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transplant
| Question | Answer |
|---|---|
| what are the 2 induction immunosuppression agents: | Basiliximab and antithymocyte globulin |
| which induction agent is used for prevention only? | Basiliximab |
| what is the boxed warning associated with basiliximab? | administer under supervision of physician experienced in immunosuppressive therapy |
| what is the boxed warning with antithymocyte globulin? | anaphylaxis can occur |
| why do you premedicate with diphenhydramine, tylenol, and steroids when using antithymocyte globulin? | to lessen infusion-related reactions |
| what are the maintenance immunosuppression medications? | calcineurin inhibitors, antiproliferative agents, and with or without steroids |
| which agents are the antiproliferative | mycophenolate and azathioprine |
| which drugs can be used as alternative to calcineurin inhibitors? | belatacept |
| which drugs can be used as alternative to antiproliferative agents? | mTOR inhibitors (sirolimus/everolimus) |
| what steroid is typically used as maintenance immunosuppression? | prednisone |
| what is the MOA of calcineurin inhibitors? | inhibit T-lymphocyte activation |
| BW with cyclosporine? | increased risk of malignancy, infections, nephrotoxicity, and blood pressure |
| what side effect (s) is/are unique to cyclosporine that tacrolimus does not have? | gingival hyperplasia, hirsutism, and hyperuricemia |
| what do you avoid when taking cyclosporine and tacrolimus? | grapefruit and St. John's worts |
| Do you ever administer from a plastic/styrofoam cup when handling cyclosporine? | no |
| what side effects are unique to tacrolimus? | alopecia and hypokalemia |
| what is something unique with tacrolimus regarding food intake? | food decreases absorption |
| for the XL/XR formulations for tacrolimus, when do you take them? | take every 12 hours or once daily in AM |
| what do you have to make sure first when a patient is on belatacept? | use in EBV seropositive patients only |
| what is the MOA of azathioprine and mycophenolate mofetil? | antiproliferative agents; alter purine nucleotide synthesis |
| whats the warning when using azathioprine? | myelosuppression due to genetic deficiency of thiopurine methyltransferase (TPMT) |
| are cellcept and myfortic interchangeable? | no |
| what are the BW with mycophenolate? | increase risk of malignancy, infection, congenital malformations and spontaneous abortions |
| which antiproliferative agent decreases effect of oral contraceptive? | mycophenolate mofetil |
| If a patient is on an mTOR inhibitor and they create this effect you need to discontinue? | pneumonitis |
| when do you not use everolimus? | within 30 days of transplant |
| what are the warnings to using mTOR kinase inhibitors? | hyperlipidemia, impaired wound healing, pneumonitis |
| for sirolimus are the tablet and oral solution bioequivalent? | no |
| what is the initial approach to an acute rejection? | treat with high dose steroids |
| can live vaccines be given post-transplant? | no |
| what type of cancer is most common following a transplant? | skin |
| These are examples of the vaccines that should not be given post-transplant? | flumist, varivax, and yellow-fever |
Created by:
KaHerre12