Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Pharm Exam 3 > Transplant Therapeutics > Flashcards

Transplant Therapeutics Flashcards

1
Q

What is the goal in general with prescribing drugs for transplant?

A

Use the lowest dose possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does triple/maintenance therapy consist of

A
  1. Anti-metabolites: AZA or mycophenolate
  2. Calcineurin inhibitors: cyclosporine or tacrolimus
  3. Prednisone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What drug can be a substitute for 1 and 2 of triple therapy?

A

Sirolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the anti-metabolite drugs?

A
  • Azathioprine

- Mycophenolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Azathioprine is a prodrug of

A

6-mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Azathioprine MOA

A

↓ circulating B and T lymphocytes, ↓ IG synthesis, and ↓ IL-2 secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical indications azathioprine

A
  • Prophylaxis of organ rejection
  • Active RA
  • Steroid-sparing agent for corticosteroid-dependent IBD
  • Tx of various autoimmune diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where are we more likely to see azathioprine than in transplant pts.?

A

Difficult to manage rheumatologic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the various autoimmune disorders AZA can be used to treat?

A
  • Psoriatic arthritis
  • Psoriasis
  • RA
  • Behcet’s dz
  • Polymyositis
  • SLE
  • Sustain remissions in systemic vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do we monitor in a pt. on azathioprine?

A
  • CBC w/ diff
  • CMP
  • Thiopurine methyltransferase (TMPT) genotyping or phenotyping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pt. w/ absent or reduced TMPT are at risk for what?

A

Severe life-threatening myelotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why are pt. w/ absent or reduced TMPT at risk for myelotoxicity?

A

These pt. have an inability to degrade the drug fully and clear it; this leads to more immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we approach prescribing AZA to pt. that are TMPT homozygous for nonfunctional alleles?

A

Do NOT prescribe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do we approach prescribing AZA to pt. that are TMPT heterozygous for nonfunctional alleles?

A

Reduce dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug interactions with azathioprine

A
  • Additive immunosuppression w/ other agents
  • ACEI
  • Allopurinol/febuxostat
  • Aminosalicylates (e.g. Mesalamine - IBD drug)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens if you use azathioprine with ACEI?

A

May induce anemia & severe leukopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What happens if you use azathioprine with allopurinol/febuxostat or aminosalicylates?

A

Increase myelosuppression risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does concomitant use of AZA and allopurinol/febuxostat cause increase myelosuppression risk?

A

Slows elimination of 6-MP by inhibiting xanthine oxidase (XO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does concomitant use of AZA and aminosalicylates cause increase myelosuppression risk?

A

May inhibit TMPT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Azathioprine ADRs

A
  • N/V, anorexia
  • Hepatotoxicity
  • Pancreatitis
  • Myelosuppression (infeciton, malignancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Renal transplant pt. have _____ risk of malignant disease

A

50-100x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most common tumors associated with renal transplant pt.

A
  • SCC of the skin&raquo_space;»

- NHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Do we use azathioprine or mycophenolate more commonly?

A

Mycophenolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mycophenolate MOA

A

↓ B and T cell proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clinical indications mycophenolate

A
  • Prophylaxis of organ rejection in pts receiving allogenic renal, cardiac, or hepatic transplants
  • Tx of lupus nephritis, psoriasis, myasthenia gravis
  • Prevention & tx of GVHD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Drug monitoring in a pt. on mycophenolate

A

CBC w/ diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Drug interactions with mycophenolate

A
  • Additive immunosuppression w/ other agents

- Fe, antacids, cholestyramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Adding Fe, antacids, or cholestyramine to mycophenolate does what to the drug and why is this a problem?

A

Decreases absorption of mycophenolate, increases rejection risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mycophenolate ADRs

A
  • N/V/D, abd cramping
  • Myelosuppression
  • Miscarriages & birth defects (BLACK BOX)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What types if birth defects occur in the fetus of a pregnant women on mycophenolate?

A
  • Cleft lip/palate

- Ear deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the calcineurin inhibitor drugs?

A
  • Cyclosporine

- Tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Are formulations of cyclosporine interchangable?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Cyclosporine is available in what formulations?

A

Solution, tablet, IV, ophthalmic gtt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Are “old” or “new” cyclosporines preferred and why?

A

“New” preferred b/c they have a more reliable Pk profile

35
Q

Cyclosporine MOA

A

↓ production/release of IL-2 -> inhibits IL-2-induced activation of resting T-lymphs

36
Q

Clinical indications cyclosporine

A
  • Prophylaxis if organ rejection in kidney, liver, & heart transplants
  • Severe, refractory RA, psoriasis, & IBD
  • Keratoconjunctivitis sicca-associated ocular inflammation (ophthalmic emulsion)
37
Q

What do we monitor in pt. on cyclosporine?

A
  • Cyclosporine trough levels
  • CMP
  • CBC w/ diff
  • BP
  • FLP
38
Q

Drug interactions w/ cyclosporine

A
  • Additive immunosuppression w/ other agents
  • Additive nephrotoxicity w/ other nephrotoxic agents
  • CYP interactions
39
Q

Cyclosporine is a substrate of CYP____

A

3A4, also P-gp

40
Q

Cyclosporine is a moderate inhibitor of CYP____

A

3A4

41
Q

Cyclosporine ADRs

A
  • Nephrotoxicity (AKI)
  • HTN
  • Neurotoxicity
  • Metabolic abnormalities
  • Myelosuppression
  • Gingival hyperplasia
  • Hirsuitism
  • N/V/D
42
Q

What cyclosporine ADR is the most common & clinically significant?

