Human disease L27 : DMARDS Flashcards
why are DMARDS the first line of treatment for autoimmune diseases
DMARDS supress the immune system, which slows and stops the disease progression.
DMARDS treat the autoimmune disease, not just the symptoms
what does DMARDs stand for
Disease-modifying anti-rheumatic drugs (DMARDs)
When is DMARDs most effective as a treatment option
most effective with early diagnosis and early introduction of the drug
the effects of DMARDS take a couple of months to take affect, if a patient is showing systemic symptoms, what can you give whilst they are waiting for the effects of DMARDS
use corticosteroids to manage the symptoms
if someone is detected of having autoimmune disorder, it is essential that you refer them to where
secondary care
(medical care that is provided by a specialist or facility upon referral by a primary care physician and that requires more specialized knowledge, skill, or equipment than the primary care physician can provide)
Azathioprine (AZA) is an immunosuppressive agent that acts through its effects as an antagonist of —————— metabolism, resulting in the inhibition of DNA, RNA, and protein synthesis
purine
the inhibition of DNA, RNA, and protein synthesis means that immune cells are not produced.
mycophenolate mofetil has teh same mechanism of action to Azathioprine. what is this mechanism and how does it differ to Azathioprine.
mycophenolate mofetil works as an immunosuppressive agent that acts through its effects as antagonist of purine metabolism, resulting in the inhibition of DNA, RNA, and protein synthesis.
it differs to azathioprine by being more potent
how does ciclosporin work on the immune system
ciclosporin, is a calcineurin inhibitor
Ciclosporin is believed to work by decreasing the function of lymphocytes.
it does this by forming a complex with cyclophilin to block the phosphatase activity of calcineurin, which in turn decreases the production of inflammatory cytokines by T‐lymphocytes.
how does hydroxychloroquine work
hydroxychloroquine interferes with the lysosomes present in the immune cells.
they then raise the pH of the cells enabling them not to function properly
if the immune cells do not work properly then they wont evoke and immune response
depending on risk factors, what might you want to consider doing before commencing patients on DMARDS
consider screening for viral infections such as HIV, HepB, HepC
DMARDS have a significant impact on your immune cells, if you have one of these conditions and commence DMARDS treatment it will affect you wellbeing
why might you want to consider a chest x ray before commencement of DMARDS
to look for any signs of tuberculosis
the side-effects of azathioprine include, bone marrow supression, red cell aplasia, neutropenia, thrombocytopenia, increased susceptibility.
what must these patients receive consistently
close monitoring
what enzyme must we check for when starting a patient on azathioprine and why?
Thiopurine methyltransferase (TPMT)
this enzyme is used for the metabolism of azathioprine.
if the patient has low count of TPMT then it would be inapropriate to start them on azathioprine
methotrexate 7.5 -15mg (up to 25mg) is administered how many times
and what supplement is required
methotrexate 7.5 -15mg (up to 25mg) is administered once per week
and folic acid supplementation is required
methotrexate is anti metabolite
