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Therapeutics Spring 2015 > Infection Prophylaxis/Tx in Transplant Patients > Flashcards

Infection Prophylaxis/Tx in Transplant Patients Flashcards

1
Q

What puts a patient at risk for CMV?

A

Latent reactivation

Donor transmission

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2
Q

What is the risk category for +/-

A

Donor/recipient

Highest risk

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3
Q

What is the risk for +/+ or -/+ ?

A

medium risk

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4
Q

What is the risk for -/-

A

lowest risk

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5
Q

What is the clinical presentation of CMV?

A

non-specific febrile syndrome- fever, low WBC, abdominal pain, nausea, vomiting, diarrhea, arthralgia
Tissue invasive infection- hepatitis, pneumonitis, enteritis
Graft injury

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6
Q

What are the prophylactic treatments for CMV?

A

Duration dependent on risk- usually 3-6 months
Valganciclovir
Ganciclovir
Acyclovir

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7
Q

What is the treatment of CMV?

A

valganciclovir/ganciclovir at higher doses
CMV IVIg- Cytogam
treat for 2 weeks min, until serology undetectable/symptoms resolved

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8
Q

What are some side effects of CMV tx?

A

needs to be renally adjusted

Bone marrow supression

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9
Q

What puts a patient at risk for pneumocystis pneumonia?

A

Immunosuppression- transplant, chemo, HIV, chronic steroid therapy, neutropenia

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10
Q

What is the clinical presentation of pneumocystis pneumonia?

A

Fever, cough, dyspne, hypoxemia, abnormal chest X-ray

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11
Q

What are the agents for the prophylactic treatment of pneumocystis pneumonia?

A

Sulfa/trimethoprim - Bactrim/Spetra
Dapsone
Pentamidine (if sulfa allergy)
Atovaquone (if sulfa allergy)

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12
Q

What are the drugs for the treatment of pneumocystis pneumonia?

A

Same meds as prophylaxis just higher doses

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13
Q

What are the risks for the herpes simplex virus?

A

Past serostatus
reactivation
new infection

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14
Q

What is the clinical presentation of herpes?

A

orolabial, genital or perianal local warts
cutaneous, esophagitis, hepatitis, pneumonia
fever, leukopenia

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15
Q

How is HSV detected?

A

PCR to check for herpese DNA

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16
Q

What are the agents for the prophylaxis of herpes?

A

ganciclovir, valganciclovir, acyclovir

Continue for a month post transplant

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17
Q

What drugs are used in the treatment of herpes?

A

Acyclovir IV or acyclovir, famcyclovir or valacyclovir PO
Doses need to be adjusted for renal insufficiency
Continue treatment till lesions are gone

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18
Q

What puts a patient at risk for candida?

A

mucocutaneous infection

type of transplant, acute renal failure

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19
Q

How does candida present clinically?

A

candidemia, UTIs, pulmonary

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20
Q

what are the agents used for the prophylaxis of candida?

A

Prophylaxis is controversial
can be universal or targeted
Antifungals at least 14 days post transplantation
Fluconazole, amphotericin B

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21
Q

What agents are used in the treatment of candida?

A 
amphotericin B
fluconazole
itraconazole
voriconazole
fungins
22
Q

What viral infection does not have a prophylactic treatment?

A

BK virus

23
Q

What is the BK virus?

A

a childhood infection that is asymptomatic/dormant in genitourinary tract. Can cause nephrotoxicity in kidney transplant patients

24
Q

How do you diagnose BK?

A

routine screening, detection by urine or blood OCR

Biopsy for neuropathy

25
Q

How do we treat BK virus?

A

minimize immunosupression
add leflunomide (Arava)
add Cipro
Add Iv Ig

26
Q

What vaccinations should be given pre-transplant?

A

Complete vaccination series and boosters before transplant
Live and inactivated vaccines safe
annual influenza/pneumococcal

27
Q

When can patients receive vaccines after transplant?

A

inactivated vaccines safe, avoid live

can give 3-6 months after transplant

28
Q

Which vaccines cannot be given to a transplant patient?

A 
MMR
Varicella
Zostavax
Nasal Influenza
all live
29
Q

What are metabolic complications post transplant?

A

hyperlipidemia

30
Q

What causes hyperlipidemia in a transplant patient?

A

immunosupressives, diet, obesity, diabetes, age, meds

31
Q

What meds can cause HLD in a transplant patient?

A

cyclosporine, tactolimus, sirolimus, prednisone

32
Q

What is the consequence of HLD in transplant patients?

A

cardiovascular disease and chronic allograft rejection

33
Q

What is the treatment for HLD in transplant patients?

A

lifestyle mods, immunosupression adjustments, lipid lowering therapy

34
Q

What is the drug of choice for HLD in transplant patients?

A

Statins, low to moderate intensity

35
Q

What immunosupressive does statins interact with?

A

calcineurin inhibitors

36
Q

What percentage of patients get post op HTN?

A

90%

37
Q

What are the causes of HTN in transplant patients?

A

immunosupression meds
kidney dysfunction
vascular compromise

38
Q

How do you treat HTN in transplant patients?

A

lifestyle mods, chance cyclosporine to tacrolomist

Antihypertensives

39
Q

What HTN drugs do CNI/mtor drugs interact with?

A

Diltiazem

Verapemil

40
Q

How do we treat new onset diabetes after transplant?

A

follow American diabetes association criteria

41
Q

What are the risk factors for gout in transplant patients?

A

serum uric acid > 7mg/dL

obesity, HTN, alcohol, diuretics, cyclosporine

42
Q

What is the treatment of gout in transplant patients?

A

steroids
colchicine - monitor for GI side effects, nephrotoxicity
Avoid NSAIDs - nephrotoxicity
allourinol, febuxostat

43
Q

What are the causes of osteoporosis in transplant patients?

A

CNIs, steroids, kidney dysfunction, alcoholsim, age, smoking, nutrition, immobiliztion

44
Q

What is the treatment for osteoporosis?

A

Exercise
Calcium, vitamin D, bisphosphonates- hard on kidneys
modify immunosupressants

45
Q

What are the risk factors for malignancy in transplant patients?

A

pre-existing conditions, viral infections, sun exposure, smorking

46
Q

What is post transplant lymphoprolifertative disorder?

A

Usually associated with EBV
Can be uncomplicated mononucleosis to full malignancy
Localized and slow or widspread with sepsis

47
Q

What are the risk factors for PTLD?

A

primary EBV, intestinal transplant, young recipient, polyclonal anti-lymphocyte antibodies

48
Q

What are the risk factors for PTLD?

A

primary EBV, intestinal transplant, young recipient, polyclonal anti-lymphocyte antibodies

49
Q

Which skin cancer is most common in transplant patients?

A

Basal cell and squamous cell

50
Q

What OTC meds should you caution patients against?

A

NSAIDs- nephrotoxicity
Decongestants- increase BP
Herbals - increase/decrease CNI or mTOR inhibitor concentration

Therapeutics Spring 2015 (12 decks)

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