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Liver Transplant Education – Medications

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Today we’re going to be reviewing some of the major medicines that you’ll be taking in life after transplant as part of our transplant team when we include our patients as part of our team we’re going to ask that you always keep an updated list of your medicines with you we also want you to take your medications as directed and try not to skip around or missed doses

Of your medicines we understand that life happens and that you may miss some doses of your medicines please try to take your medications as soon as you do remember to take it however if it is closer to the time of the next dose please skip that dose or else contact your coordinator or your your team to be directed if you do vomit as you take your medicines please

Contact your coordinator or the pharmacist and we’ll help direct you about what to do please report any side-effects that you may be having with the medication so we can help coordinate with our team to figure out what you would best serve you with these side-effects please keep your medications in the original containers as dispensed from the pharmacy however if

You do use pillbox and we do like it when our patients use pillbox it’s okay to store your medicines in the pillbox as you take them for the week as with all medications please keep them out of reach of children and animals please store your medicines in a cool dry place so that way they can stay intact and safe with regards to over-the-counter medicines please

Contact your transplant team before you do take any of these medicines there are multiple drug interactions with over-the-counter meds and so to just err on the side of safety we ask that you check with us before you take these medicines please do not take herbal supplements they have not been well studied with regards to their drug interactions so as a general

Statement to our transplant patients we do ask that you avoid the use of herbals and life after transplant not taking your medications properly is one of the major reasons for transplant failures we ask that our patients be as compliant and as precise as they can with their medications in life after transplant we’re now going to discuss some of the anti-rejection

Medicines or immunosuppressants that you may be taking after transplant the first one that we’re going to talk about is called pro graph the generic name for paragraph is tacrolimus i make a point of telling you the generic because most likely after you go home from transplant you will be taking the generics we are okay with the use of generic medications for

Immunosuppressive therapies we do ask though that whatever pharmacy it is that you’re getting your anti-rejection medicines from that they give you the same type of generic on your immunosuppressive each time they can be very small differences between the way one company makes it versus another company so to avoid those differences we do ask that your pharmacy

Dispenses the same type of generic on the medicines now your program is so important to us that every time you come to clinic we’re going to draw your blood 1 we want to see how it is that your liver is doing but 2 we also want to measure how much paragraph is in your body based upon that drug level the dose of the program does change up quite frequently some of

The major side effects that you may experience with program or lian is that it may cause headaches and hand tremors this does not happen to every single transplant patient but if you were to notice that you were getting daily headaches or your hands were a little bit shaky i would probably blame it on the pro graph now as your body gets used in the medicine much

Of the time the headaches and hand tremors will disappear however for a small group of patients the headaches and tremors can persist and even worsen so if you find that this is happening please let us know it could be a sign that your program has gotten higher than what it needs to be or you may be one of our patients who’s a bit sensitive to the medicine in

Which case we may have to change you over to something else another immunosuppressive therapy that you could be on is called celsa the generic for cell sept is michael finley moffitt ill now usually when you go home we write for the 250 milligrams capsule and depending upon what’s going on with your liver and what’s going on with your other medicines you could

Be taking anywhere between 500 to a thousand milligrams of cells up twice a day now unlike the program the dose of the cell sub c is pretty standard we only really start to change the dose around if you’d like if you start to have some side-effects from it some of the major side effects that i like for our patients to know about with cell such that it may cause

Nausea vomiting and diarrhea so if you find that you are so ill or so nauseated that’s hard for you to keep down food fluids or your medicines please contact us or if you’re having multiple loose bowel movements today you know talking five-six-seven least five minutes today again that’s a reason to contact the transplant team these type of stomach issues could be

Related to the use of cells up or you may have picked up a stomach virus or some other illness in which case the transplant team would have to explore why it was that you weren’t feeling well another anti-rejection medicine that you’ll be taking after transplant is called prednisone for our liver transplant recipients you will actually not be on prednisone forever

Most of our patients are on a prednisone taper which could last anywhere between one to three months after transplant with the high doses of prednisone that we give you in the hospital there may be some side effects which you could experience including night sweats irritability and some odd dreams now these types of side-effects should dissipate as we come down

On the prednisone dose now you may have heard that prednisone may cause issues like weight gain weak bones cataracts and so on but generally with our liver transplants we don’t see these types of side effects because you are on prednisone for a relatively short amount of time if you are not tolerating things like the program cell septum prednisone well there

Are alternative immunosuppressive therapies called neural or wrapping in which we may place you on the first one is called new oral and like the program it has a generic the generic brain url is called cyclosporine similar to the program how much new oral it is that we give you really depends upon how much is in your body so again every time you come to clinic

We’re going to draw your blood to see how your liver is doing but also to check the amount of cyclosporine that it is in your body some of the side effects that you may have with new oral is that it may cause some increases in your blood pressure and may cause some elevations and cholesterol and for some patients it may cause gum bleeding another main suppressive

Agent which you could be on is called wrapping in or sirolimus wrap immune can be used in place of or together with progra similar to the url in the program that we talked about your rapid mean dose is really going to be level dependent now unlike those two other medicines wrap amin is generally given just once a day some of the side effects that wrapping mean may

