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
|
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 |
|
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 |
|
Definition
| immunosuppressants (corticostreoids *Na retention, CNI * periph vasoconstriction, delayed graft function, persistent kidney dysfunction, Chronic allograph nephropathy |
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|
Term
|
Definition
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|
Term
|
Definition
| inhibit CYP3A4, increasing CNI levels |
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|
Term
|
Definition
| reduces expression of profibrotic transforming growth factor B1 in patients with CAN |
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|
Term
|
Definition
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|
Term
|
Definition
| beneficial in men with BPH |
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|
Term
|
Definition
| BB first line, A1 (men with BPH), Diuretics, ACE are ok, CCB's AVOID with CNI's |
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|
Term
|
Definition
| one of the strongest risk factors for CV dx in kidney transplant recipient |
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|
Term
|
Definition
| new onset diabetes after transplant (first 3 mos after transplant) |
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|
Term
| drug-induced diabetes: corticosteroids |
|
Definition
| insulin resistance, gluconeogenesis |
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|
Term
| drug-induced diabetes: Calcineurin inhibitors |
|
Definition
| decreased insulin synthesis, release and sensitivity, islet cell toxicity (Tac> CSA, greater islet cell tox) |
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|
Term
|
Definition
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|
Term
| conventional med regimen for diabetes |
|
Definition
| sulfonylureas (1st line, glipizide), metformin, insulin and others |
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|
Term
|
Definition
| reduce immunosuppression and steroid withdrawal |
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|
Term
| dyslipidemia treatment goals |
|
Definition
| LDL <100, TiGl <500, HDL> 40, non-HDL <130 |
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|
Term
|
Definition
| HMG CoA reductase inhibitors, Ezetimibe, others |
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|
Term
| increased statin and ezetimibe levels |
|
Definition
| when taken with CNI (especially CsA) |
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|
Term
|
Definition
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|
Term
| drug induced osteoporosis; corticosteroids |
|
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) |
|
Definition
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|
Term
| monitoring for osteoposis |
|
Definition
| DEXA (baseline then 1-2 yrs post transplant),electrolytes and PTH |
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|
Term
| treatment of osteoporosis |
|
Definition
| Ca+vitD (1000-1500/800-2000IU daily), lifestyle (exercise, physical therapy), bisphosphonates |
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|
Term
|
Definition
| common in chronis kidney Dx (28% of transplant recipients) |
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|
Term
|
Definition
| obesity/ WT gain, HTN, Diuretics, cyclosporine |
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|
Term
|
Definition
| may impair excretion of uric acid |
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|
Term
|
Definition
| NSAIDs (avoided due to reduced kidney function), Colchicine *USE CAUTION, corticosteroids, allopurinol |
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|
Term
|
Definition
| CNI's can inhibit colchicine metabolism |
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|
Term
|
Definition
| interacts with azathioprine increasing AZA bioavailability |
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|
Term
|
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 |
|
Definition
| for 1-6 months after transplant |
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|
Term
| prophylaxis for opportunistic bugs |
|
Definition
| may require acute reduction of immunosuppression |
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|
Term
|
Definition
| most common witin the first month post-transplant; pneumonia, wound/ surgical site, UTI, Catheters |
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|
Term
|
Definition
| septra SS 1 tab daily for 6 months, or cipro if allergic |
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|
Term
|
Definition
| most common within 2-6 months after transplant; CMV, BK virus, JC virus, EBC, herpes |
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|
Term
|
Definition
| most important virus in transplant pop; chronic rejection, allograft vasculopathy, 50-60% seropositive prior to transplant, lifelong latency |
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|
Term
|
Definition
| valcyte 450-900 mg daily X 6 months, or acyclovir 800 mg for 6 months |
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|
Term
|
Definition
| high dose valganciclovir 900 mg BID, IV ganciclovir OR cytomegalovirus IV immune globulin (Cytogam) |
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|
Term
|
Definition
| nephropathy, transplant dysfuction and graft loss, decrease immunosuppression, USE: leflunomide, cidofovir, IVIF, quinolones |
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|
Term
|
Definition
| progressive myltifocal leukoencephalopathy (demyelinating neurologic illness) |
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Term
|
Definition
| post-transplant lymphoprolipherative disease (PTLD) |
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|
Term
| herpes simplex, Herpes Zoster |
|
Definition
| typically due to reactivation of latent virus (acylovir, valacyclovir) |
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Term
|
Definition
| oral thrush and pneumocystis jiroveci pneumonia (PCP) |
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|
Term
|
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) |
|
Definition
| inhibits CYP3A4 and increases CNI |
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|
Term
| Pneumocystis jiroveci pneumonia |
|
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 |
|
Definition
| to stay up to date with routine immunizations, no live vaccines after tansplant (Zostavax) |
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|
Term
|
Definition
| 3-4 times greater than general population, risk related to intensity of immunosuppression |
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|
Term
| skin cancer (nonmelanoma) |
|
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) |
|
Definition
| reduce immunosuppression, Rituxan and chemo |
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|
Term
|
Definition
| suspected to have antitumor and antiangiogenesis properties... |
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|
Term
| mycophenolate mofetil (MMF) drug interaction |
|
Definition
| absorption: antacids, cholestyramine |
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|
Term
| azathioprine drug interaction |
|
Definition
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