Immune system + transplantation Flashcards
Examples of calcineurin inhibitors
ciclosporin and tacrlimus
What is azathioprine metabolised to?
Mercaptopurine
If allopurinol is given alongside azathioprine what needs to be considered?
Dose reduction of Azathioprine
What disease is ciclosporine used prophylactically for?
graft vs host disease
Neurotoxicity, cardiomyopathy and disturbance to glucose metabolism is associated with whihc calcineurin inhibitor?
tacrolimus
What needs to be prescribed prior to adminstration of antithymocyte immunoglobulin?
pre-treatment with paracetamol, anti histamine and corticosteroid
If a patient has absent TMPT activity, can they have azathioprine?
No - contraindicated
3 main side effects of azathioprine
- Hypersensitivity reactions - malaise, fever, vommiting diarrhoea
- Neutropenia + thrombocytopenia - dose dependent
- nausea - managed by dividing doses, giving after food + antiemetics
What pre treament screening is required before starting azathioprine?
TPMT
If a patient has reduced TPMT activity, what is the risk?
myleosuppression
Monitoring requirements for Azathioprine
FBC weekly for first 4 weeks then 3 monthly
MHRA warning regarding ciclosporin
Must be prescribed by brand name
Can a patient with uncontrolled HTN + active infection have ciclosporin?
no - contra indicated
Side effects of ciclosporin
Gingival hyperplasia, headaches, apetite decreaase, hyperglycaemiahyperlipidemia, HTN,
Monitoring requirements for ciclosporin
- ciclosporin level (trough)
- BP,
- renal function
- LFT
- serum potassium
- serum magnesium
- lipids - baseline and at 1 month
What should patients be counselled on regarding their skin when on sicrolimus
void excessive exposure to UV light
What is the MHRA warning regarding Tacrolimus?
prescribe and dispense as brand name only
Adoport, prograf, capexion and tacni are what form of tacrolimus capsules?
Immediate release BD capsules
Advagraf is what form of tacrolimus medication
Modified release taken OM
True or false - tacrolimus can cause QT prolongation?
true
Why is echocardiography needed for patients on tacrolimus?
risk of cardiomyopathy
Belimumab has an MHRA warning about what?
increased risk of serious psychiatirc events
What is the contraceptive advice regarding mycophenolate?
mycophenolate is genotoxic - females need pregancy to be ruled out before treatment. 2 tests required 8-10 days apart. Women need at least 1 form of contraception and for 6 weeks on discontinuation
Monitoring requirement for mycophenolate
FBC for 4 weeks then twice a month for 2 months then every month for the first year
Low levels of what vitamin are a risk factor for developing MS?
vitamin D
What medication is sometimes used to treat fatigue associated with MS?
Amantadine
What is the first line treatment of Oscillopsia in MS?
Gabapentin
What should patients receive prior to anti lymphocyte antibodies?
pre medication to reduce risk of infusion related side effects
If a patient is prescribed Alemtuzumab, what condition do they requrie prophylaxis medication for?
Herpes infection
Nataliumab is associated with what neurological condition?
PML - progressive multi focal leukonencepthalopathy MRI required before initiation
What food interaction should patients be aware of with ciclosporin?
Pomelo/grapefruit juice - increases Ciclosporin levels
Purple grape juice decreases levels
How often dose ciclosporin levels need to be taken?
Every weel until stable for 6 weeks then monthly
What is a risk when a patients cholesterol is < 3 and they are on ciclosporin
toxicity
What is the MHRA warning associated with giving Bevacizumab and Sunitinib?
Risk of ONJ
What should be measured if hypogammaglobinaemia is suspected following mycophenolate use?
serum immunoglobulin
Men must use a condom for how many days after completing mycophenolate course?
90 days
EGFR inhibitors have an MHRA warning about what?
serious cases of keratitis and ulcerative keratitis
Brand name for Trastuzumab
Herceptin
What is the main risk with herceptin therapy
Cardiotoxic - need to monitor function before and during treatment
What hepatic condition can RTX reactivate
Hep B