Causes that may cause an elevation in your cholesterol especially your triglycerides it may cause some decreases in your blood counts such as anemia and it may cause some mouth ulcers or rashes again like all the other anti-rejection medicines we’ll be monitoring you carefully to make sure that you are not having these side-effects these interjection medicines are

Very good at doing what it is that we intend for them to do which is a decrease your risk of rejection the downside about being on these types of therapies though is now your immune system is much weaker than what it was before so the next group of medicines are what i call our prevention medicines we’re going to try to prevent you from getting some of the common

Illnesses that transplant patients can be vulnerable to the first one that we’re going to discuss is called bactrim now bactrim is an antibiotic that has been around for many many years we use it for lots of different reasons but for you we are using it to help prevent a certain type of pneumonia called pcp pcp is an organism that we find in our environment we

Breathe it in we breathe it out but for a transplant patient the fear to get that into your lungs cause a very serious lung infection so we’re going to use the bathroom to try to prevent that bug from getting into your lungs generally we have our liver transplant patients take the bat room until they’re three months transplant anniversary you don’t have to memorize

That stop date will help remind you about when it’s time to stop the bactrim some of the side effects that you may experience with bactrim is that it may cause rashes and sun sensitivity and by sun sensitivity i just mean it’s going to be very easy for you to get sunburns while you’re taking this medicine so while you’re on the bathroom we do recommend that our

Patients wear a hat and some sunscreen if they’re going to be outside for an extended time period now if you do have been have an allergy to sulfa type medicines there are there are alternatives that we can use in place of the bactrim another prevention medicine that you could be taking after transplant is called val site val site is to help prevent a certain type

Of virus called cmv or cytomegalovirus now by the time most of us are adults we’ve already been exposed to cmv and once we’ve been exposed to cmv the virus stays sleeping or latent in our body for our transplant patients though sometimes with all the anti-rejection medicines that we give you it gives that virus a chance to wake up and cause an active infection

So what we’re going to try to do with the val site is we’re going to try to keep that virus in its sleeping form now depending upon whether or not you’ve ever been exposed to cmv the course of your val site therapy be anywhere between three to six months after transplant will help let you know at the time a transplant at the time of discharge how long it is that

You’ll be on the valve site some of the side effects that you may experience with bowel site is that it may cause some decreases in your blood counts you may not necessarily feel this but we’ll watch your laboratory work for it very carefully to make sure that this is not happening now another prevention medicine that you’ll be taking after transplant is called my

Statin we have you and my stand to help prevent thrush infections thrush is a yeast infection that can occur in your mouth and it’s related to the use of high-dose prednisone when you’re immediately post transplant it’s anticipated that by the time you go home after transplant your prentice own dose will be low enough that you’re the risk of developing thrush will

Be quite low hence you probably will not be sent to him on my stun instead it’s just a medicine that you’ll be using here in the hospital nexium is a medicine that you’ll be taking to help prevent stomach ulcers or to reduce the acid that your stomach makes we think that this is particularly important in life after transplant because some of the other medicines

Like the cell sept and prenez own can be very irritating to your stomach when you go home it could be on nexium or it could be on one of its other cousins in this class including protonix prevacid effects of members all they all do the same thing which is to reduce the acid that your stomach makes now if you don’t have a history of heartburn or reflux we’re usually

Able to stop this medicine within one to two months after transplant or so portait is a medicine that you’ll be taking after transplant to help thin down the ball that the liver makes now you may read somewhere that it’s to help prevent gall stones and wonder why it is that you’re taking it because we usually remove the gall bladder at the time of transplant we’re

Actually not using it to help prevent gall stones again it’s just to help then down the ball that the liver makes so it flows easily out of the liver and doesn’t cause a lot of congestion your usual dose of the earth so forte will usually be 500 milligrams twice a day similar to some of the other prevention medicines this is not a forever medicine as long as your

Bilirubin levels are normal within one to three months after transplant we’re usually able to stop this mess at that time the baby aspirin may be prescribed for you after transplant it used to be that every single one of our liver transplant patients would get started on a baby aspirin but we now take it on a case-by-case basis if you were taking a baby aspirin

Before transplant we will resume it after transplant however if this is a new medicine for you it’s because it’s been assessed by the surgeon and thought that you would need a little bit of aspirin help then down the blood so that it flows easily to the liver a multivitamin is something that we would like for our transplant patients to take until they’re back

To eating their normal healthy diet once this happens you may stop the multivitamin you can purchase any over-the-counter multivitamin that you would like whether it be a centrum a ther grain a flintstones chewable whatever it is that you find tasty or tolerable again once it and once you’re back to eating your normal healthy diet you can stop that multivitamin

Please remember that whatever multivitamin is that you purchased that it should not contain any herbal products again we do not want our transplant patients taking herbals and life after transplant the rest of your medicine lists will be comprised of your home medications so medicines that you were using previously to treat your blood pressure cholesterol and other

Disease states will be resumed what will be stopped in life after transplant where the medicines that we are using to treat your liver disease so no more lecture lists no more zhai faxon and hopefully no more diuretics as your brand-new liver will take care of dealing with these problems thank you so much for your time please know that we are always available for

Any questions that you may have about your transplant medicines before you go home after transplant we’ll review all of these medicines again and we’ll help make sure that you understand how to take your medicines properly after your liver transplant

Transcribed from video
Liver Transplant Education – Medications By Piedmont Healthcare