Immunosuppression

Question 1

Azathioprine - what is it and what does it breakdown which inhibits the repair ent and making of what?

Answer 1

Antimetabolite which breaks down into mercaptopurine which inhibits the repairment and making of DNA

Question 2

TPMT what is it broken down by? Why is prescreening advised?

Answer 2

Broken down by thiopurine methyltransferase
Pre screening TPMT levels is advice as under active TPMT - myelosuppression

Question 3

Side effects - TMPT side effect (4)

Answer 3

Hypersensitivity - malaise - dizziness, D,V,fever, rash, hypotension myalgia
Neutropenia and thrombocytopenia - report sore throat, bruising, bleeding
Nausea- more common at start of dose but resolves over time
Teratogenic - avoid in pregnancy

Question 4

Monitoring requirements - what are the requirements for monitoring TPMT??

Answer 4

Thiopurine methyltranferase TPMT
- Regular LFT and FBC in severe liver/renal impairment
- FBC weekly for first 4 weeks,then at least every 3 months

Question 5

Interactions OF Azathropine? The asssss

Answer 5

Azathioprine + allopurinol - increased risk of haematological toxicity
- reduce dose of Azathioprine

Azathioprine + ace I = increased risk of anaemia /leukopenia
- avoid concomitant use

Question 6

Cyclosporine - what is it and what is it described as?

Answer 6

Calcineurin inhibitor inhibiting lymphokines - suppress cell mediated response

Prescribed and dispensed by brand

Question 7

Side effects of cyclosporine

Answer 7

• hyper lipidemia, hyper tension, Hypo - mg
• renal /liver impairment
• skin reactions
  Gingival hyperplasia
  Hair changes
  Eye infla,,action and visual disturbance (in topical)
  Avoid in pregnancy and BF

Question 8

Interactions cyclosporine

Answer 8

Grape fruit and pomelo juice = increases cyclosporine exposure
- purple grape juice - decreases cyclosporine exposure

Question 9

Pre secreening

Answer 9

Excludes malignancies before systemic use

Question 10

Ciclosporin - monitor and avoid exposure to what? Topical eye???

Answer 10

LFT ,magnesium. Potassium. Lipids, crcl, blood pressure - trough levels need to be monitored - range depends on indication

Avoid exposure to UV light/sunlight
Topical (eye) use may effect driving/performing skilled tasks

Question 11

Tacrolimus

Answer 11

Calcineurin - inhibitor inhibiting lymphokines - suppresses cell mediated response

Question 12

Tacrolimus is prescribed…

Answer 12

Prescribed and dispensed by brand name

Question 13

Side effects of Tacrolimus

Answer 13

• hyper glycemia And HYPO/HYPER tension
• uricemia
• kalaemia
• renal/liver impairment
• skin reactions
  -visual disturbances
• blood dyscarasia
• cardiovascular disease - qt prolongation,cardiomyopathy in children
• nervous system disorder, peripheral neuropathy
• avoid in pregnancy and breast feeding

Question 14

Tacrolimus interactions - do not prescribe it if patients has hypersensitivity to what? What do we need to monitor? Avoid exposure to what

Answer 14

• grapefruit + pomegranate juice + pomelo juice - increases Tacrolimus exposure
• do not use if patient has hypersensitivity to macrolides
• monitor:blood pressure,ecg,blood glucose,LFT,electrolytes and crcl
• avoid exposure to UV light/ sunlight
• may effect driving/performing skilled tasks

Question 15

Mycophenolate Mofetil - what does it inhabit?what is a side effect? What does it cause? What is the MHRA Alert??

Answer 15

Inhibits purine synthesis
- bone marrow suppression - report infection or bruising or bleeding
- pure red cell aphasia - reduce dose or discontinue
- hypogammaglobulinaemia - measure immunoglobulin levels in recurrent infections
- bronchiectasis - consider if persistent cough and SOB develops

MHRA contraception advice - teratogenic:
- women : 1 effective contraception during and 6 weeks after (2 methods preferred)
- men: effective contraception during 90 days after (for partner too)