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Therapy Spring 2018 > Exam 5 last one ever > Flashcards

Exam 5 last one ever Flashcards

1
Q

NIHSS

Score?

A

High score worst

5 or greater you start looking to use a fibrolytic agent.

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2
Q

What are some indications that a pt would need higher immunosuppression?

What are some other things you want to take into account when looking at a donor recipient?

A
  • Younger in age
  • Black
  1. HLA matching gives you a indication of how its going to go after transplant
  2. If there PRA is high
    • cross matching
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3
Q

Infectious Dx prophylaxis

Typicall a ___ drug regimen

What are the drugs and the length of time needed to be on it?

A
  • CMV: Valgan in high/mod risk, acyclovir in low risk for 3-6 mos
  • PCP: Bactrim or (dapsone/pentamidine for sulfa allergic pts) for 3 mos- 1 year
  • Oral candidiasis: Nystatin swish and swallow or clotrimazole for 1-3 mos or until prednisone dose if low <20 mg daily
  • Lung transplant patients usually get addition fungal prophylaxis
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4
Q

A pts only exclusion criteria is there BP so that means its? What are the first options you should try to use?

A
  • >185/110
  • Labetalol
  • Enalaprit
  • Hydrazaline
  • IV fast acting options
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5
Q

IVIG

Uses in SOT 4

A
  • Antibody Bcell mediated rejection
  • Desensitization
  • Viral infections
  • Hypogammaglobulinemia
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6
Q

What is the preferred antimetabolite?

What is it MOA?

A
  • Mycophenolate
  • Inhibits IMDPH which inhibits cell cyle replication
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7
Q

Dosing for Atgam?

A

10-15 mg/kg/day

for 7-10 days

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8
Q

If pt is on IR tacrolimus 2 mg BID how would you convert them to Envarsus XR?

A
  • Once daily dose 70-80% of total IR dose
  • So 3 mg daily would work
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9
Q

What is the Number one cause of death after any transplant

A

Cardiovascular Dx

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10
Q

mTOR inhibitors two

notes about them?

A
  • Sirolimus
  • Everolimus
  • One or other not both
  • Used in place of calcineurin inhibitors or anti-metabolite
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11
Q

Dibigatran

A

WIthin 2 houts activated charcoal

Idarubaccizumab first line

second like PCC4

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12
Q

What are the 9 exclusion criteria for Alteplase

A
  • Current intracranial Hemorrhage
  • Bleeding diathesis
  • Active internal bleeding
  • Recent intracranial hemorrhage or intraspinal surgery or serious head trauma (<=3 mos)
  • Current severe uncontrolled HTN (SBP>= 185 mm hg or DBP >= 110) (can treat and then try)
  • Subarachnoid hemorrhage
  • Intracranial process that may increase bleeding risk
  • Actively on warfarin with INR > 1.7 or other oral anticoag (pretty much automatically exclude these pts if theyre on one)
  • Suspected aortic arch dissection
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13
Q

Hemorrhagic Stroke

Risk factors Modifiable and non

A
  • HTN, smoking, alcohol use, DM, anticoag/antiplat use(most common cause)
  • Nonmod: Cerebral amyloid angiopathy, asian
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14
Q

Common induction regimen?

A
  • INDUCTiON
  • Thymo or basiliximab
  • Plus high dose corticosteroids
  • MAINTENANCE
    • Tacro and mycophenolate with or without prednisone
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15
Q

Post stroke care management

What should be administered? 1st and 2nd line

What should be initiated or resumed?

Smoking Cessation

A
  • Antiplat started immediately unless alteplase is administered
    • 1st ASA 325 PO daily
    • 2nd- Clopidogrel 300 mg 1 then clopidogrel 75 mg PO daily
      • Used for ASA allergic pts. Or ASA failure
  • High intensity statin should be inititiated or resumed
    • Atorvastatin 80
  • Smoking cessation
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16
Q

Adverse effects of Corticosteroids?

