I+M disease immunosuppression Flashcards
AZATHIOPRINE
How does it work?
Antimetabolite-> breaks down into mercaptopurine which inhibits the reimpairment+making of DNA
AZATHIOPRINE
PRE-TREATMENT SCREENING?
CHECK TPMT LEVELS as TPMT metabolises thiopurine drugs (azathiopurine, mercaptopurine & tioguanine)
Reduced activity of enzyme? risk of myelosuppression
AZATHIOPRINE
used in what
transplant recipients and it is also used to treat a number of auto-immune conditions, usually when corticosteroid therapy alone provides inadequate control
AZATHIOPRINE- SIDE-EFFECTS? HN^2T
HYPERSENSITIVITY-> malaise/dizziness/D+V/fever
NEUTROPENIA/THROMBOCYTOPENIA-> sore throat/bruising/bleeding
NAUSEA-> common at start, resolves over time
TERATOGENIC-> avoid in pregnancy
AZATHIOPRINE- MONITORING REQUIREMENTS?
TPMT
REGULAR LFT/FBC, more often in liver/renal impairment
FBC weekly for first 4 weeks, then at least /3 months
AZATHIOPRINE- 2 main INTERACTIONS?
AZATHIOPRINE+ALLOPURINOL? haematological toxicity-> reduce AZA dose to 1/4 of usual dose
AZATHIOPRINE+ACE-i? anaemia/leucopenia-> AVOID concomitant use
Azathioprine, ciclosporin, mercaptopurine, and methotrexate have a role in the treatment of which disease
ibs
what drug given to reduce posisbility of MTX tox. unlicensed
folic acid
CALCINEURIN INHIBITORS- 2 Examples?
Ciclosporin
Tacrolimus
CICLOSPORIN/TACROLIMUS
How does it work?
inhibits lymphokines-> suppresses cell-mediated response
CICLOSPORIN/TACROLIMUS- MHRA WARNING?
PRESCRIBE AND DISPENSE BY BRAND NAME ONLY
CICLOSPORIN- SIDE-EFFECTS?
bit longer start
HYPER- glycaemia/uricemia/kalaemia/lipidaemia/tension
HYPO- magnesaemia
Renal/Liver Impairment
Skin Reactions
Gingival Hyperplasia
Hair changes (hirsutism)
Eye inflammation/vision Ls (topical)
CICLOSPORIN/TACROLIMUS- AVOID IN..?
4
PREGNANCY
BREAST-FEEDING
malignancy
uncontrolled hypertension/infections
CICLOSPORIN- INTERACTIONS
what juices can and cant you mix it with to improve taste
no grapefruit.
Can mix with orange/apple juice to improve taste
CICLOSPORIN- PRE-SCREENING?
Exclude malignancies
CICLOSPORIN- MONITORING & ADVICE?
Cameron Loves Money | Polly Loves Chanel Bags
Ciclosporin trough levels
LFT
Magnesium
Potassium
Lipids
CrCl
Blood Pressure
AVOID EXPOSURE TO UV/SUNLIGHT
TOPICAL? can affect driving/skilled etc
TACROLIMUS is also a calcineurin inhib- SIDE-EFFECTS?
HYPER-glycaemia+uricaemia/kalaemia
HYPO/HYPERtension
RENAL/LIVER IMPAIRMENT
SKIN REACTIONS
VISUAL DISTURBANCES
BLOOD DYSCRASIA
CVD (QT prolongation/cardiomyopathy in children)
Nervous system disorder/peripheral neuropathy
TACROLIMUS- INTERACTIONS? GP^2
Patient has hypersensitivity to macrolide?
GRAPEFRUIT/POMEGRANATE/POMELO juice- INCREASES tacrolimus levels
Patient has hypersensitivity to macrolide? DO NOT USE
TACROLIMUS- MONITORING & ADVICE?
Bob and Eve Baked Lovely Egg Cakes
Blood pressure
ECG
Blood glucose
LFT
Electrolytes
CrCL
AVOID EXPOSURE TO UV/sunlight
Driving/skilled L
MYCOPHENOLATE MOFETIL
How does it work?
Inhibits purine synthesis
its metabolised to mycophenolic acid which has a more selective mode of action than azathioprine.
MYCOPHENOLATE MOFETIL- RISKY SIDE-EFFECTS?
BONE MARROW SUPPRESSION->report infection/bruising/bleeding
PURE RED CELL APLASIA-> reduce dose/discontinue
HYPOGAMMAGLOBULINAEMIA-> measure immunoglobulin levels in recurrent infection
BRONCHIECTASIS-> persistent cough/SOB develops
MYCOPHENOLATE MOFETIL- MHRA CONTRACEPTION ADVICE (TERATOGENIC)
WOMEN?
MEN?
WOMEN? 1 effective contraceptive before+during+6 weeks after treatment (2 methods preferred)
MEN? during treatment+90 days after-> OR female partner
what drug used for prophylaxis of acute rejection in allogeneic renal transplantation. It is given with ciclosporin and corticosteroid immunosuppression regimens; its use should be confined to specialist centres.
basiliximab
what drug is fusion protein and co-stimulation blocker that prevents T-cell activation; it is licensed for prophylaxis of graft rejection in adults undergoing renal transplantation who are seropositive for the Epstein-Barr virus. It is used with interleukin-2 receptor antagonist induction, in combination with corticosteroids and a mycophenolic acid.
belatacept
