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