IMMUNOSUPPRESSANTS

Question 1

Types of immunosuppressants

Answer 1

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

Question 2

Azathioprine: MOA

Answer 2

• Metabolised to mercaptopourine

Question 3

Azathioprine: Indication

Answer 3

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

Question 4

Azathioprine: SE

Answer 4

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

Question 5

Azathioprine: Monitor

Answer 5

• TPMT
• LFT
• FBC weekly then 3 months

Question 6

Azathioprine: TPMT

Answer 6

Low TPMT = increased risk of myelosuppression

Question 7

Azathioprine: Interactions

Answer 7

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

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

Question 8

Azathioprine: Pregnancy

Answer 8

AVOID
- Specialist use only
- Premature birth
- Spontaneous abortion

Question 9

Mercaptopurine

Answer 9

Immunosuppressant and cytotoxic

Question 10

Ciclosporin: MHRA

Answer 10

BRAND!!!

Question 11

Ciclosporin: Indication

Answer 11

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

Question 12

Ciclosporin: Pregnancy

Answer 12

AVOID

Question 13

Ciclosporin: SE

Answer 13

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

Question 14

Ciclosporin: Interactions

Answer 14

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

Question 15

Ciclosporin: Counselling

Answer 15

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

Question 16

Ciclosporin: Monitoring

Answer 16

• LFT/ Renal
• Lipids
• BP
• Mg, K

Question 17

Tacrolimus: MHRA

Answer 17

ORAL = BRAND!!!

Question 18

Tacrolimus: SE

Answer 18

1. Nephro/neuro/ hepatotoxicity
2. Visual disturbances
3. Blood abnormalities: HYPERglycaemia, HYPERtension, HYPERK, HYPERuricaemia
4. Cardiomyopathy
5. Blood disorders

Gout, diabetes

Question 19

Tacrolimus: CI

Answer 19

Hypersensitivity to macrolides

Question 20

Tacrolimus: Counselling

Answer 20

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

Question 21

Tacrolimus: Monitor

Answer 21

• Cp
• Renal/ liver
• BP
• ECG
• Blood glucose
• K

Question 22

Mycophenolate: MOA

Answer 22

Metabolises to mycophenolic acid

Question 23

Mycophenolate: SE

Answer 23

1. Bone marrow suppression
2. Respiratory - bronchiestasis
3. Hyperglycaemia
4. Pure red cell aplasia
5. Hypogammaglobulinaemia

Question 24

Mycophenolate: Pregnancy

Answer 24

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

Question 25

Mycophenolate: Contraception

Answer 25

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

Question 26

Mycophenolate: Monitor

Answer 26

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

Question 27

Which vaccines should immunocompromised pt get

Answer 27

1. Measles
2. VZV

AVOID: live