Transplant Flashcards by Sara Bojarski

transplant of an organ from one individual to another

allograft

How well did you know this?

Not at all

Perfectly

transplant from genetically identical donor

isograft

How well did you know this?

Not at all

Perfectly

transplant in the same patient

autograft

How well did you know this?

Not at all

Perfectly

body has immune response to allograft

rejection

How well did you know this?

Not at all

Perfectly

2 crossmatching tests done before transplant to assess compatibility

human leukocyte antigen (HLA)
ABO blood group

How well did you know this?

Not at all

Perfectly

AB can give blood to

How well did you know this?

Not at all

Perfectly

A can give blood to

A, AB

How well did you know this?

Not at all

Perfectly

B can give blood to

B, AB

How well did you know this?

Not at all

Perfectly

O can give blood to

AB, A, B, O

How well did you know this?

Not at all

Perfectly

AB is a universal

receiver

How well did you know this?

Not at all

Perfectly

O is a universal

donor

How well did you know this?

Not at all

Perfectly

AB can receive blood from

AB, A, B, O

How well did you know this?

Not at all

Perfectly

A can receive blood from

A, O

How well did you know this?

Not at all

Perfectly

B can receive blood from

B, O

How well did you know this?

Not at all

Perfectly

O can receive blood from

How well did you know this?

Not at all

Perfectly

3 main BBW for all transplant meds

infection risk - immune system suppressed, prophylaxis may be needed

cancer risk - blunt protective processes

only experienced prescribers may start

How well did you know this?

Not at all

Perfectly

given to prevent acute rejection during early post transplant period

induction immunosuppression

How well did you know this?

Not at all

Perfectly

3 options for induction immunosuppression

high dose IV steroids
basiliximab (IL2 antagonist)
antithymocyte globulin

How well did you know this?

Not at all

Perfectly

MoAb that inhibits the IL2 receptor on T lymphocytes

basiliximab

How well did you know this?

Not at all

Perfectly

binds to antigens on T lymphocytes and interferes with their function

antithymocyte globulin

How well did you know this?

Not at all

Perfectly

brand names antithymocyte globulin

Atgam - equine
Thymoglobulin - rabbit

How well did you know this?

Not at all

Perfectly

BBW antithymocyte globulin

anaphylaxis

How well did you know this?

Not at all

Perfectly

AEs of antithymocyte globulin

infusion related reactions

How well did you know this?

Not at all

Perfectly

what to do before giving antithymocyte globulin

premedicate to lessen infusion reaction

How well did you know this?

Not at all

Perfectly

can antithymocyte globulin and basiliximiab be used for induction and treatment?

basiliximab - PREVENTION ONLY antithymocyte globulin - induction and treatment

what is used for maintenance immunosuppression

CNI - tacrolimus antiproliferative - MMF +/- steroids

using multiple mechanisms with different drug classes us designed to __&__

lower toxicity reduce risk of graft rejection

class that inhibits T lymphocyte activation

calcineurin inhibitors

brand names of modified cyclosporine

Gengraf Neoral

brand name of non-modified cyclosporine

Sandimmune

BBW cyclosporine

inc malignancy, infection nephrotoxicity inc BP modified and nonmodified are NOT INTERCHANGEABLE

AEs of cyclosporine

inc BG, hyperlipidemia, hyperkalemia, hypomagnesemia, gingival hyperplasia, hirsutism, neurotoxicity, hyperuricemia

monitoring for cyclosporine

trough serum K & Mg renal function LFTs BP glucose lipid profile

DDIs for cyclosporine

many 3A4 inhibitor and substrate P-gp substrate

do not administer cyclosporine oral liquid from a

plastic or styrofoam cup

brand name tacrolimus

Prograf

brand name tacrolimus ER

Envarsus XR

BBW tacrolimus

in malignancy (lymphoma, skin cancer) inc risk infection

AEs of tacrolimus

inc BP inc BG hyperlipidemia nephrotoxicity hypomagnesemia hyperkalemia alopecia neurotoxicity

monitoring for tacrolimus

tough levels serum K, phos, Mg renal function LFTs BP blood glucose lipid profile

