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PHRM 865 > transplant > Flashcards

transplant Flashcards

(67 cards)

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1
Q

thymoglobulin does what

A

lymphocyte depletion

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2
Q

thymoglobulin adverse effects

A

leukopenia
thrombocytopenia
fever, chills

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3
Q

what can we do to prevent side effects in thymoglobulin

A

premedicate with diphenhydramine or acetaminophen
prevents fever and chills

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4
Q

thymoglobulin is anti what

A

CD3

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5
Q

almetuzumab does what

A

profound depletion of T cells (CD52)

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6
Q

almentuzumab adverse effects

A

fever, chills, rigor

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7
Q

how to combat alentuzumab adverse effects

A

premedicate with acetaminophen and diphenhydramine

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8
Q

which induction meds are non-lymphodepleting

A

basiliximab

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9
Q

when do we use a Basiliximab for induction

A

history of malignancy
high infection risk
65+
HIV

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10
Q

what drugs are the cornerstone of immunosuppression

A

tacrolimus
cyclosporine
calcineurin inhibitors

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11
Q

calcineurin inhibitors drugs

A

cyclosporine
tacrolimus

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12
Q

tacrolimus formulations preference

A

ER formulation
Astagraf, Envarsus
lower overall drug dose, improved adherence, less peak effects, less swings and variability in trough concentrations

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13
Q

therapeutic drug monitoring for tacrolimus

A

goal 12 hour trough 5-15 ng/mL
50x more potent than cyclosporine

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14
Q

therapeutic drug monitoring for cyclosporine

A

100-400 ng/mL goal

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15
Q

Envarsus

A

ER tablet of tacrolimus

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16
Q

Prograf

A

IR caps given BID of tacrolimus

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17
Q

how is cyclosporine metabolized

A

CYP3A4
PGP

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18
Q

how is tacrolimus metabolized

A

CYP3A4

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19
Q

which drug metabolized by PGP

A

cyclosporine

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20
Q

elimination of cyclosporine

A

half life is variable (10-40 hours)

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21
Q

elimination of tacrolimus

A

elimination is consistent

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22
Q

out of tacrolimus and cyclosporine which is preferred

A

tacrolimus

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23
Q

adverse effects of cyclosporine

A

hypertension
hypercholesterolmeia
hypertriglyceridemia
gingival hyperplasia
hirsutism

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24
Q

adverse effects of tacrolimus

A

diabetes
neurotoxicity
- headache
- insomnia
- dizziness
-tremor
alopecia

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25
which drug causes alopecia
tacrolimus
26
which drug causes hirsutism
cyclosporine
27
which drug causes gingival hyperplasia
cyclosporine
28
which drug causes hypertriglyceridemia
cyclosporine
29
which drug causes neurotoxicity like headache, insomnia,hyperglycemia
tacrolimus
30
CYP3A4 inducers
phenytoin carbamazepine phenobarbital rifampin
31
CYP3A4 inhibitors
erythromycin, clarithromycin conazoles diltiazem, verapamil ritonavir grapefruit juice
32
how is tacrolimus eliminated
hepatically, half life would go up if impaired
33
renal dysfunction effect on calcineurin inhibitors
dose adjustments not necessary
34
antimetabolite drugs used for maintenance immunosupression
azathioprine mycophenolate mofetil mycophenolate sodium
35
azathioprine MOA
converted to 6-MP and inhibits DNA and RNA synthesis byt inhibiting immune cell proliferation (purine analog)
36
therapeutic drug monitoring for azathioprine
no TDM but can measure the nucleotide level if needed
37
azathioprine side effects
GI N/V diarrhea dyspepsia bone marrow suppression - agranulocytosis - macrocytic anemia - leukopenia - neutropenia - thrombocytopenia
38
azathiprine drug interactions
allopurinol febuxostat need to dose reduce AZA by 50-75%
39
mycophenolic acid use
in combo with calcinuerin inhibitors like tacrolimus
40
can we convert mycophenolate mofetil to mycophenolate sodium
yes 1 to 1 conversion IV to PO they are interchangeable mofetil 250 = sodium 180
41
mycophenolic acid adverse effects
contraindicated in pregnancy part of REMS - 2 forms hormonal birth control
42
drug interactions with mycophenoli acid
myelosupressive drugs like valganciclovir, sirolimus
43
mTOR inhibitors
sirolimus everolimus
44
metabolism of mTOR (sirolimus and everolimus)
CYP 3A4s and PGP
45
sirolimus used for what
kidney transplant rejection prophylaxis
46
everolims used for what
kidney and liver transplant rejection prophylaxis
47
sirolumus and everolimus adverse effects
edema hyperlipidemia hypertriglyceridemia impaired would healing mouth ulcers proteinuria
48
when can we not use sirolimus and everolimus
right after transplant due to impaired wound healing
49
what would we need before starting sirolimus and everolimus
lipid levels, has triglyceridemia and hyper lipidemia
50
when might sirolimus or everolimus be used
if switched off of mycophenolate if switched off CNIs
51
steroids used in transplant
methylprednisolone prednisone dexamethasone
52
what was the original cornerstone of immunmosuppresive therapuy
steroids
53
steroid use in transplant
usually tapered off or steroid free regimens
54
steroid adverse effects related to what
cumulative dose average dose
55
steroid adverse effects
hypertension hyperglycemia mood swings
56
t cell costimulator blocker drug
belatacept
57
belatacept not used in what disease
liver transplant
58
belatacept dose
q4 weeks at an infusion clinic
59
when do we use belatacept
replacement or adjunct to CNIs
60
belatacept contraindicated in what
EBV seronegative (need to be seropositive) not for liver translate
61
most common regimen for immunosuppression post transplant
tacrolimus + mycophenolate +/- steroid
62
other approaches to immunosuppresive therapies
CNI avoidance steroid avoidance
63
what is rituximab used for
antibody medicated rejection
64
what is IVIG used for
antibody mediated rejection
65
PJP prophylaxis used in transplant
bactrim
66
CMV prophylaxis drug used
valganciclovir PO in HSV,VZV,CMV
67
fungal infections: candida and aspergillus prophylaxis
posaconazole

PHRM 865 (33 decks)

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