5

A
  • Elevated WBC w higher doses (this can mask the picture if looking for infection)
  • Wt gain 2/2 fluid retention and increased appetite
  • Mood changes
  • Insomnia
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17
Q

CNIs vs mTORs

Advantage to chose CNIs?

A
  • Reduced hypercholesterolemia
  • Less impaired wound healing
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18
Q

2 types of CMV

A
  • Infection

Invasive: CMV that actually causes organ damage CMV induced colitis most common

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19
Q

Tacrolimus dosing information

What is more potent? Cyclo or Tacro?

What is the dosing interval?

What are the ranges?

What levels are monitored? what is the range?

IV?

A
  • 50 x more potent than cyclo
  • BID q12h, XR-XL are qd
    • 0.5->10mg BID
  • Get a 12 hour trough to monitor levels
    • 5-15 ng/mL
  • IV isnt a 1:1
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20
Q

If you think someone had a stroke what studies need to be given prior to giving ____ drug

A

Alteplase

  • Non-contrast CT-this will also rule out hemorrage
  • Finger stick blood glucose hypoglycemia can mimic
  • Oxygen sat hypoxia can mimic
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21
Q

mTOR AEs

A
  • Slow wound healing
  • Increased protein in urine (stop drug it stops)
  • Increased cholesterol and TGs(realy)
  • Myelosuppression
  • Pulmonary toxicity (sirolimus only)
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22
Q

Drug interactions with FK/Cyclo

Whats the way and the 8 drugs that increase level?

A
  • Antifungal azoles
  • Erythromycin, Clarithromycin, Azithromycin
  • Lopinavir/Ritonavir
  • Diltiazem and verapamil
  • CYP3A4 inhibitors
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23
Q

Clinical presentation for Hemorrhage usually take longer and symptoms are more drawn out.

A
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24
Q

IV admin of Alteplase

Dose?

If these 5 things develp stop infusiong and get CT

What to monitor?

What Bp range do we want to maintain and how?

What repeat testing? Before starting what?

A
  • 0.9 mg/kg max 90 mg first 10% given as a bolus over one minute then rest over 60 min
  • Severe HA, N/V, acute HTN, worsening neuro exam Dc alteplase and get CT scan
  • Monitor BP
  • <180, <105 use anti HTNs to maintain
  • Follow up CT or MRI, scan at 24 hour after IV atleplase before starting anticoagulant therapt
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25
Q

What are the risk factors for infection?

6

A
  • Technical/Surgical comp
    • Most commonly occur during 1st month
  • Net state of immunosuppression
    • Use of Antilyphocyte prep
    • Comorbidities
  • REcipient exposure
    • Donor organ
    • Nosocomial
    • Community
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26
Q

Adverse effects and Administration of Rituximab

8 AEs

Admin?

A
  • Fever, chills, nausea, dizziness, hypotension, bronchospasms, hypoxia, cytopenias
  • Premedicate:APAP, Antihistamines, corticosteroids
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27
Q

Sirolimus what is it?

Dose? and when?

What levels need to be taken and when? what is the range?

Important to note when making dose adjustments?

A
  • 2-5 mg per day in the AM
  • 24 hour trough before taking, 5-15 ng/mL
  • Need to wait 1-2 weeks before adjusting dose (biggest downfall)
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28
Q

Adverse effects of Mycophenolate and how to alleviate them?

Teratogenicity?

A
  • N/V/D can lead to colitis
    • Take with food
  • Preg Cat D black box for teratogenicity dont take when pregnant, not recommended in breast feeding
  • Use contraception for at least 6 weeks before trying to conceive
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29
Q

Who would you use Acyclovir on and why?

Dosing?

A
  • Low risk patient because it only covers HSV not CMV
  • Dose adjustement for renal dysfunction
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30
Q

Thymo rabbit one

Dose and length

Adjust in?

What is its place in therapy?

A

1.5 mg/kg/day for 3-5 doses

Polyclonal depleting

  • Induces depletion of cells from circulation

Adjust dose if leuko/thrombocytopenia

  • Induction in pts with high immune risk pt and those at increased risk of delayed graft function
  • For rejection
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31
Q

What are the immediate release formualtions of Tacrolimus?

