CaseNum213PtNameHeidiMaryamAddress2202SWSamJacksonAge59Height6'0"Weight198lbSexFRaceWhiteAllergiesNKDASectionNameOrganTransplantationCaseNameCardiacTransplantationChiefComplaintOrthotopichearttransplantationHxPresIllnessHMisa59-year-oldCaucasianfemalewithahistoryofviralcardiomyopathydiagnosedapproximatelyin1999.Shehashadprogressiveheartfailureoverthepast2yearswithshortnessofbreath,edema,andseverelimitationofactivityandiscurrentlymaintainedondobutamineandnitroprusside.Attemptstoweanoffofherinotropicsupportwereunsuccessful.Patientwaslistedandconsideredforhearttransplantation3weeksago.Pastmedicalhistoryissignificantforseveredepression,gout,andherpeszoster.Afterfindingasuitabledonor,patientunderwenthearttransplantationforviralcardiomyopathy.PastMedicalHxUnstableanginaStatuspostcerebrovascularaccidentAnemiaDepressionIngrownrightfirsttoenailGoutHerpeszosterVentriculararrhythmiaSocialHxSmokingfor20years
Noillicitdruguse
MarriedwithfivechildrenFamilyHxHermotherandfatherarealive,andshehasnofamilyhistoryofviralcardiomyopathyorMI.ReviewOfSystemsThepatientdeniesanyfever,chills,backpain,dizziness,weakness,chestpain,shortnessofbreath,orrash.Shedoeshavefatigue.Nosymptomsofgastroesophagealreflux,dysphagia,odynophagia,lowerextremityedema,orgastrointestinalbleeding.Shedoeshaveoccasionallowerextremityparesthesias.Noabdominalbloatingor1cramping.Theremainderofherreviewofsystemsisnoncontributory.PhysicalExamA59-year-oldfemaleinnoacutedistress.Vitalsignsarestable.Bloodpressure158/79mmHg,heartrate93,respiratoryrate20,temperature37.1.Oxygensaturationatroomairis98%.Postoperativehearttransplantday2CHEST:RespirationsareevenandunlaboredLUNGS:Cleartoauscultation.Noaccessorymuscleusenoted.Noretractionsnoted.CARDIAC:S1,S2,irregularrateandrhythmirregular,rubsandsignificantgallopsGI:Bowelsoundsarepresent.Nomassesororganomegalynoted.EXTREMITIES:Thereisnotedlowerextremitypittingedemabilaterally,whichthepatientstatesishernorm.Dorsalispedispulses2+bilaterally.NEUROLOGIC:Withoutasterixis.Shehasnofocalneurologicaldeficits.LabsAndDxTestsSodium141mEq/LPotassium4.1mEq/LChloride102mEq/LCO224mEq/LGlucose99mg/LAlbumin3.7g/LHCT41%Hemoglobin10.6g/dLDiagnosisHearttransplantationRxRecordDate6/16/16/18/105/25/26/110/110/1RxNoD245536D455537D244538D246539D246555D246555D346876D368654D468762Physician@@@@@@@@@DrugandStrengthCellceptCyclosporine100mgPrednisone5mgPrevacid30mgZocor40mgCapoten12.5mgZenapax1mg/kgTacrolimus1mgMycelexQuantity1003005006030100@400140Sig1gpobid2pobid2poqam1pobid1poqd1pobidq14daysforatotalof5doses2mgpobid10mgpoqidRefills323166063RPhNotesNoneavailableCaseNum213QuestNum21212QuestionWhichtwoagentsactbyinhibitingtheenzymecalcineurin,whichisneededforT-cellactivation?AnswerChoiceADaclizumabandbasiliximabAnswerChoiceBTacrolimusandmycophenolatemofetilAnswerChoiceCCyclosporineandmycophenolatemofetilAnswerChoiceDTacrolimusandcyclosporineAnswerChoiceECyclosporineandazathioprineCorrectAnswerDExplanationBothcyclosporineandtacrolimusinhibitTlymphocyteproliferationbyinhibitingcalcineurin.CyclosporineinhibitscalcineurinbybindingtocyclophilinreceptorswhiletacrolimusinhibitscalcineurinbybindingtoFKPB-12.CompetencyStmt1.2.2K-TypeCaseNum213QuestNum2122QuestionCyclosporinetroughconcentrationsshouldbemonitoredfor:
I.efficacy.
II.toxicity.
III.compliance.AnswerChoiceAIonlyAnswerChoiceBIIIonlyAnswerChoiceCIandI...
