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67 Cards in this Set
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IgG
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2nd in immune response
Most common crosses placenta |
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IgA
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Lines mucous membranes and protects body surfaces
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IgM
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First in immune response
Forms antibodies to ABO blood antigens |
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IgD
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Present in lymphocyte surface
Assists in differentiation of B lymphocytes |
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IgE
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Causes symptoms of allergic reactions
Fixes to mast cells and basophils Assists in defense against parasitic infections |
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Type I reaction
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- IgE mediated reaction
- Anaphylactic reactions - immediate, humoral First exposure: IgE--> attaches to masts cells and basophils 2nd exposure: allergen --> links to IgE bound to mast cells --> release of chemical mediators/degranulation (histamine, serotonin, leukotrienes, eosinophil chemotactic factor of anaphylaxis, kinins, bradykinins)--> target tissues/organs--> allergy symptoms-->manifestation depend on if remains local or systemic --> smooth muscle contraction, increased vascular permeability, vasodilation, hypotension, increased mucus, and itching--> mediators are short acting and are reversible |
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Histamine
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- within mast cells and basophils
- increases vascular permeability - constricts smooth muscle - stimulates irritant receptors --> - airway and larynx edema - bronchial constriction - urticaria - angioedema - pruritis - N/V - diarrhea - shock |
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Leukotrienes
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- constrict bronchial smooth muscles
- increase vascular permeability --> - bronchial constriction - enhanced effect of histamine on smooth muscles |
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Prostaglandins
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- vasodilation
- constrict smooth muscle --> - wheal and flare reaction on skin - hypotension - bronchospasm |
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Platelet-activating factor
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- in mast cells
- aggregates platelets - stimulates vasodilation --> - increased pulmonary artery pressure - hypotension |
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Kinins
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- stimulate slow, sustained smooth muscle contraction
- increased vascular permeability - stimulate mucus secretion - stimulate pain receptors --> - angioedema with painful swelling - bronchial constriction |
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Serotonin
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- from platelets
- increases vascular permeability - stimulates smooth muscle contraction --> - mucosal edema - bronchial constriction |
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Anaphylatoxins
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- from compliment activation
- stimulate histamine release --> - same as histamine |
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Type I Reaction examples
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Anaphylaxis
Atopic reactions (rhinitis, asthma, atopic dermatitis, angioedema) IgE |
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Type II Reaction
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IgG and IgM
antibodies--> antigen--> comeplemtn system --> cytolysis or enhanced phagocytosis of cells (rapid tissue damage) common target cells include erythrocytes, platelets, and leukocytes |
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Type II Reaction examples
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hemolytic transfusion reactions (AVO, Rh, autoimmune and drug hemolytic anemias)
Good pasture syndrome |
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Type III Reaction
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secondary to antibody/antigen complex
Complex formed IgG or IgM --> deposit in tissue or small blood vessel --> fixation of complement and release of chemotactic factors--> inflammation and tissue destruction of area |
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Type III Examples
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- kidneys, skin, joints, blood vessels, lungs
- SLE, RA, some acute golmerulonephritis |
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Type IV Reactions
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no immunoglobulins
- T lymphocytes --> attack antigens and release cytokines--> some attract macrophages --> enzymes release--> tissue destruction Also called a mediated immune response * delayed reactions, takes 24-28h |
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Type IV Reaction examples
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- Contact dermatitis
- hypersens to bacterial, fungal, viral infections (antigentic material released from TB--> reaction with T lymphocytes --> causing lung necrosis) - transplant rejections - some drug reactions |
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Cellular immunodeficiency =
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less than 1200 /ug or 1.2 x10^9 /L
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Good test for determining various allergic reactions to foods and anaphylaxis
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RAST (radioallergosorbent) test
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Skin tests can not be performed on who?
