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
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
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
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
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
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
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