Immunosuppressants Flashcards

1
Q

What are some diseases that would need to be treated with immunosuppressants?

A

Immune Mediated hemolytic anemia (IMHA)
Immune mediated thrombocytopenia (IMTP)
Evans Syndrome (IMHA + IMTP)
Immune Mediated Polyarthritis (IMPA)
Inflammatory Bowel Disease (IBD)
Chronic Hepatitis (CH)
Glomerulonephritis (GN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some immunosuppressive Therapies?

A

Glucocorticoids, azathioprine, cyclosporine, chlorambucil, leflunomide, mycophenolate mofetil

Human IVIG
Vincristine
Blood, antiplatelet, anticoagulant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you select the right immunosuppressive therapy?

A

Expected course and prognosis
Concurrent Disease
Safety and Efficacy
Ease administration and monitoring client compliance
Cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which immunosuppressant is the first line of therapy, effective, rapid, cheap, decreased cytokines, antigen processing, Fc receptor, T-cell function?

A

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which drugs are commonly used glucocorticoids?

A

Prednisolone (no more
mg/day)
Dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some side effects of glucocorticoids?

A

PU/PD
Panting
Polyphagia
Muscle atrophy and weakness
Hyperadrenocorticism
Vacuolar hepatopathy
Infection, sepsis
GI ulceration
Hypercoagulability
Diabetes and CHF
Calcinosis Cutis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What changes in bloodwork are normal when steroids are being administered?

A

ALP much higher than ALT
ALP and GGT very high
Total bilirubin NEVER high
Indirect liver function normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When are steroids contradicted?

A

Diabetes mellitus
Infection
Hyperadrenocorticism
NSAID therapy (Wash out 24-48hr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When can glucocorticoids be discontinued?

A

Clinical remission
Reduce by 25% every 2-4 weeks
Discontinue or lowest effective dose
Avoid decreaseing other meds at same time
Relapse - immunosuppressive

Keep at starting dose until 1-2 weeks beyond resolution of abnormal parameter

-Can discontinue at low dose 0.25mg/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should you consider other therapies when using a steroid?

A

No or poor response
Relapse
Excessive side effect
Long duration therapy anticipated
Corticosteroids contraindicated

Drug availability, patient size, cost, adverse effect, efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a drug that is a good second line therapy that inhibits purine synthesis and lymphocyte proliferation and shoud not be used in cats due to myelosuppresion?

A

Azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some side effects to azathioprine?

A

Cytopenia’s, hepatotoxicity, chronic subclinical anemia, GI signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why may it be hard to monitor hepatotoxicity in animals on azathioprine?

A

They are probably concurrently on prednisone which will affect those values

-Increased ALT and bilirubin
Need to taper off
SAM E may prevent or reverse hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a second line immunosuppressant that can be used for IMHA, ITP, IBD, IMPA, hepatitis, meningoencephalitis, pemhpagus. It is a calcineurin inhibitor (decrease IL-2 synthesis). Impairs function of T-cell and blunt immune response. It is specific for lymphocytes.

A

Cyclosporine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the onset of cyclosporine?

A

Days to months

16
Q

What are some down sides to atopica (cyclosporine)?

A

Microemulsion improve bioavailability
Expensive
Generics not as good
Metabolize cytochrome P450
GI side effect
Gingival hyperplasia, hypertrichosis, shedding, papillomatosis, hepatotoxicity, nephrotocity
NOT Myelosuppressive
Opportunistic fungal infections

17
Q

What is another second line treatment more commonly used in cats and for chronic protein losing enteropathies in dogs?

A

Chlorambucil

18
Q

What is the MOA of Chlorambcuil and what’s the onset of action?

A

Alkylating agent antineoplastic
Immunosuppressive
Low onset of action (2-4 weeks)

19
Q

What are the downsides to chlorambucil?

A

Expensive
GI
Myelosuppressive
Alopecia, poor hair growth (poodle)
Neuro in cat

20
Q

What is another second line treatment or stand alone?I It inhibits de novo pyrimidine synthesis, reduced lymphocyte proliferation

A

Leflunomide

21
Q

What are the negatives of leflunomide?

A

Well tolerated
GI in appetence, vomiting
Myelosuppression
Cutaneous drug reaction
Hepatotoxicity

22
Q

What is a drug that could stand alone in stable disease or in combo with prednisone? It is reversible inhibitor of inosine monphospate dehydrogenase that inhibits purine sythesis and lymhpocyte proliferation

A

Mycophenolate mofetil

23
Q

What are some negatives to mycophenolate mofetil?

A

GI - diarre, vomit poor appetitie, myelosuppression and lymphoma (human)
2-3 week to start working

24
What are some pros of mycophenolate?
Low toxicity Tablet size Compounding Can stand alone
25
How do you monitor response to these drugs?
Improvement in signs and clinicopathologic abnormalities Initiate prednisone taper 25% 2-4 week Acceptable Maintenace dose or discontinue 2nd line drug tapered in similar manner (after)
26
What is human IVIG?
Adjutant therapy IV immunoglobulins IgG from human plasma
27
What is the MOA of IVIG?
? Block Fc receptor, eliminate pathogenic antibodies, inhibit complement, modulates cytokine synthesis
28
What can IVIG be used to help treat?
IMHA and ITP
29
What is vincristine?
Vinca Alkaloid Disrupt intracellular muctoubules Platelet carriers reduce platelet destrucito, increase platelet 3-5 days Shorten hospitalization
30
What are side effects of vincristine?
Minimal myelotoxic perivascular extravasation Neurotoxicity GI
31
What are some other supportive therapies?
Transfusions - RBC, Fresh whole blood, plasma, platelet
32
What types of drugs are used for thromboprophylaxis?
Antiplatelet Anticoagulant
33
What are some antiplatelet drugs?
Asprin and clopidogrel
34
What are some anticoagulants?
Herpin
35
What may cause poor response to therapy?
Misdiagnosis Underlying disease Patience Incorrect duration Side effects vs disease