Immunosuppressants

Question 1

Azathioprine (Imuran)

Answer 1

A) Immunosuppressant (Purine Antimetabolite)

B)

1. Rheumatoid Arthritis (mod-severe)
2. Prevention of organ transplant REJECTION
3. Inflammatory BOWEL disease
4. SLE
5. ATOPIC dermatitis
6. Other immune and inflammatory diseases

C)
Loading: <5 mg/kg
Usual: 1-3 mg/kg

D)

1. Infection***
2. Complete BLOOD Count (myelosuppression)
3. Serum CREATININE (reduce dose)
4. Liver AMINOTRANSFERASES (lower doses)
5. IMPROVEMENT (stop if no improvement within 6 months)

E)
Labels: 8, 21, A* (Swallow whole), B (with FOOD - reduce stomach upset)
#Taking tablets with FOOD may help to reduce stomach upset
#Avoid excessive SUN exposure
**DR - persistent fever, sore throat, bruising, bleeding or paleness
S/E
*INFECTION
*GIT (diarrhoea, anorexia, nausea and vomiting, mouth ulceration and oesophagitis)

Question 2

Cyclosporin (Neoral)

Answer 2

A) Immunosuppressant OR Calcineurin Inhibitor

B)

1. Rheumatoid Arthritis (mod-severe)
2. Prevention of transplant-REJECTION
3. NEPHROTIC syndrome
4. PSORIASIS or ATOPIC dermatitis

C)
2.5 - 15 mg/kg (in 2 doses)

D)

1. TDM***
2. Complete BLOOD count
3. BP (hypertension)
4. POTASSIUM (hyperkalaemia)
5. INFECTION
6. NEUROTOXICITY*** (tremor and headaches, paraesthesia, confusion, seizures)
7. Renal NEPHROTOXICITY***
8. TEETH and GUMS (gingerval hyperplasia)
9. Hepatic function

E)
Labels: 5, 8, 9, 18, 21, A*
#Take doses 12 hours apart
#Clean your teeth and gums regularly
**DR - signs of infection
S/E
*GINGERVAL HYPERPLASIA
*GIT (nausea and vomiting, diarrhoea)
*MOTOR (shakiness, tiredness)
*NEUROPATHY (burning sensation in hands and feet)

Question 3

Leflunomide (Arava)

Answer 3

A) Immunosuppressant

B)

1. Rheumatoid Arthritis
2. Psoriatic Arthritis

C)
10-20 mg ONCE daily

D)

1. CONTRACEPTION (women)** (continue for some months after stopping)
2. INFECTION**
3. HYPERSENSITIVITY
4. BP (hypertension)
5. Complete BLOOD Count
6. Renal
7. Hepatic (raised AMINOTRANSFERASE)
8. PERIPHERAL NEUROPATHY

E)
Labels: 21, A (swallow WHOLE)
#Do not drink ALCOHOL - can increase the risk of liver damage
#Check with your doctor before receiving some VACCINES
**DR - Numbness or tingling in your fingers or toes
**DR - (Steven-Johnsons) Mouth ulcer, skin problems,
**DR - (pneumonia) cough, and difficulty breathing,
**DR - (infection) persistent fever, sore throat
**DR - (hepatitis) unusual tiredness, bruising, bleeding, paleness, abdo pain or yellowing of the skin
S/E
*GIT (abdo pain, diarrhoea, nausea and vomiting)
*HAIR (hair loss)

Question 4

Methotrexate

Answer 4

A) Folic acid antagonists OR Immunosuppresant

B)

1. Rheumatoid Arthritis (mod-severe)
2. Juvenile Idiopathic Arthritis
3. Psoriasis
4. Crohn’s Disease
5. Ectopic Pregnancy
6. Polymyositis and Dermatomyositis

C)
2.5 - 30 mg/week

D)

1. Complete BLOOD count (myelosuppression)**
2. CHEST X-Ray (Pulmonary toxicity)**
3. Infection
4. Compliance (Once a week)
5. LIVER (hepatoxicity)***
6. Concentration monitoring
7. Renal

E)
Labels: 5, 8, 10a, 20 (once a week), 21, A*
#Take tablets strictly as directed. Taken ONCE A WEEK on the same day each week
#Neoplastic indications: Take tablets on an EMPTY STOMACH with a glass of water 1hr before and 2hrs after food
#Rheumatoid Arthritis: Takes time to work (1-2 months before a noticeble difference)
**DR - (pulmonary toxicity) cough, difficulty breathing
**DR - signs of an infection
S/E
*GIT (nausea and vomiting)
*SKIN (rash)

Question 5

Hydroxychloroquinine (Plaquenil)

Answer 5

A) Immunomodulator (aminoquinoline antimalarial)

B)

1. Rheumatoid Arthritis
2. Discoid and SLE
3. Malaria (tx)
4. Juvenile idiopathic arthritis

C)
200-800 mg daily (1 or 2 doses)

D)

1. OCULAR toxicity***
2. Complete BLOOD Count (myelosuppressive)
3. Blood GLUCOSE (reduces HbA1c)
4. Renal
5. Hepatic

E)
Labels: 8 (delete skin), 21, A (swallow whole), B (with FOOD)
#Take this medicine with FOOD or a glass of MILK to reduce stomach upset
#This medicine may cause dizziness and blurred vision; if affected, do not drive or operate machinery
#RA: takes time to work; 4-12 weeks before noticing any difference
#When in bright light; wear SUNGLASSES
**DR - difficulty with your sight, particularly seeing entire words or faces, reduced vision at night, intolerance of bright light or changes in colour