Review Flashcards
1
Q
CNI
A
TACROLIMUS
CYCLOSPORINE
2
Q
ANTIPROLIFERATIVE AGENTS/ANTIMETABOLITES
A
AZATHIOPRINE
MYCOPHENOLATE MOFETIL
MYCOPHENOLATE SODIUM
3
Q
MTOR INHIBITORS
A
SIROLIMUS
EVEROLIMUS
4
Q
ANTIBODIES
A
ATGAM THYMOGLOBULIN BASILIXIMAB RITUXIMAB ATEMTUXUMAB IVIG
5
Q
PROTEASOME INHIBITOR
A
BORTEZOMIB
6
Q
POLYCLONAL ANTIBODIES MOA
A
T-CELL DEPLETION
CYTOTOXIC ACTIVITIES
MODULATION OF T CELL ACTIVATION
7
Q
POLYCLONAL ANTIBODIES ADVERSE REACTIONS
A
CYTOKINE RELEASE SYNDROME LEUKOPENIA/THROMBOCYTOPENIA SERUM SICKNESS ANAPHYLAXIS INFECTION MALIGNANCIES-PTLD
8
Q
POLYCLONAL ADVANTAGES
A
STRONGER, CAN BE USED TO TREAT REJECTION
9
Q
POLYCLONAL DISADVANTAGES
A
ACUTE SIDE EFFETS
HIGHER INFECTION RATES
HIGHER MALIGNANCY RATES
10
Q
MONOCLONAL ADVANTAGES
A
NO ACUTE SIDE EFFECTS
NOT ASSOCIATED WITH HIGH INFECTION OR MALIGNANCY RATES
11
Q
MONOCLONAL DISADVANTAGES
A
WEAKER, CANNOT BE USED TO TREAT REJECTION
12
Q
TACROLIMUS DOSING
A
0.1-0.15 MG/KG/DAY PO DIVIDED BID
13
Q
CYCLOSPORINE MOA
A
INHIBITS FIRST PHASE OF T CELL ACTIVATION
REDUCES LEVEL OF CIRCULATING T CELLS
14
Q
CYCLOSPORINE DOSING
A
5-10 MG/KG/DAY DIVIDED BID
15
Q
CNI NEPHROTOXICITY
A
TAC=CYCLO
16
Q
CNI HYPETENSION
A
CYCLO>TAC
17
Q
CNI DM
A
TAC>CYCLO
18
Q
CNI NEUROTOXICITY
A
TAC>CYCLO
19
Q
CNI COSMETIC EFFECTS
A
CYCLO>TAC
20
Q
CNI GI EFFECTS
A
TAC>CYCLO
21
Q
CNI HYPERKALEMIA
A
TAC>CYCLO
22
Q
CNI HLD
A
CYCLO>TAC
23
Q
CNI LOW MAG
A
CYCLO=TAC
24
Q
THINGS THAT INCREASE CNI LEVELS
A
- ZOLES
- MYCINS
- GRAPEFRUIT/POMEGRANATE JUICE
- DILT, VERAPAMIL, AMIO
- FLUOXETINE
- PROTEASE INHIBITORS
- REGLAN
- SIMEPRAVIR
25
THINGS THAT DECREASE CNI LEVEL
- MG/AL ANTACIDS
- KAYEXOLATE/OCTREOTIDE
- CHOLESTRYAMINE
- ANTI-EPILEPTICS
- RIFAMPIN
- NAFCILLINE
- ISONIAZID
- CARBAMEZEPINE
- HERBS (ST. JOHNS WART)
26
MTOR MOA
INHIBITS T CELL ACTIVATION AND PROLIFERATION
27
SIROLIMUS DOSING
6-12 MG LOADING DOSE
| 2-5 MG MAINTENANCE DOSE
28
SIROLIMUS/EVEROLIMUS SIDE EFFECTS
- NEUTROPENIA, THROMBOCYTOPENIA, LEUKOPENIA
- INCREASE ANEMIA
- HLD, HYPERTRIGLYCERIDEMIA
- DELAYED WOUND HEALING
- N/V/D
- MOUTH ULCERS
- INTERSTITIAL PNEUMONITIS
- THROMBOTIC MYCROANGIOGRAPHY
- PROTEINUREA
- LYMPHOCELE/LYMPHODEMA
- BONE PAIN
29
SIROLIMUS BLACK BOX WARNING
- HEPATIC ARTERY STENOSIS
| - BRONCHIAL ANASTOMOTIC DEHISCENCE
30
EVEROLIMUS DOSING
0.75 MG PO BID
31
AZATHIOPRINE DOSING
1-3 MG/KG/DAY
32
AZATHIOPRINE MOA
INHIBIT PURINE SYNTHESIS
| INHIBIT T CELL PROLIFERATION
33
AZATHIOPRINE DRUG INTERACTIONS
ALLOPURINON-> PANCYTOPENIA-> DEATH
