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
