IMMUNOSUPPRESSANTS Flashcards
Types of immunosuppressants
Antiproliferative: AMM
Calcineurin-inhibitors: T/C
CS: prednisolone
Azathioprine: MOA
- Metabolised to mercaptopourine
Azathioprine: Indication
- Organ rejection
- Auto-immune disease: IBD, RA, MG
- Severe eczema
Azathioprine: SE
- HS
- Bone marrow suppression
- Nausea
- Pancreatitis
- Teratogenic
Azathioprine: Monitor
- TPMT
- LFT
- FBC weekly then 3 months
Azathioprine: TPMT
Low TPMT = increased risk of myelosuppression
Azathioprine: Interactions
- Allopurinol: 1/4 dose of allopurinol
- ACEi: anaemia, leucopenia
Allopurinol = XOI, inhibits purine metabolism = toxic levels of azathiop
Azathioprine: Pregnancy
AVOID
- Specialist use only
- Premature birth
- Spontaneous abortion
Mercaptopurine
Immunosuppressant and cytotoxic
Ciclosporin: MHRA
BRAND!!!
Ciclosporin: Indication
- Organ/ bone marrow transplant
- IBD, RA
- Severe atopic dermatitis + psoriasis
Ciclosporin: Pregnancy
AVOID
Ciclosporin: SE
- Nephro/neuro/ hepatotoxicity
- Visual disturbances
- Blood abnormalities: HYPERlipidaemia, HYPERtension, HYPERK, HYPOMg
- Gingival hyperplasia
- Blood disorders
Ciclosporin: Interactions
- Grapefruit + pomelo = increased ciclo
- Purple grape juice = decreased ciclo
- CRAP GPS (inducers)
Ciclosporin: Counselling
- Use SPF and avoid exposure to sunlight
- Avoid grapefruit juice
- Avoid high K diet
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
- Measles
- VZV
AVOID: live
