Transplant (4/4) Flashcards
______________ heart transplant the donor heart is connected to the native heart; parallel circulation is established, and the native heart pumps blood to the lungs while the donor heart pumps to the body
heterotopic
with heterotopic heart transplant the ____________ heart pumps to the body and the ____________ heart pumps to the lungs
donor; native
heterotopic heart transplants are treated very similarly to orthotopic; but what are some additional considerations you should have for the pt who recieved a heterotropic heart transplant?
- need for strict sterility
- poor donor heart fx post transplant (expect some RV failure)
- denervation post-transplant
- typically bleed more d/t more suture lines
- more frequent atrial loss of conduction
T/F: with heterotopic heart transplant you should expect some degree of RV heart failure postoperatively
true
post cardiac transplant complications
- infection (CMV)
- malignacies (lymphomas)
- rejection
- HTN (d/t cyclosporin A & steroids)
- accelerated CAD
risk factors for rejection post cardiac transplant
- female organ to male recipient
- prolonged donor ischemia time
- previous rejection
- extremes of age
if pt comes in with LVAD for cardiac transplant, what things should you consider?
- this is def a redo sternotomy - a lot of bleeding
- how long has the LVAD been in place? - if long time = even higher bleeding risk
- infection risk
- pt is on anticoagulants
T/F: heart lung transplant will use double lumen ETT
false; single lumen
MOA of cyclosporin A
inhibits T cell proliferation and inhibits IL2 expression
s/e of cyclosporin A
- nephrotoxicity
- HTN
- gingival hyperplasia
- tremors
- hepatotoxicity
- hypokalemia
- hypomag
- parathesias
- hypertrichosis
MOA of azathioprine (imuran)
inhibits DNA synthesis and lymphocyte proliferation
s/e of azathioprine (imuran)
- leukopenia
- thrombocytopenia
- anemia
- infection
- hepatotoxicity
- N/V
- GI distress
MOA of MMF (cellcept)
Inhibits DNA synthesis and lymphocyte proliferation
s/e of MMF (cellcept)
- GI upset
- neutropenia
immunosuppressant MOA of steroids
- decreases T cell activation
- inhibits cytokine production
- inhibits leukocyte chemotaxis
s/e with steroids
- infection
- hyperglycemia
- htn
- osteoporosis
- adrenal suppression
- myopathies
- PUD
- hyperlipidema
MOA of tacrolimus
inhibits t-cell activation
s/e of tacrolimus
- nephrotoxicity
- anemia
- hyperkalemia
- hyperglycemia
- htn
- N > V
MOA of OKT3
Opsonizes and lyses T cells
s/e of OKT3
- fever/chills
- htn
- bronchospasm
- pulmonary edem a
- aseptic meningitis
- seizures
- GI upset
MOA of antilymphocyte globulin (ATG)
Opsonizes and lyses T cells
s/e of antilymphocyte globulin (ATG)
- anaphylaxis
- leukopenia & thrombocytopenia
- Hypotension
- infection
- fever/chills
- hepatitis
MOA of basilximab (simulect) or daclizumab (zenapax)
IL-2 R blocker inhibits IL-2 dependent T cell acivation
s/e of Basilximab (simulect) or daclizumab (zenapax)
- anaphylaxis
- abd pain
- fever
- chills
- weakness
- sore throat
CNS/CV complications of chronic immune suppression
- lowered seizure threshold
- DM
- HTN
- hyperlipidemia
- atherosclerosis
renal/electrolyte complications of chronic immune suppression
- decreased GFR
- hyperkalemia
- hypomag
hematologic/immunologic complications of chronic immune suppression
- increased risk of infections
- increased risk of malignancy
- pancytopenia
- poor wound healing
- osteoporosis
with a transplanted heart there is no _______________ innervation of the SA node which leads to ______________& _________
parasympathetic; higher than normal HR; no reflex bradycardia
in a post-transplanted heart, CO is ____________ dependent
SV
why may there be a delayed SNS stress response in the post transplanted heart
due to the need to activate the adrenal secretion of catecholamines
T/F: post transplanted heart typically has normal conduction
true
preop evaluation of the post-transplanted heart when they come in for another procedure
- evaluate for signs of rejection/co-morbid conditions
- EKG
- labs based on pt and procedure
- risk of infection 2/2 immunosuppressants
- general or regional
- evaluate need for transfusion/irradiated blood
- monitoring considerations
- cardiology consult
the post transplanted heart only responds to _____________ acting catecholamines
direct
what is a normal resting HR for post transplanted heart pt
90-110
effect of anticholinergics (atropine & glycopyrolate) in:
non-transplanted heart _______
transplanted heart ___________
non-transplanted heart: increase HR
transplanted heart: no effect
indirect sympathomimetics (ephedrine) in non-transplanted heart pt vs tranplanted pt
- non transplant = increase HR
- transplanted = no effect
effect of digoxin in transplanted heart
+ inotrope but no HR effect (normally decreases HR)
effect of B-agonists (epi, norepi, isopro) in transplanted heart pt
exaggerated effects of: increased HR and + inotropy
BB effect in transplanted heart pt
exaggerated effects of decreased HR and inotropy esp with exertion
effect of adenosine in transplanted heart pt
exaggerated decrease in HR
T/F: you will have reflex bradycardia with phenylephrine in the post-transplanted heart pt
false
transplanted heart pt: dopamine effects on HR and blood pressure
increase HR and BP
transplanted heart pt ephedrine effect on HR and BP
no effect/increase HR and BP
fentanyl effect on HR and BP in transplanted heart pt
no effect
norepinephrine effect on HR and blood pressure in the transplanted heart pt
increase
phenylephrine effect of HR and BP in the post-transplanted heart pt
no effect on HR and increase in BP
________________ is a form of CAD only seen in post transplanted heart patients d/t intimal thickening of coronary vessels
coronary allograft vasculopathy
