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Renal/Resp > Renal Pharm pt2 > Flashcards

Renal Pharm pt2 Flashcards

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1
Q

pharmacokinetics predisolone

A

action take >8hours

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2
Q

benefits of mTOR inhibitor sirolimus over calcineurin inhibitors Cyclosporine, tacrolimus

A

prophylaxis against cellular jrection

less vasoconstriction

no acute/chronic renal insuffciency

down regu of TGF-B+ PDGF > less interstial fibrosis

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3
Q

interleukin 2 receptor abx

A

daclizumab (95% human)

Basiliximab (75% human)

alemtuzmab (humanized)

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4
Q

drug interaction sirolimus

A

CYP3A4 inducers - Rifampin

CYP450 inhibitors - itraconazole, ketoconazole

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5
Q

___- may potentiate adverse events with calcineurin inhibitors

A

prednisolone

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6
Q

indications belatacept

A

renal transplant for patients seropos for ebstein Barr

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7
Q

indicated drug class in membranous nephropathy

A

ACEi, ARB

cotricosteroids, immunosuppresants

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8
Q

monitoring needed for mycophenolate mofetile

A

CBC to monitor hematologic side effects

GI side effects common when dose >1g bid > reduce dose

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9
Q

pharmacokinetics and side effects belatacept

A

long half life - 8-10-days

hypersensitivity

lymphoproliferative if no prior exposure to ebstein barr

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10
Q

pharmacokinetics taccrolimus

A

or or IV

more water soluble than cyclosporine

variable half -lfie

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11
Q

pharmacokinetics basiliximab

A

long half life (1 week)

given prior to surgery and 4 days following

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12
Q

3 path ot immunosuppression

A

Calcineurin

Mtor Pathway

Cell cycle pathway (antimetabolites)

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12
Q

calcineurin inhibitors

A

cyclosporine

tacrolimus

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12
Q

side effects cyclosporin

A

nephrotoxicity - vasoconstrition, induce TGFB, fibrosis+atrophy)

HTN+fluid retension

Hepatic dysfunction

tremor, headache, fatigue

Hypertrichosis (hair growth)

gum hypertrophy

hyperlipidemia, hyopmagnesmia, hypokalemia

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12
Q

pharmacokinetics mycophenolate mofetil

A

oral or IV

liver metab

long half-life - 18 hours

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12
Q

interaction with mycophenolate mofetil

Rifampin, phenobarbital, phenytoin

A

decrease MPA levels

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12
Q

interaction with mycophenolate mofetil

corticosteroids, cyclosporine

A

decrease MPA levels

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12
Q

indicated drug class in IgA nephropathy

A

ACEi

corticosteroids or immunosuppresents

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12
Q

indicated drug clase in focal segmental glomerulosclerosis

A

ACEi

corticosteroids, immunosuppresants

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13
Q

monitoring needed for azathioprine

A

complete blood count to monitor hematologic side effects

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15
Q

side effects sirolimus

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A

Edema, ascities

tachycardia, HTN

hyperlipidemia, hypokalemia, hypophos

Rash

Lymphocele > can cause ereteric compression in transplant

16
Q

mTOR inhibitor

17
Q

death post kidney transplant causes

Study These Flashcards
A

Infection

CVD

Malignancy

18
Q

issue with antiacids in calcineurin inhibitors

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A

mg and aluminum antiacids inhibit abs

should wait until 2hrs after calcineurin inhibitor dose

20
interaction with mycophenolate mofetil antacids, cholstyramine, sevelamer, feso4
decrease MPA levels
21
indicated drug class in Neprhotic syndrome
ACEi, ARB
24
pharmacokinetics sirolimus
oral abs modulated by p-glycoproteins metabolized by CYP450 very long half life (60hours)
25
higher impact on lipid levels, cyclosporine or tacrolimus?
cyclosporine greater
26
risk of HMG-CoA reductase inhibitors (statins) with calcineurin inhibitors (Tacrolimus, cyclosporine)
increased risk of rhabdomyolysis bone marrow suppression
27
costimulator Cd80 and Cd86 blocker
belatacept
29
side effects tacrolimus
pleual effusion cardial effusion cardiomyopathy in children
30
mechanism calcineurin inhibitors (Cyclosporine + tacrolimus)
bind to cyclphilin (cyclosporine) or FBKP12 (tacrolimus) complex binds and inhibits calcineurin inhibits transcription of Il-2 \> inhibit Tcell activation and prolif
31
therapeutic action prednisolone
inhibit proinflam like NF-kB activate anti-inflam genes via histone acetlyation reduce T-cell prolif and increase Tcell apop reduce Tcell activation, b-cell pro-lif
32
mechanism+metabolism azathioprine methotrexate cyclophosphamide
metabolized to 6mercaptopurine\>TIMP in liver TIMP decreases synthesis of DNA precursors block CD28 costim of Tcells
33
pharmacokinetics Azathioprine
oral short half life (3-5 hours) metabolized to TIMP in liver
34
mechanism of aaction sirolimus
binds FKBP12 \> mdoulates activity of mTOR inhibits IL-2 induced cell progression from G1 to S phase
35
drug interactions azathioprine
allopurinol \> decrease 6 mercaptopurine metabolism, must reduce azathioprine dose by 75% if used together
36
antiproliferative antimetabolitte
mycopehnolate mofetil
37
side effects azathioprine
bonemarrow supression, leucopenia, thrombocytopenia hypersensitivity reactions opportunistic infection alopecia small risk of lymphomas
38
side effects mycophenolate mofetil
**leucopenai, thrombocytopenia, anemia** HTN edema, tachycardia (electrolytes) dypsnea, cough opportunistic infections lymphoproliferative disease skin cancer
39
purine analogs antiproliferative agents block CD28 co-stimulation of Tcells
Azothioprine cyclophosphamide methotrexate
40
drug interactions cyclosporing
**nephrotoxic drugs** - NSAIDs, aminoglycosides, antimicrobials **CYP3A3 inducers - **phenytoin, carbamazepine **CPY450 inhibitors **- erythromycin, ketoconazole
41
side effects basiliximab
hypersensitivity reactions
42
critical consideration with induction agents in kidney rejections
check fluid volume status
43
pharmocokinetics cyclosporine
or or IV concentrates in liver, kidney, spleen, marrow metabolized by CYP3A4 in liver 27 hour halflife
45
interaction with mycophenolate mofetil tacrolimus, sirolimus
no change in MPA levels
46
induction agents to combat kidney transplant rejection
muronomab anti-thymocyte globulin (deplete circulating lymphocytes) daclizumab (IL-2 receptor) basiliximab (IL-2 receptor) alemtuzumab (IL-2 receptor) FTY-720 - lymphocyte homing
47
side effects prednisolone
acne cushings face hirsutism mood disorder HTN, glucose intolerance cataracts osteoporosis growth retardation
48
indicated drug class in lupus nepritis
class V corticosteroids
49
mechanism mycophenolate mofetil
competive/reversible inhibition of IMPDH \> rate limiting de-novo purine synth lymphocytes dependent on denove pathway \> inhibits B and T lymphocyte prolif

Renal/Resp (43 decks)

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