grapefruit juice
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20
Q

how would dosing change if there was a DDI inhibiting CYP3A4?

A

higher troughs resulting in lower dosing

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21
Q

how would dosing change if there was a DDI inducing CYP3A4

A

lower troughs resulting in higher dosing

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22
Q

DDI that induce CYP3A4

A

rifampin
caspofungin, terbinafine
phenytoin, phenobarbital, oxcarbazepine
st johns wart

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23
Q

Mycophenolate Mofetil

A

CellCept

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24
Q

MFF is a pro drug delayed release

A

False, it is a prog drug regular release

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25
Mycophenolic Acid Sodium
Myfortic
26
MPA is a delayed realse tablet
true
27
MPA is highly protein bound: how can that alter other drugs
can alter binding of others drugs to albumin
28
MPA MOA
inhibit IMPDH - blocking nucleotide synthesis and preventing proliferation of committed T cells
29
Comparison between MMF and MPS
1000mg of pro-drug MFF = 720 mg active drug MPS
30
DDI with MPA - enterohepatic recycling
CYA > TAC
31
DDI with MPA
Acyclovir COCs Protein bindning - aspirin + phenytoin
32
MPA AEs
GI Leukopenia Opportunistic Infections CNS
33
What AE of MPA has a major impact on adherence
severe GI
34
What are the CNS AEs associated with MPA
dizziness, insomnia, HA
35
Prednisone - Hydrocortisone comparison
5 mg to 20 mg
36
Prednisone - Dexamethasone comparison
5 mg to 0.75 mg
37
short acting glucocorticoids have ___ anti-inflammatory properties
NONE
38
short acting glucocorticoids have ___ mineralocorticoid activity
HIGH
39
intermediate acting glucocorticoids have ___anti-inflammatory and mineral0corticoid activity
MODERATE
40
long acting glucocorticoids have ___anti-inflammatory activty
HIGH
41
long acting glucocorticoids have ___mineralocorticoid activity
NONE
42
Glucocorticoid AEs
axillary and lower abdominal striae steroid induced avascular necrosis ecchymoses hyperglycemia
43
depleting induction therapies
Thymoglobulin | Alemtuzumab
44
non-depleting induction
Interleukin-2 receptor blockers
45
IL-2 receptor blocker
Basiliximab
46
Basiliximab
Simulect
47
Simulect MOA
MoAB against CD25 prevents activation of proliferation
48
AE's of IL-2 RB
minimal due to low potency | n/v/d
49
Anti-thymocyte Globulin (ATG)
thymoglobulin
50
thymoglobulin is sourced from animals and therefore could have AEs
TRUE - hypersensitivity
51
How is ATG administered
IV infusion of 4-6 hours for 2 - 4 daily doses
52
ATG MOA
coat hosts Tcells which are destroyed by complement
53
ATG AEs
flu-like syndrome = cytokine release syndrome serum sickness leukopenia
54
What is used to pre-medicate ATG administration and why
diphenhydramine and APAP - cytokine release syndrome
55
Aletuzumab MOA
directly against the CD52 surface AG - cytotoxicity and cell lysis
56
Aletuzumab lymphocyte depletetion
B cells - 3-12 months | T cells - up to 3 years
57
What is used to pre-medicate aletuzumab
IV MEPD 30 mins prior
58
Aletuzumab AEs
N/V/D lymphopenia increased risk of malignancy and opportunistic infections
59
CNI nephotoxicity
acute dose dependent increase in SCr due to afferent arteriolar vasoconstriction
60
As CNI troughs increase....
SCr may increase

Therapeutics (3 decks)

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