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Pts that can't be removed from meds that suppress immune response
Otherwise they are good to determine specific allergies that are causing symptoms |
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Positive skin test response
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wheal and flare
- size of reaction does not correlate with severity of allergy symptoms *this test has increased chance of anaphylactic reaction **Observe for itching and edema!! *Should not be left alone! |
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Cardinal principles for anaphylaxis treatment
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Speed in:
1. recognition of S/S 2. maintenance of patent airway 3. prevention of spread of allergen by using a tourniquet 4. Admin of drugs 5. treatment for shock |
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Tx for mild anaphylaxis symptoms
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- 0.2-0.5 mL of epinephrine q 10-15 min
- IV infusion 0.5mL/kg IV every 2-5 min (for hypotension) - Diphenhydramine (benadryl) for urticaria/angioedema- can also be given preventatively |
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Tx for severe symptoms of anaphylaxis
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- IV epi, followed by adminstration of high-flow oxygen 100% via non-rebreather
- volume expanders, inotropes (Dopamine)- to maintain BP |
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Latex-food syndrome
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- banana
- avocado - chestnut - kiwi - tomato - water chestnuts - guava - hazelnuts - potatoes - peaches - grapes - apricots |
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High risk for latex allergy
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- long term exposure (healthcare workes, multiple surgeries, rubber manufaturers)
- asthma, hay fever, allergies - latex-food syndrome |
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Atopic reactions
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Type 1- sensitivity to environmental allergens
- allergic rhinitis - asthma -Atopic dermatitis (eczema) - urticaria (hives) - Angioedema |
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Allergic rhinitis
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- year round or seasonal
- airbornse substances (pollens, dust, molds) - target areas are conjuntivae, mucosa of upper respiratory tract S/S- nasal discharge, sneezing, lacrimation, mucosal swelling of the airway, obstruction, pruritis around eyes, nose, throat, mouth |
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Asthma
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Manifested with dyspnea, wheezing, coughing, chest tightness, thick sputum
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Atopic dermatitis
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Chronic inherited skin disorder
- caused by several environmental allergens - skin lesions are generalized and involve vasodilation of blood vessels resulting in interstitital edema with vesicle formation |
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Urticaria
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- characterized by transient wheals
- develops rapidly after exposure to allergen and may take minutes or hours - Histamine--> vasodilation (erythema)--> transudation of fluid (wheal) and flaring - Histamine is responsible for itching |
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Angioedema
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- Localized cutaneous lesion involving deeper layers of skin and submucosa
- eyelids, lips, tongue, larynx, hands, feet, GI tract, genitalia - swelling usually begins in the face then progresses to airways - dilation and engorgement of capillaries secondary to release of histamine--> diffuse swelling - lesions may burn, sting, itch, abdominal pain if in GI tract |
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CBC with differential and allergies
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lymphocyte count < 1200 uL = cellular immunodeficiency
Eosinophils are increased with type 1 hypersens with IgE immunoglobulins |
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RAST test
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Radioallergosorbent test
- invitro diagnostic test for IgE antibodies to specific allergens - good for pts with history of severe anaphylactic reactions - sputum, nasal, and bronchial secretions tested for eosinophils |
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Skin tests
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- used to confirm specific pt with atropic disease after hx is suggestive of allergy
**CANNOT be performed on pts who cannot be removed from medications that suppress the histamine response or pts with food allergies -cutaneous scratch or prick - intracutaneous injection - wheal and flare would be a positive - a negative doesn't always mean negative - increased risk of developing anaphylactic reaction--> observe site for itching and edema **should not be left alone |
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Plasmapheresis
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removal of plasma containing components causing or though to be causing disease
- used to treat SLE, CBS, myasthenia gravis, good pasture syndrome, RA, glomerulonephritis, and thrombocytopenic purpura - plasma is removed and replaced by substitute fluids (salin, frash frozen plasma, albumin) - removed immunomediators (such as IgG and can also remove inflammatory mediators) |
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Human Leukocyte Antigen
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HLA
- major histocompatibility antigens - primarily used in matching organs and tissues for transplants - highly variable, different alleles, with many combinations |
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Organs that can be transplanted together
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kidney and pancreas
kidney and liver kidney and heart |
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Cadaver transplant
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the longer it is cold the harder it is to get it to work
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Living transplant
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better cause it still has blood going through it
- want to maintain good perfusion - live donors must meet certain criteria also |
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how matching is one
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ABO and HLA, medical urgency, time on waiting list, geography
higher on list if under 19 |
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Crossmatch
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A positive crossmatch is an absolute contraindication to transplant!
