Drugs for ILD (Iszard) Flashcards
Prednisone, an anti-inflammatory and immunosuppressive may lead to suppresion of what pathway?
What should be monitored for?
Suppression of the HPA
Monitor for Cushing’s Syndrome and Hyperglycemia
What type of drug is Mycophenolate (MPA)?
What is the Black Box Warning?
Immunosupressive Drug
Embryotoxic
What are the indications for mycophenolate (MPA)?
RA, resistant to methotrexate
Prophylaxis of organ rejection, should be used in combination with other immunosuppresant drugs
What are the side effects of mycophenolate?
Diarrhea
leukopenia
infections
What are the drug interactions of mycophenolate?
efficacy is reduced by antacids, PPIs, or drugs that enter enterohepatic circulation
May diminish efficacy of OCPs
Which drug is very successful in treating RA?
Mycophenolate
What is the black box warning for methotrexate?
Careful use as indicated by physicians with knowledge and experience using the drug
Deaths have been reported in using MTX
Used to treat malignancy, psoriasis and RA
Indications for MTX
Neoplastic dz
Psoriasis
RA and Poly-articular Juvenile RA
What are some main concerns of MTX outside of the black box warning?
fetal death
reduced elimination in renal pt’s
bone marrow suppression and aplastic anemia
hepatotoxicity with prolonged use
lung disease
diarrhea and hemorrhagic enteritis
Fatal skin reaction
Opportunistic infections (p. carinii)
What are some drugs to avoid mixing with MTX?
NSAIDs (causes MTX toxicity)
Oral Abx (interferes with enterohepatic circulation)
Hepatotoxic drugs (accelerates hepatoxicity)
Theophylline (decreases clearance)
Should women of childbearing potential use MTX?
No, not until pregnancy is excluded and they’re counseled on risks
MTX is especially toxic to which two major organs?
Liver
Kidneys
The incidence and severity of acute side effects of MTX is related to what two things?
Dose
Frequency of administration
What are the two main indications for azathioprine?
(besides ILD)
Renal Homotransplantation
RA
(and ILD obviously)
What are the contraindications for the immunosuppressive antimetabolite, azathioprine?
HSN to the drug itself
Pregnant women with RA
What are the two adverse reactions of azathioprine?
Hematologic and GI issues
What is the black box warning for azathioprine?
Chronic immunosuppression with azathioprine
increases risk of malignancy
Which drug is a kinase inhibitor used for IPF?
What are the main contraindications?
Nintedanib
No significant contraindications
What are some GI sx to watch for on nintedanib?
elevated liver enzymes
N/V/D
GI perforation during surgery
What are some hematologic concerns to watch for on nintedanib?
arterial thromboembolic events
bleeding
Should nintedanib be given to pregnant women?
No
What are the common side effects of nintedanib?
N/V/D
elevated liver enzymes
HA
HTN
Co-administration of P-gp and CYP3A4 inhibitors may increase what drug levels?
nintedanib
Monitor pt’s closely for tolerability
