Post-Transplant Immunosuppressive Medications Flashcards

Tacrolimus exerts its immunosuppressive effect by inhibiting which enzyme?

Answer: Calcineurin

Tacrolimus inhibits calcineurin, preventing IL-2 transcription and thereby blocking T-cell activation and proliferation.

Which side effect is most associated with long-term tacrolimus use in transplant recipients?

Answer: Hypertension and nephrotoxicity

Long-term tacrolimus use commonly causes nephrotoxicity and hypertension, both of which require ongoing monitoring in transplant recipients.

Mycophenolate mofetil (MMF) inhibits which enzyme to suppress lymphocyte proliferation?

Answer: Inosine monophosphate dehydrogenase (IMPDH)

MMF inhibits IMPDH, blocking de novo purine synthesis which lymphocytes rely on exclusively for proliferation, making it lymphocyte-selective.

A transplant nurse notes a tacrolimus trough level of 22 ng/mL in a 3-month post-kidney-transplant patient. What is the most appropriate action?

Answer: Notify the provider because the level is supratherapeutic

At 3 months post-transplant, tacrolimus trough targets are typically 8–12 ng/mL; a level of 22 ng/mL is supratherapeutic and requires physician notification.

Which immunosuppressant is an mTOR inhibitor used in transplantation?

Answer: Sirolimus

Sirolimus (rapamycin) is an mTOR inhibitor that blocks the intracellular signaling pathway required for T-cell proliferation after IL-2 stimulation.

Which medication is used as induction therapy in transplantation and works by depleting T lymphocytes?

Answer: Anti-thymocyte globulin (ATG)

Anti-thymocyte globulin (ATG) is a polyclonal antibody used for induction that rapidly depletes T lymphocytes, reducing the risk of early acute rejection.