What is the dosing interval?

A
  • Generic Tacro and Prograf, you can switch between the two no problem
  • BID every 12 hours
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32
Q

Cardiovascular Risks

First one: what drugs are causing it?

A
  • HTN: caused by CNIs and Roids
  • ACEI/ARB still the best choice might have to wait if doing a renal transplant.
  • CCB cna be good not verap or dilt
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33
Q

What are the two extended release formulations of Tacro? how are they dosed?

A
  • Astagraf XL
  • Envarsus XR
  • Both taken onces daily in the morning
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34
Q

rATG Adverse effects?

A
  1. Cytokine release syndrome which causes fever and chill
  2. Infection (higher than basilix)
  3. Leukopenia
  4. Malignancy
  5. Thrombocytopenia
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35
Q

WHat medications need to be given premedication prior to taking them? What are the meds?

A
  • Atgam
  • Thymo
  • APAP/Diphenhydramine/steroids (prednisone methylprednisolone) or something similar
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36
Q

What is the clinical presentatin of a acute ischemic stroke?

A
  • Sudden numbness or weakness in Face, arms, speech, trunk
  • Visual impairment
  • Dizziness, loss of balance, HA
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37
Q

rATG

Positive points 4

A

Less immunogenic

FEwer rejection episodes within 1 year

Less recurrent rejection

Higher rates of rejection reversal

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38
Q

IVIG AEs

Dose adjustements?

A
  • Infusion rxn premedication
  • Renal insufficiency: only sucrose free preps should be used
    • BBwaring risk of acute renal failure
    • Carimune NF cantains sucrose all others dont
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39
Q

Di FK/CYA

Drugs that decrease levels? 6

A
  • Nafcillin
  • Rifampin
  • Efavirenz
  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • CYP 3A4 inducers
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40
Q

Basaliximab AEs

A

Infection and Malignancy

Infection is higher in rATG

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41
Q

3-4.5 hours since symptom onset

5 things for inclusion criteria for Alteplase

A
  • ischemic stroke with neuro deficit
  • >= 18 <=80 w/o history of DM and prior stroke
  • NIHSS score <=25
  • Without imaging evidence of ischemic injury involving > 1/3 of MCA territory
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42
Q

Whats a situation where you would switch someone from prograf to CYA?

A
  • The big thing with Tacro (also hair loss) is neuronal effects so it can cause bad shaking and if thats the case you could switch to CYA (hairgrowth) but over all FK is better.
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43
Q

If pts bp is >180-230 or >105-120

Treat with?

A

Labetolol infusion dont fuck around!

44
Q

Treating Bp and you might need longer or more controll what two drugs?

A
  • Nicardipine
  • Clevidipine
45
Q

Calcineurin Inhibitors

What are the two?

MOA?

What are the brand names? of each?

A
  • Cyclosporine, CSA, Sandimmune, Neoral, Gengraf
  • Tacrolimus- Prograf, Envarsus, Astagraf XL
  • Tacro is more common cant be on both at the same time
  • Inhibits calcineurin which suppresses T cell activation by inhibiting signal 3
46
Q

If you use this medication instead of the newer one you made the wrong mothafuckin choice

A

Atgam older shitier version of thymo

47
Q

Fusion protein?

A

Betacept only one thats IV

48
Q

If pt is on IR tacrolimus 2 mg BID how would you convert them to Astagraf XL?

Are Astagraf and Envarsus interchangable?

A
  • It is a 1:1 conversion with daily dose
  • So you would give them Astagraf XL 4 mg in the morning
  • NO they are different
49
Q

Side effects of Tacro and CYA?

A
  • FK
    • Hair loss
    • Post transplant DM (both)
    • HTN(both)
    • Hyper lipids (both)
    • Hypomagnesemia (both but more here)
    • Hypophas (both but more here)
    • Hyperkal (both but more here)
    • Both very nephrotoxic
    • More neurotox here (tremor, cns)
  • CYA- Hair growth
50
Q

For the most part depending on what the pt looks like you can still go ahead and do a SOT but what is the exception where you will not do it?

