immune system and malignant disease (medium) Flashcards
what the MOA of azathioprine and how is it broken down
antimetabolite which breakdown into mercaptopurine
this then inhibits repairmen’s and making of DNA
azathioprine is broken down by TPMT
How is myelosuppression observed with azathioprine
need to prescreen TPMT levels
underactiveTPMPT means azathioprine toxicity/ myelosuppresion
what are the side effects of azathioprine
hypersensitivity: fever, rash, hypotension, malaise, dizziness, myalgia = STOP
neutropenia and thrombocytopenia: sore throat, bruising, bleeding
nausea - common at start of treatment
teratogenic
monitoring of azathioprine
TPMT
regular LFT and FBC in severe renal and liver impairment
FBC weekly for the first 4 weeks then at least every 3 months
interactions of azathioprine and management
with allopurinol - increased risk of haematological toxicity - reduce dose of azathioprine
with ACE inhibitor - increased risk of anaemia and leukopenia - avoid use together
MOA of cyclosporin and tacrolimus
calcineurin inhibitor which inhibits lymphokines and suppresses cell mediated response
similarities and differences of cautions, side effects and monitoring or cyclosporin and tacrolimus
similarities:
- both must be brand specific
- both can cause hyperglycaemia, hyperuricaemia, hyperkalameia
- both cause renal/ liver impairment
- both cause skin reactions - rashes, toxic epidermal necrolysis
- both can cause visual disturbances and eye inflammation with topical use
- both should be avoided in pregnancy and breastfeeding
- both should avoid grapefruit juice and pomelo juice
- both avoid UV/ Sunlight
- avoid high potassium diet
differences:
- cyclosporin can cause hypomagesemia, hyperlipidaemia and hypertension unlike tacrolimus
- tacrolimus may cause hypo or hypertension
- tacrolimus can cause blood dyscrasia
- tacrolimus can cause CVD - arrhythmia, cardiomyopathy in children…
- tacrolimus can cause peripheral neuropathy/ nervous system disorders (headaches/ tremors…)
- ciclosporin can cause hair changes and hirsutism
- cyclosporin can cause gingival hyperplasia
- tacrolimus must also avoid pomegranate juice
- cyclosporin should avoid purple grape juice - decreases cyclosporin conc
- magnesium needs to be monitored with cyclosporin
- tacrolimus should not be used if hypersensitivity to macrolide
monitoring parameters for tacrolimus and ciclosporin
LFT, blood pressure, CrCl, blood glucose, electrolytes
ECG also required for tacrolimus
MOA for mycophenolate
inhibits purine synthesis
side effects of mycophenolate
bone marrow suppression: infection, bleeding, bruising
pure red cell aplasia: reduce dose or discontinue
hypogammaglobulinaemia: measure immunoglobulin in recurrent infections
bronchiectasis: SOB/ cough could indicate this
MHRA warning for mycophenolate
teratogenic
male: contraception needed during and 90 days after (for partner as well)
women: contraception needed during and 6 weeks after (2 methods preferred)
what are the 3 types of MS
relapsing, progressive and both
what is considered as active MS
2 relapses in the past 2 years despite treatment
management of symptoms of MS
spasticity: baclofen, diazepam, tizanidine, dantrolene
relapse: methykprednisolone
oscillopsia (objects vibrate): gabapentin
mood alteration: amitriptyline
fatigue: amatadine or fampridine
side effects and cautions of baclofen
can cause sedation and hypotonia (low muscle strength)
increase dose slowly to avoid major side effects