CCTN Post-Transplant Immunosuppressive Medications 2 — Questions and Answers
Question 1: A renal transplant patient on mycophenolate mofetil reports severe diarrhea and nausea. What is the most appropriate nursing intervention?
- Reassure the patient that GI side effects are expected and will resolve
- Document and notify the provider — dose reduction or switch to EC-MPS may be needed (Correct answer)
- Discontinue MMF immediately without provider notification
- Administer an antiemetic and continue the current dose
Correct answer: Document and notify the provider — dose reduction or switch to EC-MPS may be needed
GI toxicity is a common MMF side effect that may require dose reduction or conversion to enteric-coated mycophenolate sodium (EC-MPS) — the provider must be notified.
Question 2: Cyclosporine A is associated with which distinctive cosmetic side effect not seen with tacrolimus?
- Alopecia
- Gingival hyperplasia (Correct answer)
- Moon face
- Acne
Correct answer: Gingival hyperplasia
Gingival hyperplasia is a distinctive side effect of cyclosporine that is not typically seen with tacrolimus, making dental hygiene especially important.
Question 3: Which drug interaction is most clinically significant for transplant patients taking tacrolimus?
- Concurrent use of aspirin
- CYP3A4 inhibitors such as fluconazole significantly increase tacrolimus levels (Correct answer)
- Concurrent use of beta blockers
- Vitamin C supplementation
Correct answer: CYP3A4 inhibitors such as fluconazole significantly increase tacrolimus levels
Tacrolimus is metabolized by CYP3A4, so inhibitors like azole antifungals can dramatically increase tacrolimus blood levels, risking toxicity.
Question 4: Prednisone is used in transplant regimens primarily for which mechanism?
- Selective T-cell depletion
- Broad anti-inflammatory and immunosuppressive effects via glucocorticoid receptor activation (Correct answer)
- Inhibition of IL-2 production specifically
- Blocking B-cell antibody production
Correct answer: Broad anti-inflammatory and immunosuppressive effects via glucocorticoid receptor activation
Prednisone acts through glucocorticoid receptors to broadly suppress inflammation and immune activation, making it useful as maintenance and anti-rejection therapy.
Question 5: A liver transplant patient is started on sirolimus. Which side effect should the nurse educate the patient about?
- Peripheral neuropathy
- Impaired wound healing and hyperlipidemia (Correct answer)
- Gingival hyperplasia
- Uveitis
Correct answer: Impaired wound healing and hyperlipidemia
Sirolimus commonly causes impaired wound healing and hyperlipidemia, and is often avoided in the early post-transplant period for these reasons.
Question 6: Basiliximab is an induction agent that acts by blocking which interleukin receptor?
- IL-4 receptor
- IL-6 receptor
- IL-2 receptor (CD25) (Correct answer)
- IL-17 receptor
Correct answer: IL-2 receptor (CD25)
Basiliximab is a monoclonal antibody that blocks the IL-2 receptor (CD25) on activated T cells, preventing IL-2-driven proliferation.
CCTN Post-Transplant Immunosuppressive Medications 2
A renal transplant patient on mycophenolate mofetil reports severe diarrhea and nausea.
What is the most appropriate nursing intervention?