Transplant

Question 1

What is an allograft

Answer 1

Transplant from one person to another of the same species

Question 2

Isograft

Answer 2

Transplant from genetically identical donor

Question 3

Autograft

Answer 3

Transplant in same patient

Question 4

What test are used to check for donor compatibility

Answer 4

HLA and ABO blood groups

Question 5

BBW of using transplant drugs

Answer 5

Infection risk → immunosuppression

Cancer risk → immune system is blunted from suppressing skin cancers

Requires experienced prescribers

Question 6

What is induction immunosuppression

Answer 6

Given immediately before or after surgery to prevent acute rejection and early post-transplant

Question 7

Drugs used for induction immunosuppression

Answer 7

No made to treat only for prevention:
Basilixumab

Used for both induction and prevention:
Antithymocyte globulin: Atgam (equine), Thymoglobin (rabbit)

Question 8

MOA of basilixumab

Answer 8

IL-2 receptor antagonist on the surface of the T lymphocyte

Question 9

MOA of steroids

Answer 9

Alters the gene transcription of IL2 and other inflammatory cytokines

Question 10

MOA of antithymocyte globulin

Answer 10

Binds to antigen T-lympocyte and interfere with their function

Question 11

Drug classes used for maintenance suppression

Answer 11

Calcineurin inhibitor
Antiproliferative
+/- Steroidq

Question 12

Purpose for prescribing multiple immunosuppressants

Answer 12

Targets multiple mechanisms lowering toxicity risk and reduce skin graft rejection

Question 13

Types of calcineurin inhibitor

Answer 13

Tacorlimus
Cyclospporine

Question 14

ADR of Antithyrmocyte Globulin

Answer 14

Anaphylaxis
Infusion-related reactions (premeditate with diphenhydramine, APAP, and steroids)

Question 15

MOA of CI

Answer 15

Inhibits T-lymphocyte activation by binding to calcineurin

Question 16

Tacrolimus

Answer 16

Prograf

Question 17

Cyclosporine

Answer 17

Gengraf, Neoral, Sandimmune

Restasis (Dry eyes)

Question 18

BBW of cyclosporine

Answer 18

Increased malignancy, infection, nephrotoxicity

Modified and unmodified cyclosporines are not interchangeable

Question 19

ADR of cyclosporine

Answer 19

↑ BG, hyperlipidemia, hyperkalemia, hypomagnesemia, hyperuricemiam neurotoxicity, nephrotoxcity, gingival hyperplasia

Question 20

Counseling on cyclosporine

Answer 20

CYP3A4 inhibitor, avoid grapefruit juice

1. Don’t use styrofoam cup, mix in glass
2. Don’t rinse syringe before or after use
3. Non-PVC to prevent leaching of DEHP
4. Use compatible diluent and use same diluent
5. Administer drink immediately and rinse container with extra diluent to ensure dose is taken

Question 21

BBW of tacrolimus

Answer 21

↑ malignancy and infection

Question 22

ADR of tacrolimus

Answer 22

Increased BP, BG, lipids, K, hypomagnesemia, neurotoxicity, alopecia, nephrotoxicity

Question 23

Counseling of tacrolimus

Answer 23

IV: non-PVC bag
Don’t interchange XL/XR to IR
Food decreases absorption

Take Q12H or once in the morning for XL or XR

Question 24

MOA of antiproliferative drugs

Answer 24

Inhibits T and B lymphocyte proliferation by inhibiting purine nucleotide synthesis

Question 25

Antiproliferatives

Answer 25

Azathioprine Mycophenolate

Question 26

Azathioprine

Answer 26

Amuran, Azasan

Question 27

Mycophenalate

Answer 27

Mofetil: CellCept Acid: Myfortic

Question 28

BBW and warning of Azathiopurine

Answer 28

Malignancy Myelosuppresion → genetic deficiency of TPMT

Question 29

BBW of Mycophenalate

Answer 29

Malignancy, infection, congenital malformations and spontaneous absorptions

Question 30

ADR of mycophenalate

Answer 30

Diarrhea, ab pain, nausea, vomiting, leukopenia

Question 31

Counseling of mycophenolate

Answer 31

CellCept and Myfortic are not interchangeable (CellCept 500 mg = Myfortic 360 mg) Myfortic is DR to reduce diarrhea CellCept IV → D5W only ↓ PO contraceptives

Question 32

MOA of mTOR inhibitors

Answer 32

Inhibits T-lymphocyte activation and proliferation by binding to mTOR

Question 33

Types of mTOR inhibitors

Answer 33

Everolimus Sirolimus

Question 34

ERVEROLIMUS

Answer 34

Zortress

Question 35

Sirolimus

Answer 35

Rapammune

Question 36

BBW of mTORs

Answer 36

Malignancy and infection

Question 37

ADR of mTOR

Answer 37

Hyperlipediemia, impaired wound healing, pneumonitis, peripheral edema, increased BP and BG Everolimus: increased risk of hepatic thrombosis → don't use within 30 days of transplant

Question 38

MOA of belatacept

Answer 38

Binds to CD80 and 86 on APC → blocking to costimulation with CD28 on T-lymphocyte

Question 39

BBW of Beltacept

Answer 39

↑ post-transplant lymphoproliferative disorder (PTLD) in patient without EBV immunity For seropositive EBV patients only Risk of infection and malignancy

Question 40

Wanring of using Belatacept

Answer 40

Treat latent TB prior to us

Question 41

Common steroid for transplant

Answer 41

Prednisone 2.5-20 mg PO QD

Question 42

Short term ADRs of prednisone

Answer 42

Fluid retention, stomach upset, mood swings, insomnia, increased appetite, weight gain, increase BG and BP

Question 43

Long term ADRs of prednisone

Answer 43

Adrenal suppression and Cushing's, impaired wound healing, Increased BP, diabetes, acne, osteoporosis, impaired growth in children

Question 44

Drug of choice for induction suppression

Answer 44

Basilixumab Antithyromyctye globuline (higher risk of rejection patients) IV high dose steroids

Question 45

Drug of choice for maintenance suppression

Answer 45

CNI (Tacrolimus > Cyclosprorine) Belatacept is alt in EBX patients Adjuct (add-on to CNI) - Antiproliferative - mTOR inhibitors Prednisone

Question 46

DDI of Azathiopurine

Answer 46

XOI (allopurinol and febuxostat)

Question 47

How do you monitor rejection?

Answer 47

Is it a sx of drug toxicity? Is it a sx of organ rejection? Is it a sx of an infection?

Question 48

Sx of acute rejection?

Answer 48

Flu-like sx ↓ in UO and fluid retention Monitor troughs 30 min before scheduled dose

Question 49

Sx of rejection infection

Answer 49

Fever 100.4F Cough Pain in passing urine, ear, sinus pain Mouth sores or wounds that won't heal

Question 50

Tx for acute rejection

Answer 50

High-dose steroid

Question 51

How to reduce infection

Answer 51

Ifection prophylaxis 6 months of transplant Avoid live vaccines