BPS 432 Lecture Notes - Lecture 15: Nephrology, Heart Transplantation, Tacrolimus

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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 dialsis reetl – not a good candidate
2. Psychiatrist and therapist use this info
3. Do’t trasplat patiets if the soke – 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. Door goes o reipiet’s isurae ut that does’t last log 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
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