| MYCOPHENOLATE MOFETIL-> BONE MARROW SUPPRESSION. SEPERATE MEDS BY 24 HOURS
34
MYCOPHENOLATE MOFETIL MOA
INHIBIT PURINE SYNTHESIS
| INHIBIT T AND B CELL PROLIFERATION
35
MYCOPHENOLATE SIDE EFFECTS
- N/V/D
- ANEMIA, THROMBOCYTOPENIA
- INFECTION
- GASTRITIS, GI BLEED
- CMV TISSUE INVASIVE DISEASE
- MALIGNANCY
36
MYCOPHENOLATE MOFETIL DURG INTERACTIONS
- ANTIVIRALS/SIROLIMUS-> INCREASED BONE MARROW SUPPORESSION
- CYCLOSPONINE-> DECREASED LEVELS OF MPA
- AZATHIOPRINE-> BONE MARROW SUPPRESSION. SEPERATE BY 24 HOURS
- CHOLESTYRAMINE-> LOWERS DRUG LEVEL
- AL/MG-> DECREASE ABSORPTION. SEPERATE BYT 2-4 HOURS
37
CORTICOSTEROIDS MOA
BLOCKS LYMPHOCYTE PROLIFERATIONS
ANTIINFLAMMATORY
38
METHYLPREDNISONE DOSING FOR REJECTION
250-1000 MG IV X 3 DAYS
39
CORTICOSTEROID SIDE EFFECTS
- EUPHORIA/DEPRESSION/MOOD DISORDERS
- HTN
- HBP
- HBS
- INFECTION
- MYOPATHY
- IMPAIRED WOUND HEALING
- HIRSUTISM
- ACNE
- WEIGHT GAIN/INCREASED APPETITE
- CUSHINGOID FACE
- OSTEOPOROSIS
40
PLASMAPHERESIS
MECHANICAL REMOVAL OF AB. DOES NOT DO ANYTHING TO THE B CELLS
41
IVIG DOSE
1-2 GM/KG
42
IVIG SIDE EFFECTS
- BACK PAIN
- HA
- FEVER/CHILLS
- BRONCHOSPASM
- HYPOTENSION
43
RITUXIMAB MOA
MONOCLONAL AB TARGETED AGAINST CD20 ANTIGEN ON B LYMPHOCYTES
44
RITUXIMAB DOSING
PREVENTION OF REJECTION- 375 MG/M2
TREATMENT OF REJECTION- 375 MG/M2
TREATMENT OF PTLD- 375 MG/M2/DOSE EVERY WEEK X 4 DOSES
45
RITUXIMAB SIDE EFFECTS
- HYPOTENSION
- FEVERS/CHILLS
- BRONCHOSPAMS
- ARRYTHMIAS
46
CMV causes what in the liver?
Vanishing bile duct
47
CMV causes what in the heart?
Coronary artery vasculopathy
48
CMV causes what in the lung?
Bronchiolitis obliterans
49
CMV causes what in the kideny?
Glomerulopathy
50
Staph is a
Bacteria
51
c-diff is a
bacteria
52
Salmonella is a
bacteria
53
Psuedonomas is a
bacteria
54
Listeria is a
bacteria
55
Candida is a
Fungal
56
Aspergillus is a
Fungal
57
PCP is a
Fungal
58
Histoplasma is a
Fungal
59
Coccidio is a
Fungal
60
Blastomycosis is a
Fungal
61
Influenza is a
Virus
62
Herpes is a
Virus
63
EBV is a
virus
64
Varicella is a
Virus
65
CMV is a
Virus
66
Toxoplama is a
Parasite
67
Cryptosporidium is a
Parasite
68
What causes increased risk of CMV reactivation?
ATG
69
CMV causes
inflammation of organs
decreased WBC
Decreased Plts
Increased LFTs
70
EBV can cause
mononucleosis -> PTLD
71
What are the symptoms of PTLD?
- mono like
- fever
- abd pain
- jaundice
- gi bleed
- change in CNS
- renal dysfunction
- hepatic dysfunction
- splenomegaly
72
What is the main treatment for PTLD?
