Dr. COOKE note
Assessment: 1. Status post cardiac transplantation. 2. Chronic diastolic heart failure. 3. Chronic allograft vasculopathy. 4. Hypertension. 5. Acute kidney injury superimposed on chronic kidney disease stage 2. 6. Rhinovirus upper respiratory tract infection. Plan: 1. Hold all nephrotoxic agents including tacrolimus. 2. Hold diuretics. 3. Monitor renal chemistries.
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Neutropenia(<1300, mainly precaution <500): HOLD MMF
Assessment: 1. Status post cardiac transplantation. 2. Chronic diastolic heart failure. 3. Chronic allograft vasculopathy. 4. Hypertension. 5. Acute kidney injury superimposed on chronic kidney disease stage 2. 6. Rhinovirus upper respiratory tract infection. Plan: 1. Hold all nephrotoxic agents including tacrolimus. 2. Hold diuretics. 3. Monitor renal chemistries.
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Neutropenia(<1300, mainly precaution <500): HOLD MMF
(no adjustment by renal hepatic)
AKI: REDUCE Tacrolimus? (nephrotoxicity: lowest of IV or PO)
(no adjustment by WBC count)
===========================BUT CURRENT SET?===
Plan 1. Continue IV antibiotics for now with Zosyn 3,375mg and could transition to Cipro/Flagyl. -alternative Augmentin/Flagyl if supposed to be on po Azithromyin for gastroparesis -would repeat CT scan if symptoms or physical exam findings change 2. Continue IV fluids and repeat BMP this PM. 3. Start liquid diet and progress as tolerated. 4. Continue immunosuppression with Tac 3/4 and MMF 500mg q 12hrs. 5. Hold Losartan and Spironolactone in setting of AKI. Can continue Hydralazine 100mg TID and Doxazosin. 7. Can continue reduced Lantus 53u daily and titrate for hyperglycemia. 8. Reduce Keppra to 750mg po BID. 9. Continue Gabapentin 300mg po BID + 600mg daily.
Obtain level and adjust
Interaction: Flagyl, Tramadol = avoid !!
Plan 1. Continue IV antibiotics for now with Zosyn 3,375mg and could transition to Cipro/Flagyl. -alternative Augmentin/Flagyl if supposed to be on po Azithromyin for gastroparesis -would repeat CT scan if symptoms or physical exam findings change 2. Continue IV fluids and repeat BMP this PM. 3. Start liquid diet and progress as tolerated. 4. Continue immunosuppression with Tac 3/4 and MMF 500mg q 12hrs. 5. Hold Losartan and Spironolactone in setting of AKI. Can continue Hydralazine 100mg TID and Doxazosin. 7. Can continue reduced Lantus 53u daily and titrate for hyperglycemia. 8. Reduce Keppra to 750mg po BID. 9. Continue Gabapentin 300mg po BID + 600mg daily.
Obtain level and adjust
Interaction: Flagyl, Tramadol = avoid !!
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