A

+ cross match

51
Q

If pts only need prophylaxis for Candidiasis what 2 drugs can they get?

A

Nystatin

or

Clotrimazole (inhibit CYP3A4)

52
Q

Sirolimus vs Everolimus

A
  • Siro
    • Longer t 1/2 harder for dose adjustment usually a week
    • More issues with wound healing
    • Once daily dosing
  • Ever
    • Shorter t1/2 usually BID but as once daily
    • Can make dose adjustments earlier
53
Q

What is the reason for the acid form of mycophenolate?

A
  • Formulated because Gi effects from mefetil were so bad they needed to make a formulation that didnt need to be activated in the stomach.
54
Q

MOA of mTORs

A

Bind to FK bind protein and inhibit cell cycle replication

55
Q

When do trough levels need to be taken for FK/CYA?

A

Before the morning dose has been taken

56
Q

The two things we can try and change so we can give alteplase are HTN and blood glucose what are the ranges we want for glucose?

If hyperglycemic treat with?

Hypo?

A

140-180

Insulin 5-10 units followed by infusion

Hypo- D50W x 1 repeat blood glucose level 15 minutes after tx

57
Q

Risk factors for Hyperactute rejection?

A
  • ABO incompatable
  • High PRA (preg,blood tranfusion, previous transplant)
    • cross match
      *
58
Q

Precautions when giving alteplase

Glucose levels?

current malignancy and expected to live for?

Something within the last something

9 things total

A
  • <50 or >400- usually treat
  • Current malignancy and life expectancy is less than 6 months dont treat
  • Ischemic stroke in the last 3 months
  • Major surgery or trauma within last 14 days
  • Recent GI/GU bleed
  • >77
  • Acute pericarditis or left heart thrombus
  • end stage renal dx with elevated aPTT
  • Pregnant
59
Q

Treatment for B cell (antibody) mediated rejection

A

Rituximab, IVIG

60
Q

Other DI with FK/CYA

what do you need to tell the patient? What med is fine to use?

A
  • Statins-inform the pt and monitor for myopathies dont need to stop therapy but need to watch
  • Pravastatin doesnt have this interaction so its preferred
61
Q

Tx Anticoag reversal

Drugs?

INR goal?

A

Vit K

First line 4-factor PCC + Vit K 5-10 mg IV

25 INR 2

50 units >6

<=1.4

62
Q

Which drug needs dose adjustments for pts with leukopenia/thrombocytopenia?

A

Antithymocyte globulin

Both of them

63
Q

Transplant pts cant use?!

A

NSAIDs

64
Q

What would be the advantage of taking Azathioprine over Mycophenolate?

A
  • LEss GI
    • Pts with like colitis or some shit
    • Otherwise myco is better
65
Q

What is the dose range of Cyclosporine?

A
  • 25 BID- >400 mg BID
66
Q

Everolimus newer one

Dosed?

Trough range and when? Dose adjustments?

A
  • 0.75 BID q 12 h
  • 12 hour trough
  • Range 3-12 ng/mL
  • Wait a week to adjust dose
  • Not equiv to affinitor
67
Q

What are the two antimetabolites?

What is there place in therapy which one is preferred?

A
  • Azathioprine
  • Mycophenolate (newer)
  • Maintenance
68
Q

2 types of CMV prevention

A
  • Pre-emptive: Arent using drugs just monitoring
    • Once virus is detected you treat
  • Prophylaxis
    • Consider coverage for most CMV and herpes
69
Q

DIs with the mTORs

A
  • Decrease levels CYP3A4
    • Azole antifung
    • Erythromycin, clarithromycin, azithromycin
    • Verapamil, Diltiazem
    • Cyclosporine
  • Increase levels
    • Carbamazepine
    • Nafcillin
    • Rifampin
    • Efavirenz
    • Phenytoin
    • Phenobarb
70
Q

What is the conversion between Mycophenolate Mofetil (MMF) and Mycophenolate Acid (MPA)

What is the dose range?