Stop or lower immunosuppresion
73
Treatment for varicella
varicella zoster immunoglobulin within 72 hours or IV acyclovir
74
Treatment for C-diff
Flagyl or oral vanco
75
How do you treat nocardia?
With sulfonamides and ceftriaxone
76
What are the symptoms of Nocardia in different organs?
Brain-HA, lethargy, confusion, seizures
Lungs- PNA, fever, cough, CP
Skin-cellulitis
77
Where is nocardia found?
In soil or water
78
Where is legionella found?
In water
79
What is the treatment for Legionella?
Quinolones, marcrolides, cipro, zithromycin, rifampin
80
What is the treatment for Hep B?
HBV immunoglobulin, enteravir, tenofovir
81
What are the two types of polyomarvirus?
BK and JC
82
What does BK affect?
-tubules and ureters
| Biopsy shows tubules with epithelial cells containing the virus
83
What does JC cause?
Progressive multifocal leukoencephalopathy.
The virus infects and lyses oligodendrocytes which leads to multifocal demyelination in the brain.
84
Where is coccidomycosis found?
Az soil
85
Where is strongyloides found?
In tropical soil
86
Where is toxoplasmosis found?
In cat feces
87
Common post of complication for heart, heartlung
PNA d/t inactive phrenic nerve, long intubation times
88
Common post of complication for heart?
CMV leading to CMV pneumonitis and gastritis
89
Common post of complication for lung?
Colonization at the anastomosis site cause dehiscence, mediastinitis, bronchial stenosis.
90
Common post of complication for kidney?
UTI, lymphocele, secondary infection or urine leak
91
Common post of complication for Pancreas?
Sepsis
92
Common post of complication for Liver?
Nosocomial gram- candida. Also, CMV, EBV, pneuomocystitis, aspergillus about 1-6 months post transplant.
93
Common post of complication for intestine?
EBV-> PTLD
| CMV most common
94
3 was the immune system protects us
- Defense
- Surveillance
- Homeostasis
95
What are cytokines?
- hormones
- 1st to respond
- T lymphocytes
- cell mediated
- responsible for allergic rxns
96
When do you get an updated pra in a senistized pt, recent blood tx, VAD pt, ped/retransplant and non sensitized pt?
- PRA >10% done monthly
- blood tx- 1-2 weeks after
- VAD pts- weekly
- peds/retransplant- 3 months
- no sensitization-6 months.
97
How is a CDC crossmatch done?
Recipient serum is mixed with donor lymphocytes and complement. If there is lysis present then it is positive.
98
How is a Flow cytometry cross match done?
Recipients serum is mixed with lymphocytes and fluorescein
99
Major sign of Hyperacute rejection?
Thrombosis
100
Major sign of acute ab mediated rejection?
Vasculitis
101
Histological findings for acute ab mediated rejection?
```
Capillary fragments
Hemorrhage
Infiltrates of neutrophils
Macrophages intravascularly
Edema
Destruction of capillaries.
```
102
Treatment for ab mediated rejection? Asymptomatic, mild, severe
Asymptomatic: hold steroid taper, change immuno meds
Mild: increase steroids, ATG, IVIG, change immuno meds
Severe: increase steroids, plasmapheresis, ATG, IVIG, change immuno meds.
103
Histological changes seen in acute cellular rejection?
```
Hemorrhage
Edema
Interstitial inflammation
Parenchymal damage
Endothelialitus
```
104
Main symptoms of chronic rejections?
Vascular fibrosis
```
Kidney-nephropathy
Arteriosclerosis
Vanishing bile duct
Interstitial fibrosis
T-cell mediated
Bronchiolitis obliterans.
```
105
Signs/symptoms of left sided heart failure
SOB, cough, wheezes, blood tinged sputum, tachycardia, cyanosis
106
Signs/symptoms of right sided heart failure
Fatige, JVD, anorexia, edema, ascites, enlarged liver and spleen.
107
Biopsy scale findings for antibody mediated rejection
```
0= no acute cellular rejection
1R= mild. Interstitial and or perivascular infiltrates with 1 focus of monocyte damage.
2R= Moderate. 2 or more foci
3R= Severe. Diffuse infiltrates
```
108
AB mediated rejection treatment based on phase
0 or 1R= no treatment, may adjust meds
2R= IV or oral steroids
3R= IV steroids. Thymo. Plasmapheresis. Mechanical support
109
S/S of chronic rejection in heart transplant
- CP
- Fatigue
- Dyspnea
110
Diagnosis and treatment of chronic rejection in heart
Stress test/left heart cath
PTCA or retransplant
