1. Please use the following CASE to answer Questions 1-8.
GF is a 27-year-old woman with lupus nephritis who is undergoing evaluation for a living unrelated renal transplant. The posttransplant maintenance immunosuppression regimen is planned to be tacrolimus, mycophenolate, and prednisone.

When should the transplant team first discuss the risks of mycophenolic acid (MPA)?

2. Which types of counseling related to the MPA REMS should be provided to GF, who is a female of reproductive potential planning to start MPA?

3. When counseling GF, which of the following MPA REMS materials should the prescriber provide to the patient?

4. Contraception counseling for GF should include which of the following acceptable birth control options?

5. GF is accepted for transplant at your center and a transplant date is set. Which test must be completed immediately prior to GF beginning therapy with MPA?

6. GF is successfully transplanted and has a normal postoperative course. She returns to the renal transplant clinic 9 months after her transplant and remains on tacrolimus, mycophenolate, and prednisone, and all labs are within normal limits. She initiates a conversation with her transplant nephrologist that she and her husband would like to get pregnant and have children in the very near future. The patient and the transplant team agree that once the patient is greater than 1 year posttransplant that they can initiate changes in her immunosuppressive regimen to help facilitate a successful pregnancy. After her clinic visit, GF's nephrologist asks the transplant pharmacist to formulate a plan for an ideal immunosuppressive regimen for GF for when she tries to get pregnant. The best possible medication conversion for GF's immunosuppressant regimen would be:

7. If during her next visit, the transplant team makes the appropriate immunosuppression conversion, what timing would you discuss with GF regarding the earliest time she can safely attempt to get pregnant after stopping mycophenolate?

8. GF returns to clinic 3 months later, but she reports that she missed her period and recently took a pregnancy test that confirmed she is pregnant. Which is a method to report a pregnancy to the Mycophenolate Pregnancy Registry?

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