What is the usual dose?

A
  • 500 mg MMF= 360 mg MPA
  • 250-1500 BID q 12 h
  • 1,000 mg every 12 hours
71
Q

Primary prophylaxis for CMV?

What is in?

What dose and for how long?

A
  • Valganciclovir- prodrug
  • 450-900 qday for 3-6 mos
  • AE
    • Neutropenia, anemia, GI disturbances
72
Q

Rituximab uses in SOT? 3

A
  • B cell (antibody) mediated rejection
  • desenitization regimens (pre-transplant)
  • Post transplant lymphoproliferative disorders
73
Q

Oral Direct Xa `Reversal

A

Rivaroxaban, apixaban, edoxaban

Try to give a bunch of different factor to over ride MOA

If within two hours of taking Anti coag and give charcoal

4-PCC

74
Q

CMV

What puts you at high risk, moderate and low risk?

A
  • D+/R-
  • D-/R+
  • D-/R-
    *
75
Q

What does Rituximab do?

A

Depletes Bcells

76
Q

mTOR inhibitors? 2

A

Sirolimus and Everolimus

77
Q

Inclusion Criteria for Alteplase

0-3 hours since symptom onset

A
  • Diagnosis of Ischemic stroke causing measurable neurologic effects
  • Age >= 18 G t G
78
Q

Ganciclovir

WHen?

A

IV form used rarely seen all drugs cause penias

requires dosage adjustment in renal

Rarely used

79
Q

Managment of BP during and after alteplase therapy when its =<180/105?

A
  • Monitor bp every 15 minutes for 2 hours after alteplase therapy then q 30 min for 6 hours, then every hour for 16 hours
80
Q

Azathioprine

Dose?

What is the preparation?

AEs? 6

DI?

MOA?

A
  • 50-150 mg qday
  • Only comes in 50 mg tablets
  1. Leukopenia, Thrombocytopenia, anemia
  2. Skin cancer
  3. Pancreatitis, lymphoma (rare)

DI

  • Xanthine Oxidase inhibitors (allopurinol)
    • Increases the concentrations of Azathio and dose reduction is needed
  • Sulfasalazine- Inhibit TPMT

Converted into 6-MP and prevents cell cycle replication

81
Q

Treatment for Ischemic Stroke

  • Time is brain tissue
  • Perform detail pt hx
  • _______ assessment within ___ min on ED arrival. Completion of what?
  • ____ of the head ___ min of ED arrival to rule out?
  • What should be given within 60 minutes?
A
  • Neurologic within 25 minutes NIHSS
  • CT scan within 45 minutes to rule out hemorrhage
  • IV TPA / Alteplase need to be given within 60 minutes
82
Q

What are the two calcineurin inhibitors? Which one is preferred and what is their place in therapy?

A

Tacrolimus (preferred), Cyclosporine

Used for maintenance

83
Q

What blood levels are drawn for Cyclosporine?

A
  • 12 hour trough levels with a range of 75-300 ng/mL
84
Q

PCP and PJP Prophylaxis

What drug? What forms? for how long? Dosage adjustments? AEs? 2

A
  • 3-12 months
  • SMX/TMP
    • DS 800/160 mg
      • 1 tab once daily 3 days per week
    • SS 400/80 1 tab once daily
  • Rash, Sun sensitivity
  • Renal dysfunction reduce dose
85
Q

What is the dose and administration of thymo?

A
  • Infusion given over 4-6 hours via central line
  • Need a 0.22 micron filter
  • 1.5 mg/kg/day for 3-5 DOSES
  • Pts also need to be premedicated; APAP, diphenhydramine, steroids
86
Q

How long will pts be on antirejection therapy?

What is a pearl of this?

A
  • Pts will be on this forever and its important for them to be adherent and not miss dose
    • If a patient is like super sick then you could possibly hold it for a few days.
87
Q

Hyperlipidemia Cardiovascular risk in SOT

Culprits? 5

Tx? What is preferred

Monitor?

