Immune response

Question 1

what do immunospuressent drugs do

Answer 1

suppress rejection in organ transplant and treat chronic inflammatory and autoimmune conditions

Question 2

calcinuerin inhibitors

Answer 2

cyclosporin and tacrolimus

Question 3

corticosteroids use

Answer 3

e.g. prednisolone

prevent rejection and in high doses to treat rejection episodes

Question 4

sirolimus

Answer 4

is a non-calcineurin inhibiting immunosuppressant licensed for renal transplantation.

Question 5

can immunosuppressants impair immune response

Answer 5

modify tissue reactions resulting in a rapid spread of infection

Question 6

immunisation or booster doses should be given ..

Answer 6

before immunosuppressive drugs used or deferred until an improvement in immunity

Question 7

cyclosporin side effects.

Answer 7

inc risk of infections, fever, headache, nausea and vomiting, diarrhoea , gingival hyperplasia , hypertension , paraesthesia and hepatic disorders

Question 8

monitoring

Answer 8

serum potassium, lFT, serum magnesium

blood lipids before and after 1st month

Question 9

if a patient taking cyclosporin experiences raised blood pressure that can’t be controlled by antihypertensives, what should be done?

Answer 9

discontinue treatment

Question 10

should ciclosporin be prescribed by brand

Answer 10

yes - diff brands

Question 11

ciclosporin interactions

Answer 11

pomegranate and grapefruit juice

Question 12

immunoglobulins

Answer 12

normal immunoglobulin administration should be considered as soon as possible after measles exposure, and varicella-zoster immunoglobulin or an antiviral [unlicensed] may be required for individuals exposed to varicella (chickenpox) or herpes zoster (shingles); for further information, see

Question 13

Tacrolimus vs ciclosporin

Answer 13

Tacrolimus is also a calcineurin inhibitor. Although not chemically related to ciclosporin it has a similar mode of action and side-effects, but the incidence of neurotoxicity appears to be greater; cardiomyopathy has also been reported. Disturbance of glucose metabolism also appears to be significant.

Question 14

immunosuppressed patients with measles should

Answer 14

Intravenous or subcutaneous normal immunoglobulin may be given to prevent or attenuate an attack of measles in individuals who do not have adequate immunity. Patients with compromised immunity who have come into contact with measles should receive intravenous or subcutaneous normal immunoglobulin as soon as possible after exposure. It is most effective if given within 72 hours but can be effective if given within 6 days.

Question 15

side effects of tac

Answer 15

headache diarrhoea , dizziness , blurred vision, inc risk of infection,
cardiomyopathy when trough conc is much higher than max recommended

Question 16

monitoring if Tacrolimus

Answer 16

Monitor blood pressure, ECG (for hypertrophic changes—risk of cardiomyopathy), fasting blood-glucose concentration, haematological and neurological (including visual) and coagulation parameters, electrolytes, hepatic and renal function.

Question 17

interactions

Answer 17

grapefruit , pomelo, and pomegranate

Question 18

should Tacrolimus be prescribed by brand

Answer 18

oral Tacrolimus should be

Question 19

which immunosuppressant is teratogenic

Answer 19

Tacrolimus, avoid getting pregnant and

Question 20

how to take Tacrolimus

Answer 20

on an empty stomach an hour before food or two hours after

Question 21

drugs used to treat IBD

Answer 21

Azathioprine, ciclosporin, mercaptopurine, and methotrexate have a role in the treatment of inflammatory bowel disease.