Sot

Front 1

What is the definition of induction therapy?

Back 1

high level of immunosuppressive therapy administered perioperatively

Front 2

What are the classes of induction agents?

Back 2

1)polyclonal antibodies
2)monoclonal antibodies

Front 3

MOA of equine antithymocyte globulin (Atgam) and rabbit antithymocyte globulin (thymoglobulin)

Back 3

1)antibodies directed against T and B cells
2)induce lymphocyte depletion, complement-mediated lysis, and induction of apoptosis

Front 4

What is the dosing schedule for polyclonal antibodies?

Back 4

7-14days

Front 5

Adverse effects of the polyclonal antibodies

Back 5

1)dose limiting myelosuppression
2)anaphylaxis
3)hypotension
4)tachycardia
5)dyspnea
6)urticaria
7)rash
8)fever
9)serum sickness (rare)

Front 6

Monitoring for polyclonal antibodies

Back 6

1)test dose
2)CBC
3)dose adjustments

Front 7

What are the 3 monoclonal antibodies used for organ transplatation?

Back 7

1)OKT3 (mAB)
2)daclizumab (humanized mAB)
3)basiliximab (chimeric mAB)

Front 8

OKT3 MOA

Back 8

1)binds to cell surface receptors (CD3) of T cells
2)inhibits T cell activation
-> leading to depletion

Front 9

daclizumab and basiliximab MOA

Back 9

1)bind to alpha chain on surface of activated T-lymphocytes
2)prevents IL-2 mediated activation and proliferation of T-cells

Front 10

Which of the monoclonal antibodies for organ transplantation are immunogenic?

Back 10

OKT3

Front 11

OKT3 pharmacokinetics

Back 11

If CD3 lymphocytes levels rise, may signify presence of anti-murine antibodies

Front 12

daclizumab pharmacokinetics

Back 12

saturates IL-2 receptors for 90-120days

Front 13

basiliximab pharmacokinetics

Back 13

saturates IL-2 receptors for 36days

Front 14

OKT3 side effects

Back 14

1)1st dose rxns include CYTOKINE RELEASE SYNDROME (mild flu-like symptoms -> life threatening shock) PREMEDICATE w/ APAP, steroids, diphenhydramine
2)pulmonary edema
3)infections

Front 15

daclizumab and basiliximab sid effects

Back 15

well tolerated

Front 16

What classes of agents are used for maintenance immunosuppression?

Back 16

1)Calcineurin inhibitors
2)Antiproliferative agents
3)Corticosteroids
4)Sirolimus

Front 17

What are 2 calcineurin inhibitors?

Back 17

1)cyclosporine (CSA)
2)tacrolimus (Prograf)

Front 18

What is calcineurin responsible for?

Back 18

gene transcription in the DNA and production of key cytokines for T-cell activity (including IL-2)

Front 19

cyclosporine MOA

Back 19

1)binds to cyclophilin
2)inhibits action of calcineurin

Front 20

tacrolimus MOA

Back 20

1)binds to FKBP-12
2)inhibits calcineurin activity

Front 21

cyclosporine adverse effects

Back 21

1)nephrotoxicity
2)neurotoxicity (tremors, SZR)
3)HTN
4)hyperlipidemia
5)GINGIVAL HYPERPLASIA
6)HIRSUTISM
7)impaired glucose tolerance
8)hyperkalemia
9)hypomagnesemia
9)infection
10)malignancy

Front 22

tacrolimus adverse effects

Back 22

1)less HTN than CSA
2)less hyperlipidemia than CSA
3)more neurotoxicity than CSA
4)more glucose intolerance
5)ALOPECIA

Front 23

Drug interactions of calcineurin inhibitors

Back 23

CYP3A4 inhibitors
1)CCBs
2)Azoles
3)macrolides (not zithromax)
4)amiodarone, ritonavir, grapefruit juice

CYP3A4 inducers
1)rifampin
2)carbamazepine
3)phenytoin

Front 24

What are 2 antiproliferative agents used in organ transplations?

Back 24

1)azathioprine (Imuran)
2)mycophenolate

Front 25

azathioprine MOA

Back 25

1)metabolized to 6-MP and ultimately 6-TIMP
2)incorporated into cellular DNA
3)inhibits purine synthesis (both de novo and salvage pathways)
4)inhibits lymphocyte proliferation

Front 26

mycophenolate MOA

Back 26

1)noncompetitively binds to inosine momophosphate dehydrogenase (key enzyme in de novo purine synthesis)
2)inhibits lymphocyte proliferation

Front 27

This antiproliferative agent undergoes enterohepatic cycling

Back 27

mycophenolate

Front 28

azathioprine adverse effects

Back 28

1)myelosuppression
2)malignancy
3)infection
4)ANEMIA
5)HEPATOTOXICITY
6)PANCREATITIS
7)ALOPECIA
8)GI adverse effects

Front 29

mycophenolate adverse effects

Back 29

1)myelosuppression
2)GASTRITIS/GI HEMORRHAGE
3)N/V/D
4)ABDOMINAL PAIN
5)infection
6)malignancy

Front 30

Cyclosporin drug interactions

Back 30

1)allopurinol (decrease dose by up to 75%)
2)bone marrow suppressing agents (ganciclovir and sirolimus)

Front 31

mycophenolate drug interactions

Back 31

1)MAGNESIUM AND ALUMINUM PRODUCTS
2)cholestyramine
3)bone marrow suppressing agents (ganiclovir and sirolimus)

Front 32

Corticosteroids MOA

Back 32

1)antiinflammatory (inhibit leukotriene and prostaglandin production)
2)immunosuppressive effects (impairment of transcription rate and expression of cytokines including IL-2; inhibit macrophage activity)

Front 33

Corticosteroid toxicity

Back 33

1)insomnia
2)steroid psychosis
3)osteoporosis
4)impaired wound healing
5)LEUKOCYTOSIS
6)pancreatitis
7)peptic ulcer
8)HTN

Front 34

Sirolimus (Rapamune) MOA

Back 34

1)binds to FKBP-12 and engages regulatory protein called target of rapamycin
2)reduces cytokine dependent cellular proliferation at G1 to S phase of cell division
3)inhibits T cell proliferation by inhibiting the cellular response to IL-2 and progression of cell cycle

Front 35

sirolimus drug interactions

Back 35

metabolized by cytochrome p450 3A4 (same as azothiprine and tacrolimus)

Front 36

sirolimus toxicity

Back 36

1)dose dependent thrombocytopenia
2)leukopenia
3)hypertriglyceridema
4)hypercholesterolemia

Front 37

Induction therapy regimen

Back 37

1)high-dose maintenance immunosuppression
2)administration of an induction agent

Front 38

Maintenance therapy regimen

Back 38

Triple-drug immunosuppression
1)calcineurin inhibitor
2)antiproliferative agent
3)corticosteroids

Front 39

What is a tacrolimus or CSA fre regimen?

Back 39

1)Rapamune is usually the primary immunosuppression
2)reduced nephrotoxicity
3)higher incidence of acute rejection

Front 40

Management of acute rejection

Back 40

1)high dose steroids
2)administration of an induction agent