What reduces absorption

A
  • Sirolimus, Everolimus, Cyclosporine, Tacrolimus, Steriod
  • Statin therapy:pravastatin is preferred
  • Monitor liver function tests
  • Bile acid sequestrants
88
Q

Basiliximab

What type of antibody?

MOA:?

What is its indication?

Dose?

Administration?

A
  • Chimeric (70% human 30% Murine) monoclonal antibody
  • Binds to CD25 (this is alpha subunit of IL2 receptor on surface of activated T cells) Inhibiting IL-2 mediated effects
  • Used for induction only not used for the tx of rejection
  • 20 mg IV on post op day 0 and post op day 4
  • SHort infusion time
    • Can be given peripherally

Also known as a Non-depleting IL2 receptor antagonist

89
Q

Which type of stroke has highest risk of mortality?

A
  • Brain stem
    • Loss of respiratory stimulation, heart function, temp reg, ability to chew or swallow
90
Q

Corticosteroids

A

Methylprednisolone (IV)

Prednisone Oral

91
Q

What are the risk factors for pts to have a higher PRA?

A
  • Pregnancy
  • blood transfusion
  • previous transplant
92
Q

What acute rejection is harder to treat?

What are the two types?

A
  • Antibody/HUmoral
93
Q

Primary ICH most common basically dont know what it is

Secondary: Something we can take out

A
94
Q

Corticosteroids

Whos gonna be on roids?

What is the most common agent?

What are the doses and when?

Following transplant what will people do?

What are the maintenance doses?

A
  • Some will be on some wont
  • Prednisone
  • 5 mg daily - 60 mg daily qAM for insomnia
  • Many pts will be on taper
  • Maintenance doses are usually <10 mg daily
95
Q

NODAT

Culprit?

tx?

5

A
  • Tacrolimus B-cell tox, Steroids (insulin resistance)
  • Immunosuppression changes: Antidiabetic agents may require dose adjustments as immunosuppression changes
  • Insulin is the best 40% of pts are on it
  • Glipizide is preferred due to liver metabolism but mostly avoided due to renal and risk of hypoglycemia
  • Metformin Monitor renal
  • DDPT4 renal function
96
Q

Mycophenolate

Administration

DIs?

A
  • Do not cut crush or chew either
  • DI
    • Pantoprazole not clinically significant
    • Cyclosporine- youll have to increase the dose of MMF if you are taking both
97
Q

Prothrombin Complex Concentrates?

A
  • 4-factor PCC Kcentra II,VII, IX, X and proteins C and S
  • If they have an allergy to heparin then you need to use FEIBA
98
Q

If someone has had a TIA Transient Ischemic Attach what is the give away?

A
  • No Radiographic evidence of infarct or tissue damage
99
Q

Fresh frozen plasma

A

SLow admin and large volume

PCC>FFP

100
Q

What brand name cannot be interchanged with any of the other products?

A
  • Sandimmune (non-modified version) cannot be interchanged no equivalent has erradic absorption
  • Neoral, Gengraf
101
Q

If you have an IV formulation of cyclosporine and want to switch them to oral what is the conversion?

A

IDK but its not 1:1

102
Q

What is another drug for PCP/PJP prophylaxis? What do you need to test for?

A

Dapsone

G6PD testing- if defficient pt at risk for methemoglobinemia

103
Q

Anticholinergic antidote

What is the indication?

A

Pts with agitated delirium and no significant QRs QT prolongation.

104
Q

Tx for I and II

PCN allerrgy?

MRSA?

Duration

A
  • Cefazolin
  • Clinda
  • Vanco
  • 24 hours
105
Q

III open fracture with no gross contamination Tx

A
  • Ceftriaxone
  • Allergy Clinda + metro
  • Add vanc for MRSA
  • 48 hours or 24 hours after wound healing
106
Q

LEthal triad

A
  • Hypoxia
  • Hypothermia
  • Acidosis
107
Q
A

Therapy Spring 2018 (5 decks)

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