Exam 3 Iszard ANCA Vasculities drugs Flashcards
What is ANCA?
Anti-Neutrophil Cytoplasmic Antibodies (ANCA)
• An autoimmune condition characterized by the inflammation of the blood vessels caused by an attack of the immune
system incorrectly and aggressively attacking cells.
What are the two types of antineutrophil cytoplasmic antibodies?
●Indirect immunofluorescence assay, using alcohol-fixed buffy coat leukocytes
●Enzyme-linked immunosorbent assay (ELISA), using purified specific antigens
What drugs can induce ANCA vasculitis?
- Hydralazine
- Propylthiouracil
- Methimazole
- Carbimazole
- Minocycline
What can be seen with ANCA-associated vasculitis when the vasculitis involves the renal medulla?
Interstitial nephritis
Decrease production of prostaglandins and leukotrienes
Decreased production and increased apoptosis of immune cell types
Decreased production of cytokines and their receptors
Decreased transmigration of neutrophils and macrophages from blood into tissues
Decreased expression of cell adhesion molecules
are effects of what?
How glucocorticoids affect the immune system
How do glucocorticoids affect the immune system?
- Decrease production of prostaglandins and leukotrienes
- Decreased production and increased apoptosis of immune cell types
- Decreased production of cytokines and their receptors
- Decreased transmigration of neutrophils and macrophages from blood into tissues
- Decreased expression of cell adhesion molecules
What are the consequences of glucocorticoid use?
- Decreased inflammation and its manifestations
- Immune suppression
- Decreased allergic/hypersensitivity reactions
- Blood in the urine.
- Foamy urine.
- Swelling in the legs.
- High blood pressure.
- Burning or difficulty when urinating.
- Back pain below the ribs.
- Swelling of the hands and feet.
are symptoms of what?
Goodpasture Syndrome
What are the symptoms of Good pasture syndrome?
- Blood in the urine.
- Foamy urine.
- Swelling in the legs.
- High blood pressure.
- Burning or difficulty when urinating.
- Back pain below the ribs
- Swelling of the hands and feet.
Should immunocompromised patients take glucocorticoids?
no- problematic
Should DM patients take glucocorticoids?
no- problematic
Should patients with peptic ulcers or infections take glucocorticoids?
no- problematic
should patients with CV conditions such as HTN, CHF, or angina take glucocorticoids?
no- problematic
Should patients with psychiatric conditions take glucocorticoids?
no- problematic
should patients with osteoporosis or posterior postmenopausal women take glucocorticoids?
no problematic
should children take glucocorticoids?
no problematic
What is type of drug is cyclophosphamide?
an alkylating agent
What drug is indicated for
- Malignant diseases
- Minimal change nephrotic syndrome in pediatric patients
Cyclophosphamide
Malignant Diseases: malignant lymphomas: Hodgkin’s disease, lymphocytic lymphoma, mixed-cell type lymphoma, histiocytic lymphoma, Burkitt’s lymphoma; multiple myeloma, leukemias, mycosis fungoides, neuroblastoma, adenocarcinoma of ovary, retinoblastoma, breast carcinoma
Minimal Change Nephrotic Syndrome in Pediatric Patients: biopsy proven minimal change nephrotic syndrome patients who failed to adequately respond to or are unable to tolerate adrenocorticosteroid therapy
Can cyclophosphamide be used in adults?
Unknown—he safety and effectiveness for the treatment of nephrotic syndrome in adults or other renal disease has not been established.
What are contraindications of cyclophosphamide ?
- Hypersensitivity to cyclophosphamide
2. Urinary outflow obstruction
Myelosuppression, Immunosuppression, Bone Marrow Failure and Infections
• Urinary Tract and Renal Toxicity • Cardiotoxicity
• Pulmonary Toxicity
• Veno-Occlusive Liver Disease
• Embryo-Fetal Toxicity
are warnings for what drug?
Cyclophosphamide
What are adverse reactions of cyclophosphamide?
Adverse reactions reported most often include
- neutropenia
- febrile neutropenia
- fever
- alopecia
- nausea
- vomiting
- diarrhea.
What are the contraindications of rituximab?
none
- FATAL INFUSION REACTIONS
- TUMOR LYSIS SYNDROME (TLS)
- SEVERE MUCOCUTANEOUS REACTIONS
- PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)
is BBW for what drug?
Rituximab
- Non-Hodgkin’s Lymphoma (NHL)
- Chronic Lymphocytic Leukemia (CLL)
• Rheumatoid Arthritis (RA) in combination with methotrexate in adult patients with moderately-to
severely-active RA who have inadequate response to one or more TNF antagonist therapies
are indications for what drug?
Rituximab
What are the indications for rituximab?
• Non-Hodgkin’s Lymphoma (NHL)
• Chronic Lymphocytic Leukemia (CLL)
• Rheumatoid Arthritis (RA) in combination with methotrexate in adult patients with moderately-to
severely-active RA who have inadequate response to one or more TNF antagonist therapies
When should rituximab use be limited?
Severe infections
What drug intreaction with rituximab can cause renal toxicity?
Cisplatin
infusion reactions, fever, lymphopenia, chills, infection and asthenia are adverse reactions for what?
Rituximab in NHL
Infusion reactions and neutropenia are common adverse reactions in what?
Rituximab in CLL
Can rituximab cause cardiovascular events?
yes
What are the indications of Azathioprine?
- Prevent renal transplant rejection
2. Management of active RA
What drugs can be continues when on azathioprine?
- Aspirin
- NSAIDs
- low dose glucocorticoids
When are the contraindications of azathioprine
- Drug HS
- Pregnancy
- RA patients previously treated with alkylating agents may have a prohibitive risk of malignancy
What is the warning of azathioprine?
Malignancy
-patients receiving immunosuppressants, including Azathioprine are at increased isk of developing lymphoma and other malignancies, particularly of the skin
What cancers are post renal transplant patients most at risk for?
- skin cancer
- reticulum cell tumor
- lymphomatous tumor
