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PPE > 6.1 Immunosuppression and DMARDs > Flashcards

6.1 Immunosuppression and DMARDs Flashcards

1
Q

What is Rheumatoid Arthritis?

A

A multisystem autoimmune disease
Causes joint deformities, CVS risk
Develops in the synovium, inflammation, proliferation then goes into cartilage and bone.
Due to an imbalance between pro/antiinflammatory cytokines

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2
Q

Which cytokines are involved in RA?

A

IL1

TNF Alpha

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3
Q

How do you diagnose RA?

A

X Rays
Morning Stiffness
Symmetrical

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4
Q

What is SLE?

A

Systemic Lupus Erythematosus
Systemic autoimmune disease
Butterfly rash

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5
Q

What is Vasculitis?

A

Inflammation that destroys blood vessels

Get pulmonary hemorrhages

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6
Q

Give examples of immunosuppressants?

A 
Corticosteroids
Azathrioprine
DMARDs
Ciclosporin and Tacrolimus
Mycophenolate mofetil
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7
Q

What do ALL immunosuppressants do? (ADRs!!!)

A

Increase malignancy
Increase infection risk - FBC
Decrease bone marrow

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8
Q

How do Corticosteroids work?

A

It decreases the production of proinflammatory cytokines by macrophages and increases anti-inflammatory cytokines.

Restrains proliferation of T helper cells.

Receptor in cytoplasm -> Nucleus and change gene expression

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9
Q

ADRs of Steroids?

A 
Weight Gain
Purple Striae
Osteoporosis
Cataracts
Cushings-like fat gain
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10
Q

How does Azathioprine work?

A

It is cleaved into 6MP which is an antimetabolite.
Inhibits purine synthesis to prevent DNA and RNA synthesis.
Metabolised by TPMT which is polymorphic
High levels –> Myelosuppression
Low –> Undertreatment

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11
Q

When do you use Azathioprine?

On what conditions?

A

Use to maintain a patient after treating them acutely with CS

IBD
Vasculitis
SLE
Dermatitis

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12
Q

What ADR can Azathioprine also cause?

A

Hepatitis - monitor LFTs

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13
Q

What type of drugs are Ciclosporin and Tacrolimus?

A

Calcineurin Inhibitors

Inhibit T helper cells by preventing IL2 production

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14
Q

When do you use calcineurin inhibitors?

A

Transplant
Atopic dermatitis
Psoriasis

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15
Q

Why is Ciclosporin particularly useful?

A

As it has no effect on bone marrow

Useful for RA and SLE

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16
Q

What are ADRs of Calcineurin Inhibitors?

A

Nephrotoxic (monitor eGFR)
Hypertension (monitor BP)
Hyperlipidaemia
GI- nausea, vomit, diarrhoea

17
Q

When do you use MM?

A

In SLE

Transplant Medicine

18
Q

What is MM?

A

Mycophenolate Mofetil is a prodrug which is converted to inhibit B and T cells
Prevents synthesis of guanine
Spares other rapidly dividing cells as they have measures against this

19
Q

ADRs of MM?

A

GI

Myelosuppression

20
Q

What is Cyclophosphamide?

A

Cytotoxic
Alkylating Agent
Suppresses B and T Cells

21
Q

When do you use Cyclophosphamide?

A 
Severe RA when all else fails
Lymphoma
Leukaemia
SLE
Wegeners Granulomas
22
Q

ADRs of Cyclophosphamide

A

Very Toxic!!
Can induce cancers esp bladder cancer (void frequently)
Infertility
Teratogenic
NEED TO MONITOR FBC and adjust in renally impaired

23
Q

What is a DMARD?

A

A disease modifying anti rheumatic drug

24
Q

What are 3 examples of DMARDs?

A

Methotrexate
Sulphasalazine
Anti-TNF alpha agents

25
Q

What is Methotrexate?

A

A folate antagonist
Gold Standard for RA treatment
Inhibits DHFR to prevent D/RNA and Protein synthesis
Best for rapidly dividing cells (active during S phase)

26
Q

Why use Methotrexate?

A

It is well tolerated
Retained in the system
Only once a week (+Folic Acid)
Can improve efficacy of other DMARDs when used in conjunction

27
Q

ADRs of Methotrexate?

A

Hepatitis, Cirrhosis
Infection Risk
Teratogenic
Aborts foetus’s

28
Q

When can you use methotrexate?

A

RA
Malignancy
Crohns
Psoriasis

29
Q

How do you monitor patients on methotrexate?

A 
Chest X Ray
FBC
LFT
U&E
Creatinine
30
Q

What is Suphasalazine a mix of?

A

5-ASA - anti-inflammatory, inhibits T cells and neutrophils

Sulphapyradine - fight infection

31
Q

When do you use Sulphasalazine?

A

Safe for pregnant people

Good for IBD (Poorly absorbed so stays in the intestines)

32
Q

ADRs for Sulphasalazine

A

Myelosuppression
Hepatitis
Rash
GI symptoms

33
Q

Advantages of Sulphasalazine?

A 
Safe for pregnancy
Non-carcinogenic
Has very few interactions
Effective
Less Toxic
34
Q

When do you use anti-TNF agents?

A

If RA is clinically active

If other treatments have failed

35
Q

Why don’t you use anti-TNF agents much?

A

Expensive
Can cause Hypersensitivity
Can cause infections
Hypogammaglobinaemia

36
Q

What is anti-TNF alpha?

A

Anti-inflammatory
Decreases joint destruction
Decreases angiogenesis

PPE (25 decks)

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