Immune System

Question 1

INT CYCLOSPORINE (imm suppressant, RA)

Answer 1

Metabolized by P450 enzyme system → MANY interactions

Question 2

S/E CYCLOSPORINE (imm suppressant, RA)

Answer 2

elevated BP
chronic interstitial nephritis
hypertrichosis
gum hyperplasia
burning hands and feet

Question 3

Red Flags CYCLOSPORINE (imm suppressant, RA)

Answer 3

Very narrow therapy window, Therapeutic Drug Monitoring

Question 4

What should be taken with Methotrexate?

Answer 4

Folic Acid

Question 5

Red Flags by condition and drug induced conditions: Autoimmune disease

METHOTREXATE CI

Answer 5

CI in liver disease

Question 6

Red Flags by condition and drug induced conditions: Autoimmune disease

INT Methotrexate

Answer 6

● Ethanol and acitretin (psoriasis med) may ↑ risk of liver injury
● Cholestyramine and colestipol may bind in the gut
● Trimethoprim may ↑ bone marrow suppression

Question 7

Red Flags by condition and drug induced conditions: Autoimmune disease

Drugs that cause psoriasis

Answer 7

● lithium
● beta blockers
● anti malarials
● NSAIDs (indomethacin)
● ACE inhibitors
● Terbinafine
● Abrupt w/d of oral corticosteroids or high potency topicals
● alcohol abuse

Question 8

Cyclosporine INTX WITH RIFAMPIN (AB) in autoimmune conditions

Answer 8

Rifampin will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative

Question 9

Red Flags by condition and drug induced conditions: Autoimmune disease

Methotrexate INTX WITH Trimethoprim

Answer 9

• trimethoprim, methotrexate. Either increases toxicity (FOLATE inhibitors) of the other by pharmacodynamic synergism.

Serious - Use Alternative.

Due to an additive antifolate effect, trimethoprim has been shown to rarely increase bone marrow suppression in patients receiving methotrexate.