Immunomodulators (long-term treatment) Flashcards
Azathioprine/mercaptopurine indication
Patients who failed 5-ASA tx
Patients who are refractory on steroids
Azathioprine/Mercaptopurine properties
Maintain remission–>little role in induction
Steroid sparing
Can be used in combo with other agents
Must be used for weeks-months to see results
Azathioprine/Mercaptopurine MOA
Azathioprine: prodrug rapidly converted to 6-MP to inhibit purine biosynthesis
6-MP: inhibits purine biosynthesis
Azathioprine/Mercaptopurine side effects
N/V/D
Fever, rash, arthralgia, pancreatitis
Anorexia, stomatitis, hepatotoxicity
Bone marrow suppression
Azathioprine/Mercaptopurine monitoring
TPMT
CBC/LFT: qweek for 1st month, q1-2 weeks, after dose change, q1-3 months after
Cyclosporine indication
inducing remission in refractory UC
patients who are refractory on steroids
Converting IV to PO
Double the IV dose divided into q12h dosing
Taper over several weeks if response
Cyclosporine side effects
Nephrotoxicity
Neurotoxicity
HTN, HLD, hyperglycemia
Gingival hyperplasia, hirsutism
Cyclosporine monitoring
BP
BUN/SCr: q2 weeks until stable
LFT: q2 weeks until stable
Cya trough conc.: goal 200-400 ng/mL, t1/2 24 hours
Cyclosporine drug interactions
CYP3A4 and PgP sustrates:
Increase conc.–> azoles, macrolide, CCB, grapefruit
Decrease conc.–> rifampin, phenytoin
Methotrexate indication
Inducing and maintenance of remission in CD
Methotrexate side effects
N/V/D
Fever, rash, alopecia
Mucositis, stomatitis, hepatitis/cirrhosis, pneumonitis
Bone marrow suppression–>add folic acid
Teratogenic–>contraception
Methotrexate contraindications
pregnancy
pulmonary effusions
chronic liver disease or EtOH abuse
Immunodeficiency
Preexisting blood dycrasias
Leukopenia/cytopenia
CrCl < 40 mL/min
Methotrexate monitoring
CBC–> q4-8 weeks
CXR
SCr–>q4-8 weeks
LFT–>q4-8 weeks
