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Module 1 - 622 > Translplant > Flashcards

Translplant Flashcards

1
Q

Lung Transplant: Acute Cellular Rejection

A

T-cells
RF: infections, acid reflux, nonadherence to IS regimen
TX; IV solumedrol, ATGAM, Campath

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2
Q

Lung Transplant:
Antibody-mediated

A

B-cells/ HLA
DSAs found in blood labs.
Dx: Transbronchial biopsy (TBBX)
TX: plasmapheresis (remove antibodies), IVIG, rituximab, bortezomib

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3
Q

CLAD

A

Persistent inflammation from immune system - leads to scaring (fibrosis of small airways)
RF: - prior acute rejections, recurrent infections, GERD, nonadherance, aspiration

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4
Q

Treatment of CLAD

A

Prevention of rejection
Azithromycin (prophyl)
Montelukast
Phonophoresis
Monoclonial antibodies

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5
Q

S/S of acute and chronic lung rejection

A

dyspnea, fatigue, cough, hypoxemia, pleural effusions, pulmonary infiltrates, declining PFTs

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6
Q

What are the 2 types of chronic lung rejection

A

1) Obstructive - BOS
2) Restrictive - CLAD

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7
Q

Bronchiolitis obliterans syndrome

A

progressive obstructive ventilatory defect w/ air trapping.
FALL IN FEV1 AND RISE IN FVC

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8
Q

Do you use high dose STEROIDS for chronic lung?

A

NO

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9
Q

CLAD -> RCLAD

A

Progressive restrictive ventilatory defect w/ air trapping
FEV1 and FVC simultaneously decrease but ratio stays the same

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10
Q

Renal Transplant Complications

A

-Bleeding
-ATN (ischemic injury leads to low UO and increase BUN/Creat)
-Hyperkalemia
-Urine leaks
-Ureteral obstruction
-Graft thrombosis (sudden cessation of urine output, graft swelling, gross hematuria)
-Lymphocele (iliac vessels, clear protein containing fluid)

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11
Q

What is the most common Infection/UTI in transplanted pts

A

BK type polyoma virus
-elevated serum creat and hematuria
-TX: IV CIDOFOVIR and/or reduce IS regimen

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12
Q

Cause of death in post transplant pts

A

CV EVENTS - AMI, CVA, CHF
-prevent CV disease

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13
Q

S/S of acute kindney transplant rejection

A

Pyrexia, tenderness over graft site, oliguria, acute renal failure, increasing BUN/Creat, weight gain, HTN, edema, general malaise

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14
Q

Liver Transplant: How to assess for rejection

A

bile production, coagulation factors, LFTs (initally elevtated then decrease), ammonia

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15
Q

Is pancreatic transplant associated with renal transplant

A

Yes

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16
Q

Pancreas Transplant S/S of rejection

A

-urinary amylase levels reflect rejection
-HYPERGLYCEMIA IS A LATE SIGN AND WHEN EVIDENT, REJECTION IS IRREVERSIBLE
-Sepsis
-Abd pain
-increase lipase/amylase

17
Q

Complications of Intestinal transplant

A

-rejection: abd pain, n/v, change in stools, infection, biliary leaks, perforations, bleeding, ascites, bowel obstruct
-HYPERMOTILITY SEEN EARLY POST-TRANSPLANT - ATTRIBUTED TO DENERVATION

18
Q

Complications of stem cell transplant

A

-Infection - Neutropenia and immunocompromised
-VENO-OCCLUSIVE DISEASE OF THE LIVER: hyperbilirubiemia, rapid weight gain, ascites, RUQ pain, hepato/splenomegaly, Jaundice
-Graft vs Host: SKIN RASH, GI ENTERITIS, LIVER DYSFUNCTION
-Rejection: PANCYTOPENIA

19
Q

Do immunospression drugs alter inflammatory response

A

YES
-many may NOT present w/ typical fever and leukocytosis even if an infection taking place

20
Q

What does fever in transplantation mean?

A

Infection or rejection

21
Q

CMV in transplant pts!

A

-Can lead to infection + rejection
-Can be systemic involving eyes, brain, GI tract, blood, lungs
-Encephalopathy
-TX: ganciclovir IV or PO valcyte therapy

22
Q

Are viral infections in TP patients concerning?

A

YES
high incidence in morbidity and mortality > can occur new or reactivation of latent infection
-Herpes is high risk in these pts > test HSV-PCR > can spread to brain, empiric cyclovir

23
Q

Tuberculosis

A

4 drug tx for 1 year:
-IHN
-Rifampin
-Ethanmbutol
-Pyrazinamide

24
Q

What do you treat listeria with?

A

Ampicillin IV

25
Q

Nocardia

A

Tx: high dose PCN
Can spread to brain (MRI) and lungs

26
Q

Should you assess for opportunistic infections in TP pts

A

Yes

27
Q

Aspergillus TX

A

Abelcet
Voriconazole therapy

28
Q

Pseudomonas (Gram -)

A

Zosyn / Cefepime , meropenen

29
Q

How do you tx EBV viremia

A

run IS regimen at lower dose

30
Q

PCP/PJP

A

Bactrim
Inhaled pentamidine - prophylaxis

31
Q

Post Transplant Prophylaxis Meds

A

Azole- fungal
Valcyte- prevent CMV
Bactrim - PJP

32
Q

What is drug of choice for HTN in TP pts?

A

Calcium CB like Norvasc - least likely to interfere with IS meds and decrease renal vascular resistance

33
Q

Tx choice of DM in TP pts?

A

Lantus and aspart
NO PO ANTIHYPERGLYCEMIC AGENTS

34
Q

What can Sirolimus cause?

A

Hyperlipemia

35
Q

Important info on antimetabolites
Cellcept, myfortic

A

Cellcept > n/v/d
associated w/ high risk for skin cancer
stop w/ squamous cell carcinoma

36
Q

Tacro

A

monitor levels
can be nephrotoxic
cyclosporine is good alternative CNI

37
Q

mTOR inhibitors
Sirolimus

A

CHECK LIPID PANEL
usually given for renal protection
Hypersensitive pneumonitis - SOB > STOP DRUG AND STEROID THERAPY
can lead to impaired wound healing

Module 1 - 622 (3 decks)

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