Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AHN 554 > Transplant > Flashcards

Transplant Flashcards

1
Q

incidence of transplantation

A

over 120k people waiting for transplant
kidney most sought organ
# of deceased donors stagnant, 8k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

deceased donor transplant

A

brain dead

non-heart beating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

living donor

A

related
unrelated
paired exchange
altruistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

absolute and relative contraindications to receive organs

A 
malignancy 
active infection
active drug/tobacco/illicit drug abuse
noncompliance
HIV/AIDS (relative)
Morbid Obesity (relative)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cell Mediated immunity includes:

A

activated t lymphocytes are triggered by cytokines interleukin 2
cytokines are proteins that induce cell mediated and humoral responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Humoral or antibody immunity

A

production of antibodies from B lymphocytes
B cell recognizes matching antigen and digest it, binds to MHC molecule then attracts matching T cell that helps B cell multiply and form antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are cytokines

A

cytokines are proteins that induce cell mediated and humoral responses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the major histocompatibility complex

A

a group of genetic loci located on the short arm of chromosome 6 that creates the human leukocytes antigen (HLA) which recognize self and nonself
a total of 6 HLA genes are inherited and indentified via tissue typing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is panel reactive antibody?

A

measurement of preformed HLA antibodies

elevated PRA may render a pos. crossmatch and may limit chance of transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a crossmatch

A

final test to eval. the reactivity of donor to recip.
performed on all renal tx recip. b4 surgery
retrospective crossmatching performed on all other tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Allograft rejection?

A

When the recip. immune system realizes graft is nonself

Local and systemic immune responses, may lead to inflammation, deterioration of graft fx and eventual necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hyperacute rejection
Timing
Type of immune response

A

Rare
Occurs within minutes
Humorally mediated
Rapid tissue necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Accelerated acute rejection
Timing
Type of immune response

A

Occurs 1-5 days postop
Cellularly and Humorally mediated
Difficult to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acute rejection
Timing
Type of immune response

A

Occurs within 1st few months but can occure anytime
Cellularly mediated in 90%
Amenable to tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chronic organ rejection
Timing
Type of immune response

A

Cell mediated and humorally initiated injury to the endothelium and vascular sclerosis

Occurs slowly and leads to eventual graft loss

No definitive tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

S and S of rejection

A

Graft tenderness

Dependent on organ being rejected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is immunosuppression

A

The pharmacological manipulation of the immune system performed to prevent or suppress rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is induction therapy administered and what does it consist of

A

Induction therapy is administered before or after transplantation for up to 2 weeks to delay the onset of the 1st rejection episode or to limit the initial quantity of calcineurin inhibitors

Consists of monoclonal or polyclonal antilymphocyte antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does maintenance therapy consist of and how long is it done

A

Maintenance therapy consists typically of a calcineurin inhibitor, a corticosteroid and a antimetabolite
Maintenance therapy must be provided for the life of the allograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What to avoid while taking calcineurin

A

Grapefruit juice can increase plasma drug levels

Meds metabolized via cytochrome P450 enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Hypertension with organ transplant

A

Can be pre existing or calls to by calcineurin inhibitors or corticosteroids

Use calcium channel blocker however single agent therapy is typically not effective

Avoid hypotension with kidney transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Post transplant diabetes mellitus

A

Maybe directly related to corticosteroid use (glycogenesis) and calcineurin inhibitors (decrease insulin resistance)

Associated with higher incidence of graft loss

Must monitor glycemic index closely

23
Q

Renal insufficiency with organ transplant

A

Can be due to nephrotoxicity associated with calcineurin inhibitors

Tx is reducing calcineurin dose, Managing high blood pressure and diabetes and avoiding nephrotoxic meds (NSAIDS, Anti-inflammatory drugs, diuretics, and some antibiotics)

24
Q

Hyperlipidemia with organ transplant

A

Immunosuppressive agents, ESPECIALLY SIROLIMUS, raise lipid levels
Increases chance of cardiovascular disease and chronic aallograft nephropathy

