Special considerations/Current conditions Flashcards
(43 cards)
Infection risk is increased, due to…
Suppression of the immune system
Risk of infection is related to…
Overall level of immunosuppression
Greater in three months post transplant, and after treatment for acute rejection
Infections related to transplant/immunosuppressed individuals need to be…
Treated aggressively - any signs/symptoms should be promptly reported and investigated
Due to immunosuppression, ____ is required for…
Prophylaxis - common opportunistic pathogens
The most common opportunistic infection post transplant is…
Cytomegalovirus (CMV)
CMV risk is dependent on ____.
Donor/recipient serology
D+R- > D+R+ > D-R-
CMV infection may present as…
Viremia (flu-like sx’s, decrease in WBC, platelets)
Enteritis, pneumonitis, hepatitis, retinitis
Prophylaxis for CMV is usually with…
Valganciclovir
Depends on risk level (serology) - this would also be used for treatment
Pneumocystis Jiroveci Pneumonia (PJP) is common in immunosuppression, therefore prophylaxis is…
Co-trimoxazole - various dosing regimens
Herpes with immunocompromised patients…
May experience reactivation
Epstein-Barr virus is a major cause of…
Post transplant hypoproliferative disorder
Prophylaxis/monitoring for Epstein-barr is done…
When?
Based on serology - commonly done for D+R-
Primarily for children - exposure likely already taken place in adults
Polyoma BK virus is associated with…
Nephropathy, graft lost in kidney transplants
Higher levels of immunosuppression
Other noteworthy infections that may be more common in transplant patients include…
Flu, Covid
Fungal infection
Malignancy rates are ____ in transplant patients - most common types include…
Increased; most commonly present as skin, cervical, anorectal, lymphoma
PTLD
Post-transplant lymphoproliferative disorder (PTLD) may present as…
Has a varied clinical presentation - may be nodal/extrandoal, localized in allograft or disseminated, or may be indistinguishable from other lymphomas
If a patient presents with PTLD, we should…
Decrease immunosuppresion
Consider rituximab
Osteoporosis/osteopenia treatment includes…
Getting regular bone density testing
Optimizing Vitamin D + Calcium
Targeting treatment with bisphosphonates for high risk patients
These medications can help minimize GI side effects…
H2RA or PPI for dyspepsia/GI AE’s - PPI prophylaxis is routine in many centers
If a patient is experiencing GI AE’s, we should consider drug causes, including…
Immunosuppressive therapies: Mycophenolate > Tacrolimus > Cyclosporine
Sirolimus - mouth ulcers
Steroids - GI upset, ulcerogenic
Consider antibiotics, antihyperglycemics, certain supplements, etc.
These immunosuppressive drugs may cause hyperlipidemia…
Sirolimus > Cyclosporine - Tacrolimus
1st line medications for hyperlipidemia for transplant are ____, however…
Statins - however, increased risk for myopathy/rhabdomyolysis
Treating hyperlipidemia often introduces drug interactions such as….
Increased statin levels (start at 1/2, titrate)
Cholestyramine will adversely affect absorption of mycophenolate + cyclosporine
Ezetimibe + CNI will increase level of both drugs, caution
Optimal BP for transplant patients…
Is unknown - extract from general population and treat as a high-risk patient (?130/80)
Often, a lower target is better than a higher target
