Clinical Questions Flashcards
What is an allograft transplant?
When one individual donates an organ to another individual
What is an autograft transplant?
When the individual is his/her own donor
What blood type is the universal donor?
O type (no antigens, AB antibodies)
What blood type is the universal receiver?
AB type (AB antigens, no antibodies)
What drugs can be used for induction of immunosuppression?
Antithymocyte Globulin (Atgam, Thymoglobulin)
Basilixumab
What is the lymphocyte depleting agents?
Antithymocyte globulin (Atgam, Thymoglobulin)
What are the non-lymphocyte depleting agent for induction?
Basilixumab
What is the first line therapy for transplant immunosuppression maintenance?
CNI + antimetabolite
(Tacrolimus or Cyclosporine) + (Azathioprine or Mycophenolate)
What induction prophylaxis is the best option for patients at high risk for rejection?
Antithymocyte Globin (Atgam, Thymoclobulin) is the best option
What factors decrease you risk of transplant rejection?
Immunosuppression
Malignancy
Increased Age
What drugs should you avoid with CNI therapy?
Nephrotoxic agents, CYP3A4 inducers/inhibitors
What is the conversion between Cellcept and Myfortic?
Cellcept 500 mg = Myfortic 360 mg
What can be added to CNI + antimetabolite with initiate treatment if there is high risk for rejection?
Steroids (prednisone [deltasone]) needs to be added
A female patient with a liver transplant is needing maintenance therapy. What medication may increase mortality?
Tacrolimus ER should be avoided
A transplant patient with HTN, HLD, and gout is needing maintenance therapy. They are currently on rosuvastatin, lisinopril, and allopurinol. Which transplant therapy is contraindicated?
Azathioprine is contraindication
What drug is a great alternative when you cannot use CNI for maintenance transplant?
Belatacept is an alternative
What vaccines should be given to transplant patients?
Influenza annually
Pneumococcal vaccine in adults > or = 19
Varicella (LIVE) needs to be before transplant
What OTC drugs can be used to help with weight loss?
bitter orange
concentrated green tea powder
guarana
overall not recommended
When is weight loss medications appropriate to recommend?
BMI > or = 30; BMI > or = 27 and have HLD, HTN, or diabetes
How long should you treat with a weight loss drug before determining efficacy?
12 weeks of treatment. If < 5% weight loss, discontinue medication
What drugs cause weight gain?
Antipsychotics (clozapine, risperidone, quetiapine)
Insulin
Sulfonylureas, TZD, metglitinides
Divalproex/Valproic acid
Gabapentin/Pregabalin
Lithium
Mirtazapine
Steroids
TCAs
Conditition: Hypothyroidism
What weight loss drugs are appropriate for pregnancy?
None. All should not be continued in pregnancy.
When should bariatric surgery be considered?
BMI > or = 40; BMI > or = 35 and have HTN, HLD, or diabetes