DDI tacrolimus

3A4 and P-gp substrate

for IV tacrolimus, you must use

non-PVC bag

with XL and IR tacrolimus, do NOT

interchange

how does food affect tacrolimus

decreases absorption

class that alters purine nucleotide synthesis

antiproliferative agents MMF/MPA azathioprine

BBW azathioprine

inc malignancy

warnings azathioprine

myelosuppression - may be due to genetic TPMT deficiency

brand name of mycophenolate mofetil

CellCept

brand name of mycophenolic acid

Myfortic

BBW MMF/MPA

inc malignancy inc infection inc risk congenital malformations and spontaneous abortions

AEs of MMF/MPA

diarrhea, abdominal pain, NV, leukopenia

myfortic and cellcept are not

interchangeable

MPA (myfortic) is EC to reduce

diarrhea

MMF (CellCept) IV is only stable in

D5W

DDI MMF/MPA decreases the efficacy of

OCs

class that inhibits T lymphocyte activation/proliferation

mTOR kinase inhibitors everolimus sirolimus

mTOR BBW

inc malignany inc infectione

warnings mTOR

hyperlipidemia impaired wound healing pneumonitis -- d/c drug if develops

do not use everolimus when

within 30 days of transplant

AEs of mTOR

peripheral edema inc BP inc BG

monitoring for mTOR

trough

DDI for mTOR

3A4 and p-GP substrate

sirolimus tablets and solution are NOT

bioequivalent

binds to CD80 and CD86 and blocks costimulation with CD28 on T lymphocytes

belatacept

BBW belatacept

inc risk post transplant lymphoproliferative disorder (PTLD) -- use in EBV seropositive patients only inc risk infection and malignancy

warning belatacept

treat latent TB prior to use

short term steroid AEs

fluid retention, stomach upset, emotional instability, insomnia, inc appetite, weight gain, acute risk in BG and BP

long term steroid AEs

adrenal suppression/Cushing, impaired wound healing, inc BP, DM, acne, osteoporosis, impaired growth in children

when is antithymocyte globulin used for induction

higher risk of rejection

what is an alternative to using a CNI (tac *>cyc)

belatacept

what is used adjuvant to CNI to achieve adequate immunosuppression

antiproliferative (myco** > aza) mTOR

cyclosporine inhibits 3A4 cyclosporine and tac are 3A4 substrates so

inducers decrease CNI conc inhibitors increase CNI conc both interact with most drugs

mycophenolate can decrease levels of

hormonal contraception

avoid using azathioprine with

xanthine oxidase inhibitors (allopurinol or febuxostat)

drug food/natural products do not use with CNIs

GFJ SJW

caution using drugs with what effects with CNIs

nephrotoxic inc BG inc BP

caution using drugs with what effects with steroids

inc BG inc BP

caution using drugs with what effects with mTOR

worsen lipids

caution using drugs with what effects with azathioprine

myelosuppressive

symptoms of rejection? kidney?

flu like symptoms kidney- decrease in UOP, fluid retention

certain type of immunosuppressant monitoring and it is done when?

trough 30 mins before schedule dose

transplant recipients must monitor for

symptoms of infection

arises from T-cell (cellular) or B-cell (humoral or antibody) mechanisms

acute rejection

initial approach to treat rejection

high dose steroids

transplant recipients are at increased risk of infections which can be

bacterial viral opportunistic

infection prophylaxis is essential when

6 months post transplant after receiving treatment for acute rejection

which vaccine cannot be given post transplant

live vaccines

type of cancer common post-transplant and how to prevent

skin cancer sunscreen

rejection meds can cause ___ syndrome

metabolic

when can inactivated vaccines be given post transplant? exception?

3-6 months flu- 1 month

important vaccines for transplant recipients

flu pneumo (20x1,21x1,15x1 then 23x1 after 8 weeks) varicella- PRE-TRANSPLANT, close contacts, anyone gets rash avoid contact or go to MD hep B- pre or post

counseling for immunosuppressants

exactly as prescribed stay consistent trough is 30 mins before scheduled dose

when to take tacrolimus

Q12H or QAM for XL or XR

how to administer oral cyclosporine solution

use provided syringe do not rinse syringe before or after use compatible diluent at room temp mix dose and diluent thoroughly, no plastic or styrofoam cup administer immediately, rinse with extra diluent

Transplant Flashcards

(94 cards)