Drugs for Glomerulonephritis Flashcards
What 9 drugs can be used to treat Glomerulonephritis?
Prednisone, Methylprednisolone Rituximab Cyclophosphamide Mycophenolate Azathioprine Methotrexate Cyclosporine, Tacrolimus
What 9 drugs can be used to treat Glomerulonephritis?
Prednisone, Methylprednisolone Rituximab Cyclophosphamide Mycophenolate Methotrexate Azathioprine Cyclosporine, Tacrolimus
What are 2 Glucocorticoids?
Prednisone
Methylprednisolone
Which Glucocorticoid is non-fluorinated and is more potent?
Methylprednisolone
What is the MOA for Prednisone?
- Binds Glucocorticoid Receptor and complexes with NF-KB and AP-1 transcription factor
- (+) lipocortin
==> immunosuppression and no eicosanoid synthesis
What is Prednisone converted to in the liver?
Prednisolone
What is the outcome of Prednisone use?
Relieves pain and inflammation while waiting for DMARD effects and treats flares of autoimmune diseases
What is a possible syndrome and its attributes that is a side effect of the glucocorticoids?
Cushing’s syndrome
= buffalo hump, truncal obesity, striae, acne, hirsutism
Besides Cushing’s syndrome, what are some other side effects of taking Glucocorticoids?
CNS issues
Impaired glucose tolerance and salt/water retention
Osteoporosis
Infections
What is Rituximab?
Antibody that targets CD-20
Describe how Rituximab works
- @ 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
What 1 thing can Rituximab treat?
Granulomatosis with Polyangiitis
Rituximab can treat Granulomatosis with Polyangiitis. But if it is used with _____ it can treat Rheumatoid Arthritis
With Methotrexate
What is a possible side effect of Rituximab?
Infusion - related hypersensitivity reactions
When using Rituximab, what can be (+) that may indicate a higher likelihood of responsiveness?
(+) rheumatoid factor or anti-ccp
MOA for Cyclophosphamide?
Forms irreversible DNA crosslinks
At low doses, what is the general effect of Cyclophosphamide?
Immunosuppressant
At high doses, what is the general effect of Cyclophosphamide?
Cancer cell apoptosis
What 1 thing can Cyclophosphamide treat?
Nephrotic Syndrome
This drug forms irreversible DNA crosslinks and can treat Nephrotic Syndrome
Cyclophosphamide
MOA for Mycophenolate?
(-) inosine monophosphate dehydrogenase
– noncompetitive and reversible
MOA for Mycophenolate and what that causes?
(-) inosine monophosphate dehydrogenase
==> blocks guanine nucleotide synthesis in lymphocytes
What are possible adverse effects of Mycophenolate?
Hematologic and GI toxicities
Fetal harm
This drug can pretty much treat any of the Glomerulonephritis’s and is prophylaxis for transplant rejection
Mycophenolate
MOA for Azathioprine?
Purine antimetabolite that forms 6-thio-gtp to impair lymphocyte function
MOA for Azathioprine?
Purine antimetabolite that forms 6-thio-gtp to impair lymphocyte function
What 3 things can Azathioprine treat?
Lupus nephritis
Granulomatosis with Polyangiitis
Microscopic polyangiitis
What 3 things can Azathioprine treat?
Lupus nephritis
Granulomatosis with polyangiitis
Microscopic polyangiitis
What is a possible side effect of Azathioprine?
Bone marrow suppression
What is the MOA for Cyclosporine and Tacrolimus?
(-) calcineurin –> NFAT not (+) –> T cells not activated because certain cytokines like IL-2 are not produced
What is the MOA for Cyclosporine and Tacrolimus?
(-) calcineurin –> NFAT not (+) –> certain cytokines like IL-2 not (+) –> T cells not (+)
What 2 things can Cyclosporine and Tacrolimus treat?
Lupus nephritis
FSGS
What is a possible adverse effect of Cyclosporine?
Nephrotoxicity
What is a possible adverse effect of Tacrolimus?
Nephrotoxicity
MTX
Methotrexate
MOA for Methotrexate?
Blocks purine and thymidine synthesis
Methotrexate is fast and effective. How long until effects are noticed?
3-6 weeks
Methotrexate is a 1st line agent for what?
Rheumatoid Arthritis
How is Methotrexate given?
Once per week
What are possible adverse effects of methotrexate when given at high doses?
Fetal death Bone marrow suppression Hepatic fibrosis GI ulceration Pneumonitis
What are possible adverse effects of Methotrexate when given at high doses?
Fetal death Bone marrow suppression Hepatic fibrosis GI ulceration Pneumonitis
At low doses, Methotrexate is very well tolerated. What should patients take weekly though?
Folate supplements