A

Nephrotoxicity (reversible after dose reduction)

43
Q

Cyclosporine-induced HTN

A
  • Caused by renal vasoconstriction & Na+ retention
  • 1st wks of therapy
  • Usually responds to dose reductions
44
Q

Cyclosporine-induced neurotoxicity

A
  • Severe HA, visual abnl, seizuers r/t acute HTN

- Mild tremor common (35-55%)

45
Q

Cyclosporine-induced metabolic abnormalities

A
  • Glucose intolerance (=post-transplant DM)
  • Hyperlipidemia
  • Hyperuricemia (exacerbate gout)
46
Q

Where does tacrolimus come from?

A

It is a macrolide ABX produced by the bacteria streptomyces tsukubaensis

47
Q

Tacrolimus MOA

A

↓ production/release of IL-2 -> inhibits IL-2-induced activation of resting T-lymphs
*binds to immunophilin instead of cyclophilin

48
Q

Clinical indications tacrolimus

A
  • Immunosuppression for heart, kidney, or liver transplant
  • Refractory ulcerative colitis
  • Moderate-to-severe atopic dermatitis*
49
Q

For what clinical indications is the oral/injection form of tacrolimus used?

A
  • Immunosuppression

- Refractory UC

50
Q

For what clinical indications is the topical form of tacrolimus used?

A

Atopic dermatitis

51
Q

What do we monitor in a pt. on tacrolimus?

A
  • CBC w/ diff
  • CMP
  • BP
  • Drug concentration*
52
Q

Drug interactions w/ tacrolimus

A
  • Additive nephrotoxicity w/ other nephrotoxins

- CYP interactions

53
Q

Tacrolimus is a substrate of CYP___

A

3A4, also P-gp

54
Q

Tacrolimus ADRs

A

Similar to cyclosporine

- Nephrotoxicity, myelosuppression….

55
Q

What ADRs are more common with tacrolimus c/t cyclosporine?

A
  • PTDM

- Alopecia

56
Q

What ADRs are more common with cyclosporine c/t tacrolimus?

A
  • Hirsuitism
  • Gingival hyperplasia
  • HTN
57
Q

What is our corticosteroid of choice for transplant therapy?

A

Prednisone

58
Q

Prednisone is a prodrug of

A

Prednisolone

59
Q

Where in the body is prednisone converted to prednisolone?

A

In the liver

60
Q

Prednisone MOA

A

Not fully understood

- Lower doses inhibit cytokine production

61
Q

High doses of prednisone are believed to be

A

Lymphotoxic

62
Q

Clinical indication of prednisone

A

Prevention & tx of organ transplant

63
Q

Drug interactions w/ prednisone

A
  • Additive immunosuppression

- Antagonizes effect of anti-DM meds

64
Q

How does prednisone antagonize DM drugs?

A

Induces hyperglycemia

65
Q

What do we monitor in a pt. on prednisone?

A
  • BP

- Blood glucose

66
Q

Prednisone “acute” ADRs

A
  • Insomnia, nervousness
  • Increased appetite
  • Hyperglycemia
67
Q

Prednisone “chronic” ADRs

A
  • Hirsutism
  • Cataracts
  • Fat redistribution* (Cushingoid)
  • Fluid retention
  • Osteoporosis*/AVN
  • Poor wound healing
  • HPA-axis suppression/growth suppression*
  • Myopathy
68
Q

Pts. on prednisone have the following sx r/t myopathy:

A
  • Proximal muscle weakness

- Muscle wasting

69
Q

Pts. on prednisone DO NOT have the following sx r/t myopathy:

A
  • Myalgias

- Muscle tenderness

70
Q

Which occurs first in pt. on prednisone r/t myopathy: UE or LE weakness?

A

LE weakness (more severe)

71
Q

What are the implications of LE weakness in pt. on prednisone?

A

Interferes w/ ADLs

72
Q

Prendisone-induced myopathy is uncommon at what dose?

A

<10mg/d

73
Q

Prednisone-induced myopathy is common at what dose?

A

> 40-60mg/d for 1 month

74
Q

Prednisone-induced myopathy is a……

A

Diagnosis of exclusion

75
Q

Sirolimus is an example of what type of drug?

A

mTOR inhibitor (mammalian target of rapamycin)

76
Q

Sirolimus MOA

A

Inhibition of mTOR suppresses cytokine-drive T cell proliferation
*binds to immunophilin like tacrolimus

77
Q

Clinical indications sirolimus

A
  • Prophylaxis of organ rejection in pts receiving renal transplants
  • Used in triple therapy maintenance regimens in place of calcineurin inhibitor or antimetabolitc (depends on transplant center)
78
Q

What do we monitor in a pt. on sirolimus?

A
  • Drug concentration
  • CBC w/ diff
  • CMP
  • FLP
  • BP
79
Q

Sirolimus is a substrate of CYP____

A

3A4; also P-gp

80
Q

Sirolimus ADRs

A
  • HA
  • Tremor
  • HTN
  • Edema
  • PTDM
  • Renal dysfcn
  • similar to tacrolimus
81
Q

Belatacept MOA

A
  • Select T-cell costimulation blocker

- Inhibits cytokine production

82
Q

Clinical indications belatacept

A

Prevention of rejection of renal transplant

- Only indicated for use in EBV seropositive pt.

83
Q

Drug interactions w/ belatacept

A
  • Additive immunosuppression
84
Q

Belatacept ADRs

A
  • Leukopenia/anemia, N/V/D (20%)
  • Myelosuppression (malignancy, infection)
  • Post-transplant lymphoproliferative disorder (PTLD) possible

Clinical Pharm Exam 3 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions