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AP III > Transplant (4/4) > Flashcards

Transplant (4/4) Flashcards

1
Q

______________ 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

A

heterotopic

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2
Q

with heterotopic heart transplant the ____________ heart pumps to the body and the ____________ heart pumps to the lungs

A

donor; native

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3
Q

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?

A
  1. need for strict sterility
  2. poor donor heart fx post transplant (expect some RV failure)
  3. denervation post-transplant
  4. typically bleed more d/t more suture lines
  5. more frequent atrial loss of conduction
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4
Q

T/F: with heterotopic heart transplant you should expect some degree of RV heart failure postoperatively

A

true

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5
Q

post cardiac transplant complications

A
  1. infection (CMV)
  2. malignacies (lymphomas)
  3. rejection
  4. HTN (d/t cyclosporin A & steroids)
  5. accelerated CAD
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6
Q

risk factors for rejection post cardiac transplant

A
  1. female organ to male recipient
  2. prolonged donor ischemia time
  3. previous rejection
  4. extremes of age
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7
Q

if pt comes in with LVAD for cardiac transplant, what things should you consider?

A
  1. this is def a redo sternotomy - a lot of bleeding
  2. how long has the LVAD been in place? - if long time = even higher bleeding risk
  3. infection risk
  4. pt is on anticoagulants
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8
Q

T/F: heart lung transplant will use double lumen ETT

A

false; single lumen

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9
Q

MOA of cyclosporin A

A

inhibits T cell proliferation and inhibits IL2 expression

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10
Q

s/e of cyclosporin A

A
  1. nephrotoxicity
  2. HTN
  3. gingival hyperplasia
  4. tremors
  5. hepatotoxicity
  6. hypokalemia
  7. hypomag
  8. parathesias
  9. hypertrichosis
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11
Q

MOA of azathioprine (imuran)

A

inhibits DNA synthesis and lymphocyte proliferation

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12
Q

s/e of azathioprine (imuran)

A
  1. leukopenia
  2. thrombocytopenia
  3. anemia
  4. infection
  5. hepatotoxicity
  6. N/V
  7. GI distress
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13
Q

MOA of MMF (cellcept)

A

Inhibits DNA synthesis and lymphocyte proliferation

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14
Q

s/e of MMF (cellcept)

A
  1. GI upset
  2. neutropenia
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15
Q

immunosuppressant MOA of steroids

A
  1. decreases T cell activation
  2. inhibits cytokine production
  3. inhibits leukocyte chemotaxis
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16
Q

s/e with steroids

A
  1. infection
  2. hyperglycemia
  3. htn
  4. osteoporosis
  5. adrenal suppression
  6. myopathies
  7. PUD
  8. hyperlipidema
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17
Q

MOA of tacrolimus

A

inhibits t-cell activation

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18
Q

s/e of tacrolimus

A
  1. nephrotoxicity
  2. anemia
  3. hyperkalemia
  4. hyperglycemia
  5. htn
  6. N > V
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19
Q

MOA of OKT3

A

Opsonizes and lyses T cells

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20
Q

s/e of OKT3

A
  1. fever/chills
  2. htn
  3. bronchospasm
  4. pulmonary edem a
  5. aseptic meningitis
  6. seizures
  7. GI upset
21
Q

MOA of antilymphocyte globulin (ATG)

A

Opsonizes and lyses T cells

22
Q

s/e of antilymphocyte globulin (ATG)

A
  1. anaphylaxis
  2. leukopenia & thrombocytopenia
  3. Hypotension
  4. infection
  5. fever/chills
  6. hepatitis
23
Q

MOA of basilximab (simulect) or daclizumab (zenapax)

A

IL-2 R blocker inhibits IL-2 dependent T cell acivation

24
Q

s/e of Basilximab (simulect) or daclizumab (zenapax)

A
  1. anaphylaxis
  2. abd pain
  3. fever
  4. chills
  5. weakness
  6. sore throat
25
Q

CNS/CV complications of chronic immune suppression

A
  1. lowered seizure threshold
  2. DM
  3. HTN
  4. hyperlipidemia
  5. atherosclerosis
26
Q

renal/electrolyte complications of chronic immune suppression

A
  1. decreased GFR
  2. hyperkalemia
  3. hypomag
27
Q

hematologic/immunologic complications of chronic immune suppression

A
  1. increased risk of infections
  2. increased risk of malignancy
  3. pancytopenia
  4. poor wound healing
  5. osteoporosis
28
Q

with a transplanted heart there is no _______________ innervation of the SA node which leads to ______________& _________

A

parasympathetic; higher than normal HR; no reflex bradycardia

29
Q

in a post-transplanted heart, CO is ____________ dependent

A

SV

30
Q

why may there be a delayed SNS stress response in the post transplanted heart

A

due to the need to activate the adrenal secretion of catecholamines

31
Q

T/F: post transplanted heart typically has normal conduction

A

true

32
Q

preop evaluation of the post-transplanted heart when they come in for another procedure

A
  1. evaluate for signs of rejection/co-morbid conditions
  2. EKG
  3. labs based on pt and procedure
  4. risk of infection 2/2 immunosuppressants
  5. general or regional
  6. evaluate need for transfusion/irradiated blood
  7. monitoring considerations
  8. cardiology consult
33
Q

the post transplanted heart only responds to _____________ acting catecholamines

A

direct

34
Q

what is a normal resting HR for post transplanted heart pt

A

90-110

35
Q

effect of anticholinergics (atropine & glycopyrolate) in:
non-transplanted heart _______
transplanted heart ___________

A

non-transplanted heart: increase HR

transplanted heart: no effect

36
Q

indirect sympathomimetics (ephedrine) in non-transplanted heart pt vs tranplanted pt

A
  1. non transplant = increase HR
  2. transplanted = no effect
37
Q

effect of digoxin in transplanted heart

A

+ inotrope but no HR effect (normally decreases HR)

38
Q

effect of B-agonists (epi, norepi, isopro) in transplanted heart pt

A

exaggerated effects of: increased HR and + inotropy

39
Q

BB effect in transplanted heart pt

A

exaggerated effects of decreased HR and inotropy esp with exertion

40
Q

effect of adenosine in transplanted heart pt

A

exaggerated decrease in HR

41
Q

T/F: you will have reflex bradycardia with phenylephrine in the post-transplanted heart pt

A

false

42
Q

transplanted heart pt: dopamine effects on HR and blood pressure

A

increase HR and BP

43
Q

transplanted heart pt ephedrine effect on HR and BP

A

no effect/increase HR and BP

44
Q

fentanyl effect on HR and BP in transplanted heart pt

A

no effect

45
Q

norepinephrine effect on HR and blood pressure in the transplanted heart pt

A

increase

46
Q

phenylephrine effect of HR and BP in the post-transplanted heart pt

A

no effect on HR and increase in BP

47
Q

________________ is a form of CAD only seen in post transplanted heart patients d/t intimal thickening of coronary vessels

A

coronary allograft vasculopathy

48
Q
A

AP III (20 decks)

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