Immunosuppressant

Question 1

what are immunosuppressant

Answer 1

• dampen immune response
• use in transplant rejection
• tx autoimmune condition i.e. ra, lupus chrons UC

Question 2

Name antiproliferatives

Answer 2

azathioprine (used when treatment not alone managed by corticosteroid)
- mercaptopurine - prodrug of aza
- mycophenolate- metabolise to mycophencolic acid (longer DOA than aza)

Question 3

what drug given with mercapto to reduce dose

Answer 3

allopurinol

Question 4

what risk of immunosuppressants

Answer 4

avoid live vaccine inc risk of infection

Question 5

calcineurin inhibitors example

Answer 5

ciclosporin and tacrolimus

Question 6

immunosuppressant list

Answer 6

calcineurin inhibitor
anti-proliferative
other
betalacept
man’s
sirolimus
corticosteroid
antithymocyte immunoglobulin

Question 7

azathioprine moa

S/e counsel/ interaction

Answer 7

inhibit purine synthesis; DNA rna replicaation inhibit

increase risk of infection due to bone marrow suppression
test for TPMT enzyme if its too low aza wont be metabolised

s/e
1) blood dyscrasia
2) pancreatitis
3)hypersensitivity
4)nausea
consul; take with or after food; as nausea (anti-emetic temp reduces the dose)

interaction; allopurinol dose reduced with Aza, as causes allopurinol toxicity

Question 8

mycophenolate mofetil moa

Answer 8

inhibit guanosine synthesis therefore DNA RnA prod

Question 9

mycophenolate s/e

Answer 9

1) blood dyscrasia
2) hypoglobulinaemia (low IG) = INC infection risk
3) bronchiectasis / pulmonary fibrosis
4) gI disturbances (ulceration perforation)

Question 10

pregnancy

Answer 10

causes miscarriages; genotoxic
must be on PPP
exclude pregnancy via 2 tests before hand
at least 1 effective contraception up until 6 weeks after stopping

for male and female EFFECTIVE CONTRACEPTION UP UNTIL 90 days of stopping drug

Question 11

Tacrolimus moa

Answer 11

inhibits calcineurin which activates T cells

Question 12

s/e of tacrolimus

Answer 12

1) blood disorders
2) nephrotoxic
3) increase hyperkalemia and hperglycaemia ( go hand in hand)
4) photosensitivity -avoid tan and sunbed use high spf
5) cardiomyopathy (hyperthropic change)

Question 13

oral tacrolimus prescribing

Answer 13

prescribe by brand name and dispense (diff bioavailability )

Question 14

what is tacrolimus metabolised by

Answer 14

CYP450

Question 15

Interaction of tacrolimus

Answer 15

increase toxicity (enzyme inhibitors)+ grapefruit juice SICKFACES.COM
therapeutic failure- scrap gp (inducers)
nephrotoxicity increase- carnival camp
increase hyperkalemia = had beans

Question 16

CARNIVAL CAMP

Answer 16

calcineurin inhibitor cisplatin
ace I and arbs amphoterin b
radiocontrastb mtx
nsaid penicillin
ifosfamide
vancomycin
aminoglycoside
lithium

Question 17

had beans

Answer 17

heparin
acei arbs
digoxin
beta blockers
eplerenone
amilorde
nsaid
spironolactone
(trimethoprim)

Question 18

ciclosporin moa

Answer 18

blocks calcineurin, inhibit T cell activation

Question 19

s/e ciclosporin

Answer 19

1) blood dyscrasia monitor FBC
2) hyperkalaemia/ glycaemia monitor electrolyte and fluid
3) nephrotoxic monitor RFT
4) gingival hypersensitivity

prescribe by brand and dispense

Question 20

food interaction with ciclosporin

Answer 20

avoid pomelo and grapefruit juice