Immune-mediated disease in clinical practice – treatment options

Question 1

Nursing care is vital

Answer 1

assess pain, comfort and general condition of the patient

Question 2

Glucocorticoids - effects - cellular level

Answer 2

Associate with binding proteins - transcortin and albumin
after dissociation from binding proteins, passively diffuse into cell
Bind to a cytoplasmic receptor
Conformational change of receptor unmasks DNA binding domain - associates with GREs following nuclear translocation

Question 3

Glucocorticoids - Potential adverse effects - body systems

Answer 3

Central nervous system
Musculoskeletal system
Gastrointestinal tract
Fluid, electrolyte balance
Metabolic
Endocrine
Immune system

Question 4

Alkylating agents

Answer 4

Alkylate DNA, causing breaks in molecule and cross-linking of twin strands
Inhibit protein synthesis in resting cells, prevent
mitosis and kill dividing cells

Question 5

Alkylating agents - examples

Answer 5

Cyclophosphamide, ifosfamide, chlorambucil
Melphalan, mechlorethamine, nitrosoureas
Procarbazine, dacarbazine

Question 6

Alkylating agents - Chlorambucil

Answer 6

Rapidly metabolised to phenylacetic acid
Slowest acting, least toxic of all alkylating agents
Myelosuppression generally not observed until ≥ 1 month
Urinary and faecal excretion
Administered without food

Question 7

Alkylating agents - Azathioprine

Answer 7

Greater ↓of cellular than humoral immunity
Hepatic metabolism to activate
Compete with endogenous adenine and guanine - non-functional nucleic acid strands
Slow immunosuppressive effect?
Haematological, gastrointestinal, hepatic ± neuromuscular toxicity

Question 8

Alkylating agents - Vincristine, vinblastine

Answer 8

Bind to tubulin, blocking polymerisation
break down pre-formed microtubules – increased release of platelets (PLTs) from megakaryocytes
used in rx/ of ITP
Can be given as bolus IV, or to pre-load PLTs
Severe extra-vascular vesicants (irratation/blisters)
Haematological, GI, neurological toxicity

Question 9

Alkylating agents - Ciclosporin

Answer 9

Isolated from Cylindrocarpon lucidium + Trichoderma polysporum
IV and oral forms
Large volume of distribution - 1° hepatic metabolism
Therapeutic drug monitoring – acute and chronic
GI, renal, hepatic toxicity + hirsutism, gingival
hyperplasia, papillomatosis ± diabetogenic

Question 10

prednisone/prednisolone

Answer 10

synthetic glucocorticoid
used to treat infl + auto-immune disease
immune suppressants