Immunosuppressants Flashcards

1
Q

Mycophenolate?

A
  • *Mike cooking chicken bones on BBQ - everyone gets gastro Sx, and can see bones (bone marrow suppression)
  • Depletes guanine nucleotides in T and B cell lymphocytes, inhibits proliferation - stops cell mediated response and antibody formation
  • Side effects:
  • GI upset - diarrhoea and vomiting
  • Leucopenia (low WCC) - (bone marrow suppression)
  • Anaemia
    Infectious
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2
Q

Tacrolimus?

A
  • Calcineurin inhibitor - inhibit calcineurin, impair transcription IL2 and others for T cells –> suppress T cells and T cell dependent B cell activation
  • Side effects:
  • Hyperglycemia/diabetes
  • Hypomagnesium
  • Neurotoxicity (seizures, tremors)
  • CYP450
    Does not increase cholesterol, ?UTD dyslipidemia
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3
Q

Tacro and cyclosporin?

A

Calcineurin inhibitors
* Triple M - metabolic syndrome (HTN, diabetes, hyperlipidemia)
* + cyclo (psycho - calling gorilla) - hyperplasia gingiva, hair

Both - Tacro and Cyclosporin
* Nephrotoxicity
* Hypertension
* Diabetes (more with tacro)
* Neurotoxicity
* Hyperkalemia
* Hypomagnesium
Dyslipidemia

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4
Q

Cyclosporin?

A
  • Acts on T helper cells, increased TGF beta
  • Side effects:
  • Gingival hyperplasia
  • Hirsuitism (most common with long term use)
  • Trichosis - hair
    Can cause IgA deficiency
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5
Q

Hydroxychloroquine (Plaquenil)?

A
  • Rheum, SLE, malaria
    Increases lysosomal pH in antigen presenting cells
  • Retinal toxicity - irreversible
  • Corneal toxicity - reversible
  • Long QT
  • Nausea - not GI ulcers
    Skin - hyperpigmentation
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6
Q

Methotrexate?

A
  • Inhibits dihydrofolate reductase leading to low folate and defective DNA synthesis and cell death
  • Nausea GI upset 25%
  • Liver toxicity 10-20% - dose reduction/with-hold if LFT persistent > 2 x ULN
  • Macrocytosis (folate deficiency) and bone marrow suppression
  • Stomatitis
  • Skin - macular punctate cutaneous eruption
  • CNS - headache, fatigue, malaise
  • Alopecia
  • Fever
  • Infection
  • Lung fibrosis

Monitoring
* Pre - CXR, PFTs
2 weekly FBE, LFT then reduce to 3 monthly

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7
Q

Azathioprine and 6 mercaptopurine?

A
  • 6MP impedes DNA synthesis - purine antagonist -blocks adenine and guanine
  • Thiopurines, anti-rejection agents in transplant
  • Inhibits proliferations of cells esp lymphocytes, down regulation immune system
  • Bone marrow toxicity 4% - dose dependent, occurs early, increased risk if TPMT deficient
  • Liver dysfunction 1-3%
  • GI upset
  • Pancreatitis 2-5%
  • Infection risk - VZV, measles, EBV
  • Malignancy - 4 x risk of lymphoma, sun related skin damage
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