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CPT > 8. Immunosuppression > Flashcards

8. Immunosuppression Flashcards

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1
Q

What is the clinical criteria for diagnosing RA?

A 
Morning stiffness >1hour
Arthritis >3joints
Arthritis of hand joints
Symmetrical arthritis
Rheumatoid nodules
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2
Q

What is the non-clinical criteria to diagnose RA?

A

Serum rheumatoid factor/anti-CCP antibodies

X-ray changes

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3
Q

Name some immunosuppressants

A 
Corticosteroids 
Methotrexate
Azathioprine
Ciclosporin 
Tacrolimus
Mycophenolate mofetil
Leflunomide
Cyclophosphamide
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4
Q

What is the mechanism of action of corticosteroids?

A

Prevent interleukin IL-1 and IL-6 production by macrophages

Inhibit all stages of T-cell activation

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5
Q

What is azathioprine used for?

A

SLE and vasculitis - as maintenance therapy
IBD
Atopic dermatitis
Bullous skin disease
Many other uses as ‘steroid sparing’ drug

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6
Q

What should be done before prescribing azathioprine?

A

Test TPMT activity (thiopurine methyltransferase)

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7
Q

What are the ADR to azathioprine?

A

Bone marrow suppression
Increased risk of malignancy
Increased risk of infection
Hepatitis

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8
Q

Name some calcineurin inhibitors

A

Ciclosporin

Tacrolimus

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9
Q

When are ciclosporin and tacrolimus used?

A

Transplantation

Atopic dermatitis and psoriasis

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10
Q

What is the mechanism of action of calcineurim inhibitors?

A

Active against helper T-cells, preventing production of IL-2 via calcineurim inhibition
Ciclosporin binds to cyclophilin protein
Tacrolimus binds to tacrolimus-binding protein

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11
Q

When is mycophenolate mofetil used?

A

Primarily in transplantation

Good efficacy as induction and maintenance therapy for lupus nephritis/vasculitis maintenance

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12
Q

What is the mechanism of action of mycophenolate mofetil?

A

Prodrug
Inhibits inosine monophopshate dehydrogenase (IMD) - required for guanosine synthesis
Impairs B and T cell proliferation
Spares other rapidly dividing cells

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13
Q

What are the ADR with mycophenolate mofetil?

A

Nausea, vomiting, diarrhoea

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14
Q

What is the mechanism of action of cyclophosphamide?

A

Cross links DNA so that is cannot replicate

Suppresses T and B cell activity

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15
Q

What are the indications of cyclophosphamide?

A

Lymphoma, leukaemia, solid cancers
Lupus nephritis
Wegener’s granulomatosis

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16
Q

What are the ADR of cyclophosphamide?

A

Increased risk of bladder cancer, lymphoma and leukaemia
Infertility
Monitor FBC and adjust dose in renal impairment

17
Q

What are the indications for methotrexate?

A

RA
Malignancy
Psoriasis
Crohn’s disease

18
Q

What is the mechanism of action of methotrexate in cancer?

A

Competitively and reversible inhibits dihydrofolate reductase
Therefore inhibits the synthesis of DNA, RNA and proteins

19
Q

What are the adverse effects of methotrexate?

A 
Mucositis
Marrow suppression
Hepatitis 
Cirrhosis
Pneumonitis 
Inferior risk
Highly teratogenic, abortifacient
20
Q

What is sulfasalazine used for?

A

RA

IBD

21
Q

What are the immunological effects of sulfasalazine?

A

T cell inhibition of proliferation
Possible T cell apoptosis
Inhibition of IL-2 production
Neutrophil reduced chemotaxis and reduced degranulation

22
Q

What are the adverse effects of sulfasalazine?

A 
Myelosuppression
Hepatitis 
Rash
Nausea
Abdo pain/vomiting
23
Q

What is rituximab used for?

A

RA
Lupus
Vasculitis

24
Q

What does rituximab cause?

A

B cell apoptosis

CPT (30 decks)

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