- Metabolised to mercaptopourine

1. HS 2. Bone marrow suppression 3. Nausea 4. Pancreatitis 5. Teratogenic

1. Nephro/neuro/ hepatotoxicity 2. Visual disturbances 3. Blood abnormalities: HYPERlipidaemia, HYPERtension, HYPERK, HYPOMg 4. Gingival hyperplasia 5. Blood disorders

IMMUNOSUPPRESSANTS Flashcards by Saaliha R

Types of immunosuppressants

Antiproliferative: AMM
Calcineurin-inhibitors: T/C
CS: prednisolone

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Azathioprine: MOA

Metabolised to mercaptopourine

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Azathioprine: Indication

Organ rejection
Auto-immune disease: IBD, RA, MG
Severe eczema

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Azathioprine: SE

HS
Bone marrow suppression
Nausea
Pancreatitis
Teratogenic

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Azathioprine: Monitor

TPMT
LFT
FBC weekly then 3 months

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Azathioprine: TPMT

Low TPMT = increased risk of myelosuppression

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Azathioprine: Interactions

Allopurinol: 1/4 dose of allopurinol
ACEi: anaemia, leucopenia

Allopurinol = XOI, inhibits purine metabolism = toxic levels of azathiop

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Azathioprine: Pregnancy

AVOID
- Specialist use only
- Premature birth
- Spontaneous abortion

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Mercaptopurine

Immunosuppressant and cytotoxic

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Ciclosporin: MHRA

BRAND!!!

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Ciclosporin: Indication

Organ/ bone marrow transplant
IBD, RA
Severe atopic dermatitis + psoriasis

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Ciclosporin: Pregnancy

AVOID

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Ciclosporin: SE

Nephro/neuro/ hepatotoxicity
Visual disturbances
Blood abnormalities: HYPERlipidaemia, HYPERtension, HYPERK, HYPOMg
Gingival hyperplasia
Blood disorders

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Ciclosporin: Interactions

Grapefruit + pomelo = increased ciclo
Purple grape juice = decreased ciclo
CRAP GPS (inducers)

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Ciclosporin: Counselling

Use SPF and avoid exposure to sunlight
Avoid grapefruit juice
Avoid high K diet

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Ciclosporin: Monitoring

LFT/ Renal
Lipids
BP
Mg, K

Tacrolimus: MHRA

ORAL = BRAND!!!

Tacrolimus: SE

Nephro/neuro/ hepatotoxicity
Visual disturbances
Blood abnormalities: HYPERglycaemia, HYPERtension, HYPERK, HYPERuricaemia
Cardiomyopathy
Blood disorders

Gout, diabetes

Tacrolimus: CI

Hypersensitivity to macrolides

Tacrolimus: Counselling

Avoid sunlight
Avoid grapefruit juice
Avoid high K diet
May affect driving

Tacrolimus: Monitor

Cp
Renal/ liver
BP
ECG
Blood glucose
K

Mycophenolate: MOA

Metabolises to mycophenolic acid

Mycophenolate: SE

Bone marrow suppression
Respiratory - bronchiestasis
Hyperglycaemia
Pure red cell aplasia
Hypogammaglobulinaemia

Mycophenolate: Pregnancy

PPP
- Exclude pregnancy before starting treatment (2 tests 8-10 days apart)
- Congenital malformation
- Spontaneous abortion

Mycophenolate: Contraception

Women: 1 effective method before during and 6 weeks after Men: effective cp during and for 90 days after

Mycophenolate: Monitor

- FBC every week for 4 weeks - then twice a month for 2 months - then monthly

Which vaccines should immunocompromised pt get

1. Measles 2. VZV AVOID: live