Immunosuppression Flashcards
SEs of steroids
Derm - hirsutism, poor wound healing, acne
Haem - high neuts, low leucs
EYEs- cataract and retinopathy
HTN
Fluid and salt retention
Metabolic/ endo: Weight gain, lipid profile (high trigly and chol)
Osteoporosis
Proximal myopathy
Behavioural changes
GIT effects - Peptic ulcer disease, pancreatitis
Mycophenolate SEs
Myelosuppression
Gut (N+V, constipation)
Malignancy
Tacrolimus SEs
HTN
GIT
Nephrotoxicity
Neurotoxicity
Malignancy
Infection
Minimise cancer risk in setting of immunosupression
Skin checks
HPV vax
Sun protection
Mx issue - post-renal transplant
Monitor for signs of rejection
Medication management e.g. dosette box (adherence most common reason for rejection)
Monitor for SEs of immunosupression
Malignancy - skin checks, HPV vax, sun protection
Monitor for disease recurrence
- proteinuria, BP, biopsy to diagnose
Mx issue - post-renal transplant - surveillance invx
Monthly - Ht, Wt, BP, UA immunosupressant levels
Yearly ophthal, skin checks
2 yearly DEXA
Heart t/p: Largest contributor to graft longevity?
CARDIAC ALLOGRAFT VASCULOPATHY
Accelerated for of coronary artery disease. Progressive thickening of BVs, with sparing of recipients.
Often SILENT, as heart is denervated (so no angina).
Clinical presentation: arrhythmias, CCF< sudden death
Diagnosis: coronary angiography
Cure: re-transplantation
Signs of rejection in cardiac t/p
Fatigue, fluid retention, fever, diaphoresis, abdo symptoms, gallop rhythm
Malignancy following transplant
Skin cancer
PTLP disorders - usually reactivation of EBV
Med safety on warfarin
Adherence - give same time everyday
INR monitoring - 4-6 weekly, GP
Diet - consistent, avoid large amounts of food rich in vit k e.g. kale
Avoid - aspirin, fish oil, consult dr before starting alt meds
Signs of bleeding
Store safely - out of reach of other children
IE prophylaxis - general measures
Strict dental hygiene - dentist 6 monthly
Cutaneous hygiene - clean wounds well
Prompt tx of infections
Discourage tattoos or piercings
IE prophylaxis - pre-procedure.
Who?
What ABx?
What procedures?
Prosthetic valve - any prosthetic material
Previous episode of IE
Cyanotic HD
Amox or ampicillin
Clindamycin if allergic to penicillin
Prior to: dental procedures, skin or soft tissue procedures, resp tract, TOE, GI or urinary procedure
Dev delay and heart disease
Approx half of children with congenital cardiac disease have neurodevelopmental delay.
Multifactorial - cyanosis, surgeries, prolonged hospitalisation, associated syndromes
