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Long Term Management of Transplant Populations
Therapeutics of Special Populations Exam 2
59
Pharmacology
Professional
03/31/2014

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Cards

Term
long term immunosuppression
Definition
individualized, weight benefit vs. risk
Term
too much immunosuppression
Definition
Cardiovascular disease, metabolic abnormalities, bone dx, opportunistic infection, malignancy, nephrotoxicity
Term
not enough immunosuppression
Definition
graft regection
Term
calcineurin inhibitors (CNI)
Definition
tacrolimus (Prograf), cyclosporin
Term
antiprolifratives
Definition
mycophenolate mofetil (Cellcept), mycophenolate sodium (Myfortic), azothiaprine
Term
mTOR inhibitors
Definition
sirolimus (Rapamune)
Term
pre-transplant risk factors of HTN
Definition
pre-existing HTN, renal artery stenosis, kidney dysfunction, non-compliance, race (African American, hispanic)
Term
post-transplant risk factors of HTN
Definition
immunosuppressants (corticostreoids *Na retention, CNI * periph vasoconstriction, delayed graft function, persistent kidney dysfunction, Chronic allograph nephropathy
Term
Target goal for HTN
Definition
130/80
Term
dilt and verap
Definition
inhibit CYP3A4, increasing CNI levels
Term
ACE inhibitors
Definition
reduces expression of profibrotic transforming growth factor B1 in patients with CAN
Term
hold ACE if
Definition
SCr > 30%
Term
alpha-1 antagonists
Definition
beneficial in men with BPH
Term
HTN treatment:
Definition
BB first line, A1 (men with BPH), Diuretics, ACE are ok, CCB's AVOID with CNI's
Term
Diabetes
Definition
one of the strongest risk factors for CV dx in kidney transplant recipient
Term
NODAT
Definition
new onset diabetes after transplant (first 3 mos after transplant)
Term
drug-induced diabetes: corticosteroids
Definition
insulin resistance, gluconeogenesis
Term
drug-induced diabetes: Calcineurin inhibitors
Definition
decreased insulin synthesis, release and sensitivity, islet cell toxicity (Tac> CSA, greater islet cell tox)
Term
treatment goal for HbA1c
Definition
7-7.5
Term
conventional med regimen for diabetes
Definition
sulfonylureas (1st line, glipizide), metformin, insulin and others
Term
diabetes treament
Definition
reduce immunosuppression and steroid withdrawal
Term
dyslipidemia treatment goals
Definition
LDL <100, TiGl <500, HDL> 40, non-HDL <130
Term
dyslipidemia med regimen
Definition
HMG CoA reductase inhibitors, Ezetimibe, others
Term
increased statin and ezetimibe levels
Definition
when taken with CNI (especially CsA)
Term
pravastatin
Definition
lest drug interactions
Term
drug induced osteoporosis; corticosteroids
Definition
decreased absorption of Ca and phosphate, increased urinary exretion of Ca, and inhibition of osteoblasts
Term
drug-induced osteoporosis: calcineurin inhibitos (CsA > Tac)
Definition
high turnover osteopathy
Term
monitoring for osteoposis
Definition
DEXA (baseline then 1-2 yrs post transplant),electrolytes and PTH
Term
treatment of osteoporosis
Definition
Ca+vitD (1000-1500/800-2000IU daily), lifestyle (exercise, physical therapy), bisphosphonates
Term
GOut
Definition
common in chronis kidney Dx (28% of transplant recipients)
Term
risk factors for GOUT
Definition
obesity/ WT gain, HTN, Diuretics, cyclosporine
Term
cyclosporine
Definition
may impair excretion of uric acid
Term
treatment of GOUT
Definition
NSAIDs (avoided due to reduced kidney function), Colchicine *USE CAUTION, corticosteroids, allopurinol
Term
colchicine
Definition
CNI's can inhibit colchicine metabolism
Term
allopurinol
Definition
interacts with azathioprine increasing AZA bioavailability
Term
opportunistic infections
Definition
risk is greatest within first 6 mos and after treating an episode of acute rejections
Term
prophylaxis for bacterial, viral and fungal infections
Definition
for 1-6 months after transplant
Term
prophylaxis for opportunistic bugs
Definition
may require acute reduction of immunosuppression
Term
bacterial infections
Definition
most common witin the first month post-transplant; pneumonia, wound/ surgical site, UTI, Catheters
Term
bacterial prophylaxis
Definition
septra SS 1 tab daily for 6 months, or cipro if allergic
Term
viral infections
Definition
most common within 2-6 months after transplant; CMV, BK virus, JC virus, EBC, herpes
Term
Cytomegalovirus
Definition
most important virus in transplant pop; chronic rejection, allograft vasculopathy, 50-60% seropositive prior to transplant, lifelong latency
Term
CMV prevention
Definition
valcyte 450-900 mg daily X 6 months, or acyclovir 800 mg for 6 months
Term
CMV treatment
Definition
high dose valganciclovir 900 mg BID, IV ganciclovir OR cytomegalovirus IV immune globulin (Cytogam)
Term
BK virus causes
Definition
nephropathy, transplant dysfuction and graft loss, decrease immunosuppression, USE: leflunomide, cidofovir, IVIF, quinolones
Term
JC virus causes
Definition
progressive myltifocal leukoencephalopathy (demyelinating neurologic illness)
Term
epstein barr virus
Definition
post-transplant lymphoprolipherative disease (PTLD)
Term
herpes simplex, Herpes Zoster
Definition
typically due to reactivation of latent virus (acylovir, valacyclovir)
Term
fungal infections
Definition
oral thrush and pneumocystis jiroveci pneumonia (PCP)
Term
oral thrush
Definition
after induction therapy, prophylax with clotrimazole troche after meals and before bedtime 1-3 months or nystatic suspesion
Term
Azole antifungal (clotrimazole)
Definition
inhibits CYP3A4 and increases CNI
Term
Pneumocystis jiroveci pneumonia
Definition
occurs within 2-6 month of transplant, prophylax with TMP/SMX SS daily for 6 months
Term
important for patients and household contacts
Definition
to stay up to date with routine immunizations, no live vaccines after tansplant (Zostavax)
Term
cancer risk
Definition
3-4 times greater than general population, risk related to intensity of immunosuppression
Term
skin cancer (nonmelanoma)
Definition
most common is squamous cell carcinoma, basal cell carcinoma, kaposi's sarcoma, USE DAILY SUNSCREEN!
Term
Post transplant lymphoproliferative disease (PTLD)
Definition
reduce immunosuppression, Rituxan and chemo
Term
sirolumus
Definition
suspected to have antitumor and antiangiogenesis properties...
Term
mycophenolate mofetil (MMF) drug interaction
Definition
absorption: antacids, cholestyramine
Term
azathioprine drug interaction
Definition
allopurinol
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