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CDM 3 Exam 3 > Lecture 2 - Transplant Complications > Flashcards

Lecture 2 - Transplant Complications Flashcards

1
Q

What makes you think rejection

A

Bump SCr = kidney
Bump LFTs = liver
HF symptoms, fluid overload = heart
Shortness of Breath = lungs

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2
Q

1st line for Acute Cellular rejection streatment

A

Steroids

Pulse dosing, based on organ
Generally 3 days +/- taper

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3
Q

2nd line therapy for Acute Cellular rejection treatment

A

usually refractory, used for severe rejection
Doses range based on organ

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4
Q

Last line for Acute Cellular rejection treatment

A

Alemtuzumab

For persistent severe rejection

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5
Q

Methylpred to Prednisone conversion

A

4:5

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6
Q

Corticosteroid monitoring when using for rejection treatment

A

watch Blood sugar, may req insulin
Trouble sleeping
Blood pressure
Admin high doses at least 18hrs apart

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7
Q

Treatment of AMR w/ Pulse steroids, Thymoglobulin, Belatacept works on…

A

T cell
APC

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8
Q

Treatment of AMR w/ Rituximab works on…

A

B cell

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9
Q

Treatment of AMR w/ Bortezomib works on…

A

Plasma cell

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10
Q

Treatment of ARM w/ Plasmapheresis works on…

A

antibodies

essentially removing antibodies

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11
Q

Treatment of ARM w/ Ecolizumab works on….

A

complement system

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12
Q

Treatment of ARM w/ IVIG works on…

A

all the parts

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13
Q

IVIG Adverse reactions

A

infusion reactions so need to premedicate

Hemolytic anemia when pts are non-O blood type

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14
Q

Rituximab dosing info

A

weight based dosing
Pre-medicate
Monitor for HepB reactivation

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15
Q

Bortezomib dosing info

A

Does m2
IV push has to be over 3-5 sec
SubCu can avoid infusion related reactions

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16
Q

Bortezomib monitoring

A

Hepatic function
Myelosuppression
Peripheral sensory/motor neuropathy

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17
Q

Eculizumab dosing info

A

varies depending on organ
IV infusion over 30 min

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18
Q

Eculizumab dosing info

A

varies depending on organ
IV infusion over 30 min

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19
Q

Eculizumab monitoring

A

Has REMS, pts req vaccination with meningitis vaccines or prophylaxis with abx for duration after therapy

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20
Q

Pharmacy concerns Eculizumab

A

$$$$$
commonly non-formulary
Special order from drug company
REMS program

21
Q

2 way street to prevent infections

A

Screen recipient and donor

22
Q

Pneumocystis (PJP)

A

Risk related to time post transplant
All organs get prophylaxis initially
Duration organ/center specific

Preferred agent is bactrim

23
Q

PJP 1st line agent

A

Bactrim
SS QD or BS MWF

False SCr elevation, leukopenia

24
Q

PJP 2nd line agent

A

Atovaquone
1500mg QD

$$$$
“yellow paint” liquid

No renal dosing

25
Q

PJP 3rd line agent

A

Dapsone
100mg QD

No renal dosing

Check G6PD, risk for methemoglobinemia
High hematologic toxicities

26
Q

CMV Risk factors

A

D+/R- = 56-80%
D-/R+ = 0-27%
D+/R+ = 27-39%
D-/R- = < 10%

small bowel,liver,lung at highest risk

27
Q

CMV prevention

A

minimum of 200 days = Valganciclovir = renal dose adjustment

28
Q

CMV symptoms

A

Flue-like = Diarrhea,fever, malaise
Leukopenia** viral phenotype
Colitis** most common CMV disease

29
Q

1st line for CMV

A

Gamciclovir = IV, use if concern for oral absorption
Valganciclovir = oral

most common SE Thrombocytopenia/Neutropenia

30
Q

1st line in UL97 resistant CMV

A

Foscarnet

31
Q

Foscarnet info

A

extremely nephrotoxicity
aggressively pre-hydrate
monitor for electrolyte abnormalities

32
Q

Treatment of CMV

A

reduce immunosuppression = d/c dose of mycophenolate if possible

Monitor CMV viral loads weekly

Renal dose adjustments in all 4 drugs

33
Q

Letermovir info

A

doesn’t cover HSV, use with Acyclovir
CYP3A4 inhib*** = tacrolimus lvls

role emerging for prophylaxis CMV in pt who cant tolerate valganciclovir

AE = GI + Peripheral edema

34
Q

Maribavir info

A

oral, weak inhib of CYP3A4

Doesn’t cross BBB but does cross blood-retinal barrier

ADE: Dysgeusia, Diarrhea, Nausea, Vomiting, Fatigue

Typically for treatment resistance disease

35
Q

Prophylaxis CMV treatment

A

start valganciclovir

if leukopenia concern, watchful waiting vs letermovir

avoid maribravir and wait for CMV vaccine

36
Q

Treatment-Viremia CMV

A

1st line ganciclovir/valganciclovir

monitor response if concern for resistance consider new agents

37
Q

Treatment - Resistant Disease CMV

A

consider Maribravir depending on disease dissemination

38
Q

Candida fungal prophylaxis

A

Nystatin = 1st line for oral
Fluconazole as backp

39
Q

Aspergillus fungal prophylaxis

A

Oral azole
close monitoring of tacrolimus

40
Q

1st line therapy or severe fungal infection

A

liposomal ampotericin

41
Q

Ritonavir w/Tacrolimus when treating COVID w/ Paxlovid

A

Ritonavir effects Tacrolimus so have to hold immunosuppression once starting therapy such as paxlovid

42
Q

vaccines that should be avoided in immunocompromised patients?

A

Live vaccines are CI post transplant

Give pre-transplant

43
Q

Infection prevention living tips

A

frequent hand washing
avoid smoking
avoiding well water
no raw/undercooked foods
avoid public buffets or street food
avoid cleaning animal cages

44
Q

transplant Hypertension treatment of choice?

A

CCB = amlodipine/nifedipine
ACE/ARB consider if proteinuria/DM, 1yr out and more stable

45
Q

Transplant Hyperlipidemia treatment of choice?

A

Cyclosporine has more effects with statins than tacrolimus

Only can use pravastatin with cyclosporine

atorvastatin ok with tacrolimus

46
Q

What pain med should be avoided after transplant?

A

Avoid NSAIDs, just Tylenol/acetaminophen

47
Q

New onset diabetes after transplant info

A

Renal dosing of therapeutic agents
Insulin = new regiment for pts
Consider SGLT-2 inhibitors

Hypoglycemia risk with decrementing steroids

48
Q

Osteoporosis post transplant info

A

renal dosing for therapeutic agents

Calcium supplements, but that affects Myclophenolate absorption

49
Q

Gout post transplant info

A

DI:

Taco inc colchicine conc*
allopurinol/Azathio also interact* Allo is CI
Febuxostat

Avoid NSAIDs

Pulse steroids typically treatment for gout attack

CDM 3 Exam 3 (9 decks)

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