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PCH CCTC Study > Pharmacology > Flashcards

Pharmacology Flashcards

(68 cards)

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1
Q

Corticosteroids belong to what class of medications?

A

Interleukin 1 inhibitors

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2
Q

Which medications are calcineurin inhibitors?

2 items

A
  • tacro
  • cyclosporine
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3
Q

Which medications are antiproliferative agents?

2 items

A
  • azathioprine
  • mycophenolate mofetil
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4
Q

Which medications are mTOR inhibitors?

2 items

A
  • sirolimus
  • everolimus
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5
Q

Which medications are antibodies?

6 items

A
  • Atgam
  • thymoglobulin
  • basilixamab
  • rituximab
  • alemtuzumab
  • IVIG
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6
Q

Is ATG monoclonal or polyclonal?

A

polyclonal

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7
Q

What are the advantages of polyclonal induction agents?

2 items

A
  • stronger
  • can be used to treat rejection
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8
Q

What are disadvantages of polyclonal induction agents?

3 items

A
  • common acute side effects
  • higher infection (CMV) and malignancy rates
  • potential to develop antibodies
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9
Q

Is basiliximab monoclonal or polyclonal?

A

monoclonal

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10
Q

What are advantages of monoclonal induction agents?

* 2 items

A
  • no acute side effects
  • not associated with infection and malignancy
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11
Q

What are disadvantages of monoclonal induction agents?

2 items

A
  • weaker
  • cannot be used for rejection
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12
Q

Why would a polyclonal antibody (ATG) be used intraoperatively?

A

to reduce delayed graft function

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13
Q

Why would a polyclonal antibody (ATG) be used for induction?

A

to prevent acute rejection

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14
Q

Why would a polyclonal antibody (ATG) be used for rescue?

A

to treat rejection

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15
Q

What are polyclonal antibodies mechanism of action?

2 items

A
  • t-cell depletion
  • cytotoxic activities
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16
Q

What side effects (related to lab values) can be attributed to polyclonal antibodies?

2 items

A
  • leukopenia
  • thrombocytopenia
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17
Q

What is the mechanism of action for CNIs?

A

inhibition of t-cell activiation

This leads to reduced circulating t-cell activators.

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18
Q

The adverse effect of nephrotoxicity for cyclosporine and tacrolimus is…
1. worse for tacro
2. the same
3. worse for cyclosporine

A

2

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19
Q

The adverse effects of neurotoxicity for cyclosporine and tacrolimus is…
1. worse for tacro
2. the same
3. worse for cyclosporine

A

1

Side effects include tremors, HA, parasthesias, PRES

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20
Q

The adverse effects of hematological changes for cyclosporine and tacrolimus is…
1. worse for tacro
2. the same
3. worse for cyclosporine

A

2

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21
Q

CNIs can cause what hematological adverse effects?

3 items

A
  • HUS
  • Thrombocytopenic Purpura
  • Thrombocytopenia
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22
Q

The adverse effect of hyperlipidemia for cyclosporine and tacrolimus is…
1. worse for tacro
2. the same
3. worse for cyclosporine

A

3

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23
Q

The adverse effect of hyperglycemia for cyclosporine and tacrolimus is…
1. worse for tacro
2. the same
3. worse for cyclosporine

A

1

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24
Q

What is the most common side effect of CNIs?

