immunosuppressants Flashcards
azathioprine - SEs, monitoring and interactions
AZA - antimetabolite which breaks down into mercaptopurine - inhibits repairment of DNA
aza broken down by TPMT (thiopurine methyltransferase)
- pre-screening TPMT as underactive TPMT - myelosuppression
SEs:
hypersensitivity
neutropenia/thrombocytopenia - report sore throat, bleeding, bruising
nausea - more common at start
teratogenic - avoid in pregnancy
monitoring:
TPMT
regular LFT and FBC in renal/liver impairment
FBC weekly for first 4 weeks, then every 3 months
interactions:
azathioprine + allopurinol - increased risk of haematological toxicity
- reduce AZA dose
azathioprine + ACE-i - increased risk of anaemia/leucopenia
- avoid using together
ciclosporin SEs, monitoring, interactions
ciclosporin - calcineurin inihibitor - inhibiting lymphokines - suppresses cell mediated response
prescribed and dispensed by brand name
SEs:
hyper - glycaemia, lipidaemia, tension, uricemia, kalaemia
hypo-Mg
renal impairment
skin reactions
gingival hyperplasia
hair changes
eye inflammation and visual disturbance (in topical use w eyes)
avoid in pregnancy and breastfeeding
interactions:
grapefruit + pomelo juice - increases exposure
purple grape juice - decreases exposure
pre screening - exclude malignancies before systemic use
monitor - LFTs, Mg, K, lipids, CrCl, BP
avoid UV exposure
topical eye use may affect driving/skilled tasks
tacrolimus - SEs, monitoring, interactions
ciclosporin - calcineurin inihibitor - inhibiting lymphokines - suppresses cell mediated response
prescribed and dispensed by brand name
SEs:
hyper - glycaemia, uricemia, kalaemia
hypo or hypertension
renal/liver impairment
skin reactions
visual disturbances
blood dyscrasia
CVD (QT prolongation)
peripheral neuropathy
avoid in pregnancy/breastfeeding
interactions:
grapefruit + pomelo + pomegranate juice - increases exposure
monitor BP, ECG, blood glucose, LFT, electrolytes, CrClm
mycophenolate mofetil SEs, interactions, monitoring
inhibits purine synthesis
bone marrow suppression - report infection, bleeding, bruising
pure red cell aplasia - reduce dose, discontinue
hypogammaglobulinaemia - measure immunoglobulin levels in recurrent infections
bronchiectasis - consider if persistent cough/SOB develops
MHRA contraception advice:
- teratogenic
- women - 1 effective contraception during and 6 wks after (2 methods preferred)
- men - effective contraception during and 90 days after
