Drugs for Glomerulonephritis

Question 1

What 9 drugs can be used to treat Glomerulonephritis?

Answer 1

Prednisone, Methylprednisolone
Rituximab
Cyclophosphamide
Mycophenolate
Azathioprine
Methotrexate
Cyclosporine, Tacrolimus

Question 2

What 9 drugs can be used to treat Glomerulonephritis?

Answer 2

Prednisone, Methylprednisolone
Rituximab
Cyclophosphamide
Mycophenolate
Methotrexate
Azathioprine
Cyclosporine, Tacrolimus

Question 3

What are 2 Glucocorticoids?

Answer 3

Prednisone

Methylprednisolone

Question 4

Which Glucocorticoid is non-fluorinated and is more potent?

Answer 4

Methylprednisolone

Question 5

What is the MOA for Prednisone?

Answer 5

• Binds Glucocorticoid Receptor and complexes with NF-KB and AP-1 transcription factor
• (+) lipocortin
  ==> immunosuppression and no eicosanoid synthesis

Question 6

What is Prednisone converted to in the liver?

Answer 6

Prednisolone

Question 7

What is the outcome of Prednisone use?

Answer 7

Relieves pain and inflammation while waiting for DMARD effects and treats flares of autoimmune diseases

Question 8

What is a possible syndrome and its attributes that is a side effect of the glucocorticoids?

Answer 8

Cushing’s syndrome

= buffalo hump, truncal obesity, striae, acne, hirsutism

Question 9

Besides Cushing’s syndrome, what are some other side effects of taking Glucocorticoids?

Answer 9

CNS issues
Impaired glucose tolerance and salt/water retention
Osteoporosis
Infections

Question 10

What is Rituximab?

Answer 10

Antibody that targets CD-20

Question 11

Describe how Rituximab works

Answer 11

• @ the pre-B cell stage, cells express CD-20 on their surface
• Once Rituximab destroys CD-20, B cells are converted to Plasma cells
  = Decreased B cells but normal immunoglobins

Question 12

What 1 thing can Rituximab treat?

Answer 12

Granulomatosis with Polyangiitis

Question 13

Rituximab can treat Granulomatosis with Polyangiitis. But if it is used with _____ it can treat Rheumatoid Arthritis

Answer 13

With Methotrexate

Question 14

What is a possible side effect of Rituximab?

Answer 14

Infusion - related hypersensitivity reactions

Question 15

When using Rituximab, what can be (+) that may indicate a higher likelihood of responsiveness?

Answer 15

(+) rheumatoid factor or anti-ccp

Question 16

MOA for Cyclophosphamide?

Answer 16

Forms irreversible DNA crosslinks

Question 17

At low doses, what is the general effect of Cyclophosphamide?

Answer 17

Immunosuppressant

Question 18

At high doses, what is the general effect of Cyclophosphamide?

Answer 18

Cancer cell apoptosis

Question 19

What 1 thing can Cyclophosphamide treat?

Answer 19

Nephrotic Syndrome

Question 20

This drug forms irreversible DNA crosslinks and can treat Nephrotic Syndrome

Answer 20

Cyclophosphamide

Question 21

MOA for Mycophenolate?

Answer 21

(-) inosine monophosphate dehydrogenase

– noncompetitive and reversible

Question 22

MOA for Mycophenolate and what that causes?

Answer 22

(-) inosine monophosphate dehydrogenase

==> blocks guanine nucleotide synthesis in lymphocytes

Question 23

What are possible adverse effects of Mycophenolate?

Answer 23

Hematologic and GI toxicities

Fetal harm

Question 24

This drug can pretty much treat any of the Glomerulonephritis’s and is prophylaxis for transplant rejection

Answer 24

Mycophenolate

Question 25

MOA for Azathioprine?

Answer 25

Purine antimetabolite that forms 6-thio-gtp to impair lymphocyte function

Question 26

MOA for Azathioprine?

Answer 26

Purine antimetabolite that forms 6-thio-gtp to impair lymphocyte function

Question 27

What 3 things can Azathioprine treat?

Answer 27

Lupus nephritis Granulomatosis with Polyangiitis Microscopic polyangiitis

Question 28

What 3 things can Azathioprine treat?

Answer 28

Lupus nephritis Granulomatosis with polyangiitis Microscopic polyangiitis

Question 29

What is a possible side effect of Azathioprine?

Answer 29

Bone marrow suppression

Question 30

What is the MOA for Cyclosporine and Tacrolimus?

Answer 30

(-) calcineurin --> NFAT not (+) --> T cells not activated because certain cytokines like IL-2 are not produced

Question 31

What is the MOA for Cyclosporine and Tacrolimus?

Answer 31

(-) calcineurin --> NFAT not (+) --> certain cytokines like IL-2 not (+) --> T cells not (+)

Question 32

What 2 things can Cyclosporine and Tacrolimus treat?

Answer 32

Lupus nephritis | FSGS

Question 33

What is a possible adverse effect of Cyclosporine?

Answer 33

Nephrotoxicity

Question 34

What is a possible adverse effect of Tacrolimus?

Answer 34

Nephrotoxicity

Question 35

MTX

Answer 35

Methotrexate

Question 36

MOA for Methotrexate?

Answer 36

Blocks purine and thymidine synthesis

Question 37

Methotrexate is fast and effective. How long until effects are noticed?

Answer 37

3-6 weeks

Question 38

Methotrexate is a 1st line agent for what?

Answer 38

Rheumatoid Arthritis

Question 39

How is Methotrexate given?

Answer 39

Once per week

Question 40

What are possible adverse effects of methotrexate when given at high doses?

Answer 40

``` Fetal death Bone marrow suppression Hepatic fibrosis GI ulceration Pneumonitis ```

Question 41

What are possible adverse effects of Methotrexate when given at high doses?

Answer 41

``` Fetal death Bone marrow suppression Hepatic fibrosis GI ulceration Pneumonitis ```

Question 42

At low doses, Methotrexate is very well tolerated. What should patients take weekly though?

Answer 42

Folate supplements