- a positive match means that the recipient has cytotoxic antibodies to to the donor! - you WANT A NEG! |
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Hyperacute transplant rejection
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- antibody mediated humoral
- minutes to hours after transplant due to blood vessel destruction - person had preexisting antibodies against transplanted tissue or organ - remove organ ASAP - kidney is most susceptible |
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Acute transplant rejection
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- days to months after transplant, within the first 6 months
- mediated by recipients lymphocytes which have been activated against the donor tissue or organ - another type occurs when anti0donor antibodies develop after transplantation - requires long term use of immunosuppressants (higher doses at first which increases infection risk!) |
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Chronic transplant rejection
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- occurs over months or to yers and is IRreversible
- unknow reasons or from repeated episodes of acute rejection - transplanted organ is infiltrated with large numbers of T and B cells characteristic of an on-going, low-grade immune-mediated injury --> results in fibrosis and scarring |
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Transplant rejection manifestation in liover
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- loss of bile ducts
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Rejection manifestations in kidney
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fibrosis and glomerulopathy
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rejection manifestation in heart
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accelerated CAD
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rejection manifestations in lung
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bronchiolitis
- supportive therapy, retransplanted |
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Immunosuppressive therapy concerns
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- Increased risk of infection
- Increased risk of malignancies - Increased risk of toxicity - side effects - need suppression to prevent rejection but need immune response to prevent massive infection and malignancies |
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Cyclosporine, tacrolimus
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- most effective immunosupressant
- need for life! - do not cause bone marrow suppression or alterations in inflammatory response - potentially nephrotoxic and don't mix with grapefruit juice |
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Initial immunosupression
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triple therapy, one being a steroid so want to wean them off steroid as as soon as possible
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Monoclonal antobidies
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---mab
a flu-like syndrome may develop during the first few days of tx from cytokine release (fever, rigors, HA, myalgias, various GI disturbances) |
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Graft versus Host disease (GVHD)
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- when immunocompentent pt is trasfused or transplanted with immuno-competent cells
- blood prducts from fetal thymust or fetal liver or bone - graft rejects recipient - 7-30 days onset - little can be done to modify - skin, GI liver ar target organs - donor T cells attacking host cells - palms of hands and soles of feet--> generalized erythema, pruritus, rash, desquamation - liver-->jaundice to hepatic coma |
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S/S of GVHD
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- rash
- jaundice - hepatic coma - watery diarrhea - mild pruritus - pain on pressure - palms/soles - N/V - abdominal pain - dark yellow urine * be cautious if a pt receiving bone marrow transplant is experiencing a rash--> could be this! tx is steroids and immunosuppressive agents (most effective in prevention!) - radiate blood products before adminsitration |
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Advantages of a live donor
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- better pt and graft survival rate regardles of HLA match
- immediate organ availaility - immediate function (minimal cold time) - opportunity to have recipient in best condition (elective surgery) |
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Deceased donors
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- donors must be regularly healthy and declared brain dead
- brain dead donor must have effective cardiovascular function to preserve organs (dopamine to keep BP up, mech vet, etc.) - age most suitable is 2-70 |
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Preop nursing teaching
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- educate on procedure and expected outcome
- including dialysis may be needed immediately after (kidney transplant) - need for immunosuppressant drugs and infection prevention |
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Postop nursing management of live donor
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Live Donor
- similar to post op laproscopic procedures - monitor for renal function - acknowledge "gift" |
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Postop nursing management of kidney recipient
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- maintenance of fluid and electrolyte balance
- in ICU for 12-24 hours post transplant - large volumes of urine may be produced soon after blood supply established (due to new kidney ability to filter BUN, surgical fluids, inhibition of concentration) - watch venous pressure--> don't want a lot of BP fluctuation - may have trouble concentrating urine - avoid dehydration * a sudden decrease in urine output is a cause for concern (could be dehydration, rejection, urine leack, obstruction) - common obstruction is blood clot in catheter - patency must be maintained (remains in bladder for 3-5 days to allow for anastomosis healing) |
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Post operative teaching of kidney recipient
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- prevention and treatment of rejection, infection, complications of surgery, purpose and side effects of immunosuppression
- frequent blood tests and clinic visits to detect early rejection signs - immunosuppressive therapy |
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Chronic rejection...
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should be put back on transplant list
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Immunosuppressants and cardiovascular disease
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- increased incidence of atherosclerotic vascular disease
- immunosuppressants can worsen HTN and dyslipidemia |
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most common secondary malignancies
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basal cell carcinoma of skin and lymphoma (nutrition, antioxidants)
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