Board Certified Transplant Pharmacist
(BCTXP) exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant
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1. Which immunosuppressant is a calcineurin inhibitor?
A) Mycophenolate mofetil
B) Tacrolimus
C) Sirolimus
D) Azathioprine
Calcineurin inhibitors (CNI) like tacrolimus inhibit T-cell activation by
blocking calcineurin. Mycophenolate and azathioprine are
antimetabolites; sirolimus is an mTOR inhibitor.
2. What is the primary mechanism of action of mycophenolate
mofetil?
A) Calcineurin inhibition
B) mTOR inhibition
C) Inhibition of inosine monophosphate dehydrogenase
D) IL-2 receptor blockade
Mycophenolate inhibits inosine monophosphate dehydrogenase,
reducing guanosine nucleotide synthesis and suppressing lymphocyte
proliferation.
3. Which laboratory test is essential for monitoring cyclosporine
therapy?
,A) Serum creatinine
B) Trough blood levels (C0)
C) ALT/AST
D) White blood cell count
Trough levels are used to optimize cyclosporine dosing and reduce
toxicity, particularly nephrotoxicity.
4. A kidney transplant patient develops new-onset diabetes after
transplant (NODAT). Which drug is most likely contributing?
A) Sirolimus
B) Tacrolimus
C) Mycophenolate
D) Basiliximab
Tacrolimus is diabetogenic due to impaired insulin secretion;
cyclosporine has a lower risk.
5. Which agent is commonly used for induction therapy in kidney
transplantation?
A) Tacrolimus
B) Mycophenolate mofetil
C) Prednisone
D) Basiliximab
Basiliximab is an IL-2 receptor antagonist used for induction to
reduce acute rejection risk.
6. Sirolimus is contraindicated in which scenario?
A) Liver transplant
B) Heart transplant
,C) Delayed wound healing
D) Kidney transplant
Sirolimus impairs wound healing and should be avoided immediately
post-surgery.
7. What is the primary adverse effect of calcineurin inhibitors?
A) Hepatotoxicity
B) Myelosuppression
C) Nephrotoxicity
D) Pulmonary fibrosis
CNIs are nephrotoxic due to vasoconstriction of renal arterioles and
chronic tubulointerstitial fibrosis.
8. What is the main purpose of induction therapy in organ
transplantation?
A) Reduce infection risk
B) Reduce cost
C) Prevent early acute rejection
D) Minimize drug interactions
Induction therapy provides potent immunosuppression in the
immediate post-transplant period to prevent acute rejection.
9. Which drug requires therapeutic drug monitoring via trough
levels?
A) Tacrolimus
B) Prednisone
C) Azathioprine
D) Belatacept
, Tacrolimus has a narrow therapeutic index and variable
pharmacokinetics, necessitating trough monitoring.
10. Which antiviral is used for cytomegalovirus (CMV) prophylaxis
in high-risk transplant patients?
A) Acyclovir
B) Oseltamivir
C) Valganciclovir
D) Ribavirin
Valganciclovir is first-line CMV prophylaxis in seronegative recipients
receiving organs from seropositive donors.
11. What is the main mechanism of action of belatacept?
A) mTOR inhibition
B) Calcineurin inhibition
C) Co-stimulation blockade (CD80/86 binding)
D) Antimetabolite inhibition
Belatacept prevents T-cell activation by blocking CD28-mediated co-
stimulation via CD80/86 binding on antigen-presenting cells.
12. Which immunosuppressant is most associated with
hyperlipidemia?
A) Tacrolimus
B) Sirolimus
C) Mycophenolate
D) Cyclosporine
Sirolimus (and to a lesser extent cyclosporine) increases triglycerides
and cholesterol.
(BCTXP) exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant
Download Pdf
1. Which immunosuppressant is a calcineurin inhibitor?
A) Mycophenolate mofetil
B) Tacrolimus
C) Sirolimus
D) Azathioprine
Calcineurin inhibitors (CNI) like tacrolimus inhibit T-cell activation by
blocking calcineurin. Mycophenolate and azathioprine are
antimetabolites; sirolimus is an mTOR inhibitor.
2. What is the primary mechanism of action of mycophenolate
mofetil?
A) Calcineurin inhibition
B) mTOR inhibition
C) Inhibition of inosine monophosphate dehydrogenase
D) IL-2 receptor blockade
Mycophenolate inhibits inosine monophosphate dehydrogenase,
reducing guanosine nucleotide synthesis and suppressing lymphocyte
proliferation.
3. Which laboratory test is essential for monitoring cyclosporine
therapy?
,A) Serum creatinine
B) Trough blood levels (C0)
C) ALT/AST
D) White blood cell count
Trough levels are used to optimize cyclosporine dosing and reduce
toxicity, particularly nephrotoxicity.
4. A kidney transplant patient develops new-onset diabetes after
transplant (NODAT). Which drug is most likely contributing?
A) Sirolimus
B) Tacrolimus
C) Mycophenolate
D) Basiliximab
Tacrolimus is diabetogenic due to impaired insulin secretion;
cyclosporine has a lower risk.
5. Which agent is commonly used for induction therapy in kidney
transplantation?
A) Tacrolimus
B) Mycophenolate mofetil
C) Prednisone
D) Basiliximab
Basiliximab is an IL-2 receptor antagonist used for induction to
reduce acute rejection risk.
6. Sirolimus is contraindicated in which scenario?
A) Liver transplant
B) Heart transplant
,C) Delayed wound healing
D) Kidney transplant
Sirolimus impairs wound healing and should be avoided immediately
post-surgery.
7. What is the primary adverse effect of calcineurin inhibitors?
A) Hepatotoxicity
B) Myelosuppression
C) Nephrotoxicity
D) Pulmonary fibrosis
CNIs are nephrotoxic due to vasoconstriction of renal arterioles and
chronic tubulointerstitial fibrosis.
8. What is the main purpose of induction therapy in organ
transplantation?
A) Reduce infection risk
B) Reduce cost
C) Prevent early acute rejection
D) Minimize drug interactions
Induction therapy provides potent immunosuppression in the
immediate post-transplant period to prevent acute rejection.
9. Which drug requires therapeutic drug monitoring via trough
levels?
A) Tacrolimus
B) Prednisone
C) Azathioprine
D) Belatacept
, Tacrolimus has a narrow therapeutic index and variable
pharmacokinetics, necessitating trough monitoring.
10. Which antiviral is used for cytomegalovirus (CMV) prophylaxis
in high-risk transplant patients?
A) Acyclovir
B) Oseltamivir
C) Valganciclovir
D) Ribavirin
Valganciclovir is first-line CMV prophylaxis in seronegative recipients
receiving organs from seropositive donors.
11. What is the main mechanism of action of belatacept?
A) mTOR inhibition
B) Calcineurin inhibition
C) Co-stimulation blockade (CD80/86 binding)
D) Antimetabolite inhibition
Belatacept prevents T-cell activation by blocking CD28-mediated co-
stimulation via CD80/86 binding on antigen-presenting cells.
12. Which immunosuppressant is most associated with
hyperlipidemia?
A) Tacrolimus
B) Sirolimus
C) Mycophenolate
D) Cyclosporine
Sirolimus (and to a lesser extent cyclosporine) increases triglycerides
and cholesterol.
