BPS 432 Lecture Notes - Lecture 15: Nephrology, Heart Transplantation, Tacrolimus
6 Feb 2017
School
Department
Course
Professor
Transplant
1. Transplant team
a. Physicians
i. Surgeons, nephrologists, psychiatrist and therapist (need workup – freedom
after dialysis, potent medications), ID (at risk for infection)
b. Nurse
i. Inpt, coordinators for recipient and donor, clinic manager
c. Pharmacist
i. Inpt (daily care rounds)
ii. Transplant clinic
iii. Electronic BP monitoring – CPA with nephrologist and surgeon, can increase BP
drugs
1. Controlling BP helps keep kidney for longer
d. Nutritionist
i. Dietary restrictions
e. Social worker
i. For rec and donor
ii. SW is at dialysis clinic
1. Has’t ee to dialsis reetl – not a good candidate
2. Psychiatrist and therapist use this info
3. Do’t trasplat patiets if the soke – increased risk for malignancy
f. Anciliary staff
i. Clinic secretaries, data coordinator, financial coordinator
ii. Need supplemental insurance
iii. Physically cannot work – that sick – usually an issue, only have Medicaid, or on
disability
1. This does not cover it
iv. Door goes o reipiet’s isurae ut that does’t last log either
1. Surgical complication etc – donor needs insurance
2. Pharmacist Responsibilities
a. DN > HTN as biggest reasons for kidney transplant (10-15 years ago it was opposite)
i. Meds, contrast dye, congenital, toxic dose or overdose causing renal
dysfunction (amg?),
ii. You’ll alread ork ith these people with CVD, HLD, HF, HTN, CVA – need to
know about cardiology
1. Care for pt with CVD
2. Transplant meds increase lipids, HTN – must manage this, control it
before transplant, prednisone and prograf makes blood sugar worse
3. Immunosuppressants → ID
iii. Good PK, Vd knowledge, drugs will change kinetics and renal function
iv. Cumulative toxicity → can only keep kidney for 10 years (nephrosclerosis)
1. Heart transplant pt may have kidney failures
b. Many other comorbid conditions that will affect immunosuppressant drugs
c. Continuous assessment of drug therapy
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Need to make sure that the pt will take good care of their organ. Dialysis by definition cvd, high inflammatory state, risk for plaque rupture, mi/cva risk. Lives alone, no family (need support for meds etc) Sh: alone with cats, cigars, etoh, meals on wheels, difficulty climbing stairs (hf) Hd 2 to 2 failed renal transplants noncompliance with imm. supp. meds. Per social worker only comes to dialysis 1-2 days weekly leaves an hour early. Pmh: htn, esrd, failed kidney transplant x2, obstructive uropathy. Sh: 3-4 (cid:862)(cid:373)arijua(cid:374)a (cid:271)lu(cid:374)ts(cid:863) haha dail(cid:455), se(cid:454)uall(cid:455) a(cid:272)ti(cid:448)e (cid:373)ultiple part(cid:374)ers, li(cid:448)es (cid:449)ith gra(cid:374)d(cid:373)other. 3rd transplant was refused ubt is now ready. Beneficial to accumulate time on the list during workup phase gets you further ahead. Kid(cid:374)e(cid:455)s (cid:374)ot take(cid:374) out (cid:449)he(cid:374) o(cid:374) dial(cid:455)sis (cid:271)e(cid:272)ause the(cid:455) (cid:373)a(cid:455) ha(cid:448)e so(cid:373)e residual a(cid:272)tio(cid:374) that"s helpi(cid:374)g. Acidosis (fixed acid that cannot clear by kidneys) Overload volume (cid:272)a(cid:374)"t (cid:272)li(cid:373)(cid:271) flight of stairs et(cid:272) Uremia some pt have bun of 100-150, k of 4. 9-5.
