Immune System And Malignant Disease Drugs Flashcards
Corticosteriods example
Dexamethasone
Hydrocortisone
Prednisolone
Corticosteriod mechanism of action
Corticosteriods prevent interleukin IL-1 and IL-6 production by macrophages. This causes inhibiton of all stages of T cell activation.
Corticosteriods indications
Urticaria
RA
SLE
Polymyalgia Rheumatica
Corticosteriods ADRs
Hypertension
Hyperkalaemia
Increased risk of osteoporosis
Corticosteriods drug interactions
Diuretics
Anti-epileptic drugs
Rifampicin
Azathioprine indications
IBD
RA
SLE
Azathioprine mechanism of action
Azathioprine inhibits purine synthesis. This occurs as azathioprine is cleaved to from 6-MP which is an anti-metabolite that decreases DNA and RNA synthesis. This causes decreased whitr blood cell production.
Azathioprine ADRs
Bone marrow supression
Increased risk of malignancy
Increased risk of infection
Hepatitis
Azathioprine drug interactions
Other immunosuppressants
Azathioprine pre-prescription test
TPMT activity test as the TPMT gene is highly polymorphic and in low levels of the gene there is a risk of myelosuppression.
Calcineurin inhibitors example
Ciclosporin
Tacrolimus
Calcineurin inhibitor indications
Used in transplantation
Atopic dermatitis
Psoriasis
Calcineurin inhibitor contra-indications
Renal impairment due to toxicity
Check BP and eGFR regularly
Calcineurin inhibitor drug interactions
Pomegranate juice
Calcineurin inhibitor ADRs
GI upset
Anxiety
Headache
Calcineurin inhibitor mechanism of action
The drugs bind to proteins and form complexes which bind to calcineurin. This inhibits production of IL-2 which works against helper T cell activation.
Mycophenolate mofetil drug class
Immunosuppressant
Mycophenolate mofetil indication
Used in transplantation
SLE
Vasculitis
Mycophenolate mofetil mechansim of action
The drug inhibits inosine monophosphate dehydrogenase which is required for guanosine synthesis. This impairs B and T cell proliferation. However other rapidilt dividing cells are spared.
Mycophenolate mofetil ADRs
GI upset
Bone marrow suppression
Headache
increased risk of infection
Cyclophosphamide indications
Lymphoma
Leukaemia
SLE
Wegener’s granulomatosis
Cyclophosphamide considerations
Significant toxicity -
Increased risk of bladder cancer
Infertility
Renal impairment
Methotrexate indications
RA
Malignancy
Psoriasis
Crohn’s disease
Methotrexate mechanism of action in malignancy
Methotrexate competitively and reversibly inhibits DHFR. This affects purine and thymidine synthesis and therefore inhibits synthesis of DNA, RNA and proteins.
Methotrexate ADRs
Mucositis
Marrow suppression
Hepatitis - cirrhosis
Infection risk
Methotrexate considerations
Methotrexate is highly teratogenic and abortifacient- induces abortion
Sulfasalazine indications
RA
Sulfasalazine mechanism of action
Inhibiton of T cell proliferation and inhibition of IL-2 production
Reduced chemotaxis and degranulation
Sulfasalazine ADRs
Myelosuppression
Hepatitis
Rash
Nausea an vomiting
Anti-TNF therapy effects
Decreased inflammation, angiogenesis and joint destruction
Anti-TNF therapy considerations
Risk of TB reactivation