A

HTN

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25
What is the dermatological side effect of tacrolimus?
hair loss
26
What are the dermatological side effects of cyclosporine? | 2 items
* hair growth gingival hyperplasia
27
The gastrointestinal adverse effects for cyclosporine and tacrolimus are... 1. worse for tacro 2. the same 3. worse for cyclosporine
1
28
What GI adverse effects associated with cyclosporine? | 5 items
* nausea * vomiting * anorexia * bloating * bad smell
29
Drugs/foods that increase tacro/cyclosporine levels include... | 7 items
* antifungals ('azole meds) * metoclopramide * grapefruit/pomegranate juice * simepravir * 'mycin meds * diltizame, verapamil * amiodarone
30
Drugs/foods that decrease tacro/cyclosporine levels include... | 10 items
* cholestyramine * kayexalate * ocreatide * probucol * Mg and Al antacids * rifampin * herbs * nafcillin * phenytoin * phenobarbitol
31
mTOR inhibitors are structurally similar to what medication?
tacrolimus
32
What is the mechanism of action for mTOR inhibitors?
inhibiting t-cell activation and proliferation
33
When is sirolimus used? | 3 items
* adjunct to prevent chronic rejection * if intolerant of CNIs * used for steroid-free protocols
34
When CNIs and sirolimus are used syngergistically, what does it allow for? 1. higher levels of CNIs and lower levels of sirolimus 2. lower levels of both CNIs and sirolimus 3. lower levels of CNIs and higher levels of siolimus
2
35
What is the loading dose, maintenance dose, and target trough level for sirolimus?
* 6-12 mg loading * 2-5 mg maintenance * trough level 6-12
36
What 3 hematological lab results may be caused by sirolimus?
* neutropenia * thrombocytopenia * leukopenia
37
The incidence of anemia is increased when sirolimus is used with what other medication? 1. tacro 2. steroids 3. mycophenolate 4. phenytoin 5. phenobarbitol
3
38
Sirolimus can cause which of the following? 1. hyperlipidemia and hypertriglyceridemia 2. hyperlipidemia and hypotriglyceridemia 3. hypolipidemia and hypertriglyceridemia 4. hypolipidemia and hypotriglyceridemia
1
39
Sirolimus may cause what in relation to its inhibition of cell and muscle proliferation?
delayed wound healing
40
How do nausea, vomiting, and diarrhea side effects compare between sirolimus and mycophenolate mofetil? 1. they are the same 2. worse in sirolimus 3. worse in mycophenolate mofetil
3
41
What side effects of the mouth can be caused by sirolimus?
mouth ulcers
42
What is the treatment for interstitial pneumonitis while on sirolimus?
discontinuation of drug
43
How does sirolimus affect a UA?
causes proteinuria
44
What are the 2 black box warnings for sirolimus?
* hepatic artery thrombosis liver patients * bronchial anastomotic dehiscence lung transplant patients
45
What is everolimus used for?
prevention of rejection in low-mod risk renal transpant recipients
46
What 3 medications can everolimus be used with?
* basiliximab * low dose cyclosporine * corticosteroids
47
Everolimus is given at the same time as what other medication?
cyclosporine
48
What is the dosing for everolimus?
0.75 mg PO BID
49
What are the side effects of everolimus? | 12 items
* hypercholesterolemia * hypertriglyceridemia * leukopenia * anemia * mouth ulcers * acne * impaired wound healing * lymphocele * proteinuria * nephrotoxicity * graft thrombosis * rash ## Footnote These are very similar to sirolimus
50
When is azathioprine used?
for those who don't tolerate mycophenolate
51
What is the mechanism of action for azathioprine?
inhibits t-cell proliferation
52
What is the dosing for azathioprine?
1-3 mg/kg/day
53
What are the side effects of azathioprine? | 9 items
* leukopenia * thrombocytopenia * nausea/vomiting * macrocytic anemia * alopecia * pancreatitis * hepatotoxicity * malignancy * infection
54
What drugs does azathioprine have an interaction with? | 2 items
* allopurinol * mycophenolate ## Footnote Allopurinol: Switch to cellcept. Causes profound pancytopenia. Mycophenolate: separate stopping and starting by 24 hours
55
What is the mechanism of action of mycophenolate mofetil?
Inhibits T and B cell proliferation
56
What delays mycophenolate absorption?
food
57
What are the side effects of mycophenolate? | 7 items
* diarrhea * nausea/vomiting * anemia * thrombocytopenia * infections * CMV tissue invasion * malignancy
58
What are the mycophenolate drug interactions? | 6 items
* ganciclovir, valgan..., acycl... * cyclosporine * sirolimus * aza * cholestyramine * aluminum/mag containing antacids
59
Mycophenolate drug interactions ganciclovir, valganciclovir, acyclovir, and sirolimus may cause what?
increased risk of bone marrow suppression
60
The drug interaction between mycophenolate and cyclosporine may cause what?
decreased level of MPA
61
The drug interaction between mycophenolate and aza may cause what?
toxicity ## Footnote 24 hours between stopping one and starting another
62
The drug interaction between mycophenolate and cholestyramine may cause what?
decrease in mycophenolate levels
63
The drug interaction between mycophenolate and antacids may cause what?
decreased absorption
64
What is plasmapheresis?
The removal of circulating antibodies. ## Footnote Does not affect b cells.
65
What is IVIG used for?
prevention and treatment of humoral rejection
66
What is rituximab used for? | 2 items
* humoral rejection * PTLD
67
What are the treatments for antibody mediated rejection? | 6 items
* plasmapheresis * IVIG * rituximab * antithymocyte globulin * cyclophosphamide * bortezomib
68
What medications are used to prevent PCP? | * 4 items
* sulfamethoxazole/trimethoprime * pentamidine inhalation * dapsone * atovaquone

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