Drugs to Treat ANCA Vasculitis and Goodpasture's Syndrome (Iszard)

Question 1

What are two ANCA assays that are widely used?

Answer 1

1. Indirect immunofluorescence assay
   
   • use alcohol-fixed buffy coat leukocytes
2. Enzyme-linked immunosorbent assay (ELISA)
   
   • use purified specific antigens

Question 2

What are 5 common drugs that can cause Drug-Induced Vasculitis? (H/P/M/C/M)

Answer 2

hydralazine
propylthiouracil
methimazole
carbimazole
minocycline

Question 3

What are 3 common consequences of using Glucocorticoids?

Answer 3

1. dec. inflammation
2. immune suppression
3. dec. allergic/hypersensitivity rxns

Question 4

Cyclophosphamide

What is it, what two things is it commonly used for, and what is a major limitation to use?

Answer 4

• alkylating agent used for MALIGNANT Dz and Minimal Change Nephrotic Syndrome in pediatric patients
  
  • also those unable to tolerate adrenocorticosteroid therapy

Limitations: effectiveness for treatment of nephrotic syndrome in adults or other renal disease NOT well established

Question 5

Cyclophosphamide

What are its two major contraindications and what are 3 warnings of use?

Answer 5

CI: hypersensitivity and urinary outflow obstruction

W: UT/Renal toxicity, cardiopulmonary toxicity, embryo-fetal toxicity

Question 6

Rituximab

What is it, what 3 diseases is it commonly used for(NHL,CLL,RA), and what is its major limitation of use?

Answer 6

• CD20-directed cytolytic antibody indicated for treatment of patients with Non-Hodgkins Lymphoma, Chronic Lymphocytic Leukemia, and Rheumatoid Arthritis (with methotrexate)

Limitation: NOT recommended for use in pts with SEVERE ACTIVE INFECTIONS

Question 7

Rituximab

What are 4 Black Box Warnings of use? (FIR,TLS,SMR,PML)

Answer 7

1. fatal infusion reactions
2. tumor lysis syndrome (TLS)
3. severe mucocutaneous reactions
4. progressive multifocal leukoencephalopathy (PML)

Question 8

Rituximab

What is its most important adverse reaction and how does it interact with Cisplatin?

Answer 8

AR: INFUSION REACTIONS, as well as serious infections and cardiovascular events

• can cause RENAL TOXICITY when used in combination with CISPLATIN

Question 9

Azathioprine

What are its two main indications of use (RHR,ARA)
what are its two major contraindications (HS,P)
what is a major warning of use? (L+M)

Answer 9

I: adjunct to prevent Renal Homotransplant rejection and management of active rheumatoid arthritis to reduce signs/symptoms

CI: hypersensitivity and pregnancy

W: malignancy patients at INCREASED RISK of developing lymphoma and skin malignancies

maintain immunosuppressive drug therapy at LOWEST effective levels possible