25
Q

Common medications for prophylaxis or rejection

A

Tacrolimus (prograf), cyclosporine, everolomus, sirolimus, azathioprine, mycophenolate, prednisone, solumedrol

26
Q

Common medications for induction therapy

A

Basiliximan, alemtuzumab, antithymocyte globulin (ATG, thymoglobulin), solumedrol

27
Q

Common medications for treatment of rejection

A

Rituximab, iv immunoglobulin (gamunex, carimune), solumedrol, belatacept

28
Q

Side effects of calcineurin inhibitors

A

Tremors, renal dysfunction, high blood sugar, high blood pressure, hirsutism, gingival hyperplasia

29
Q

What meds cause myopathy in cardiac recipients

A

Cyclosporine and hmg-coa

30
Q

Bone dz with organ transplant

A

Osteoporosis is common complication
Need baseline and annual bone scans
Tx: minimal corticosteroid use, supplemental calcium, biphosphates, hormone replacement

31
Q

Malignancy with transplant

A

Increased incidence lymphoma, skin ca and kaposi’s sarcoma

Lymphomas are related to infection with Epstein barr from positive organs

Tx: minimal or cease immunosuppression, give chemo and radiation

Poor prognosis

32
Q

Leading cause of death in transplant

A

Infection

Highest risk 1st 6 months postop

33
Q

Viral infection with transplantation

A

Biggest threats are cytomegalovirus and denoviris

Monitor with antigenemia and PCR

Prophylactically treat with ganciclovir or valganciclovir

34
Q

Fungal infection with transplantation

A

Most common is candida in liver transplant and aspergillus in lung transplant

Prophylaxis with fluconazole or itraconozole

Give Bactrim from pneumocystis

35
Q

Bacterial infection with transplantation

A

Most common type of infection with transplantation

Most common mycobaxterium, tb, pseudomonas, listeria

36
Q

Hyperacute rejection

A

rare
occurs within minutes
humorally mediated
rapid tissue necrosis

37
Q

accelerated acute rejection

A

occurs 1-5 days postop
cellularly and humorally mediated
difficult to treat

38
Q

acute rejection

A

cellularly mediated in 90%
typically occurs within 1st few months but may occur anytime
amenable to tx

39
Q

chronic rejection

A

cell mediated and humorally initiated injury to the endothelium and vascular sclerosis
occurs slowly and leas to evenual graft loss
no definitive tx

40
Q

gold standard for diagnosis of organ rejection

A

biopsy of allograft

alternative tests are organ specific

41
Q

tx for organ rejection

A

high dose corticosteroids, optimizing immunosuppresant regimen and antilymphocytic therapy

42
Q

subjective findings for kidney rejection

A

decreased urine output, chills, arthralgias/myalgias, graft tenderness, may be symptomatic

43
Q

objective findings for kidney rejection

A

elevated BUN and creatinine, increased resistive indices on US

44
Q

Subjective findings for liver rejection

A

fatigue, pruritis, graft tenderness

45
Q

objective findings for liver rejection

A

elevated liver enzymes, bilirubin, dark colored urine, jaundice, ascities

46
Q

subjective findings for lung rejection

A

cough, sob, fatigue

47
Q

objective findings for lung rejection

A

fever, pulmonary effusions and infiltrates, decrease in spirometry, hypoxemia

48
Q

subjective findings for heart rejection

A

fatigue, exercise intolerance, sob

49
Q

objective findings for heart rejection

A

atrial arrhythmias, new s3, friction rub, JVD, edema, pulmonary edema

50
Q

subjective findings for pancreas rejection

A

graft tenderness

51
Q

objective findings for pancreatic rejection

A

elevated amylase and lipase, hyperglycemia (late), elevated creatinine (if kidney/pancreas recipient

52
Q

subjective findings for intestine rejection

A

malaise, abdomen pain, change in stools, nausea, vomiting

53
Q

objective findings for intestine rejection

A

endoscopic eval may reveal edema , erythema, and reduced peristalsis, serum citrulline may be marker for rejection

AHN 554 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions