Immunosuppression Flashcards
Describe Rheumatoid Arthritis. (3)
An autoimmune inflammatory condition initially localised to the synovium before spreading to the dissolution of bone and cartilage.
Describe the causes of RA. (2)
Increased amount of pro-inflammatory cytokines (IL-1, IL-6, TNF-alpha) compared to anti-inflammatory ones.
Describe the symptoms of RA. (5)
Morning stiffness for over an hour Swelling of over 3 joints Rheumatic nodules Serum rheumatoid factor or anti-CCP antibodies X Ray changes
Describe the treatment goals of RA. (2)
Relieve symptoms
Prevent joint destruction
Describe the treatment goals for SLE and vasculitis. (3)
Relieve symptoms
Reduce mortality
Prevent organ damage from disease process or therapies
Describe the MoA of azathioprine. (2)
Antiproliferative immunosuppressant - interferes with DNA / RNA synthesis.
Describe the use of azathioprine. (3)
SLE
Vasculitis
IBD as maintenance therapy
Describe the consideration that need to be made when prescribing azathioprine. (3)
It is metabolised by the TPMT gene, which is highly polymorphic, so just test TPMT levels before prescribing.
Describe the adverse effects of azathioprine. (4)
Bone marrow suppression - monitor FBC
Increased risk of malignancy esp in transplant
Increased risk of infection
Hepatitis - monitor LFTs
Name two calcineurin inhibitors. (2)
Describe their MoA (2)
Ciclosporin
Tacrolimus
Inhibits calcineurin, which normally activates T cells through IL-2
Describe the common uses for calcineurin inhibitors. (4)
Widely in transplants, atopic dermatitis, psoriasis.
Less common in rheumatology.
Describe the main ADR of calcineurin inhibitors. (2)
Renal toxicity. Need to monitor BP and eGFR regularly.
Describe the metabolism of calcineurin inhibitors, and why this is important. (2)
CYP450 metabolised
DDIs common.
Describe the MoA for mycophenolate mofetil. (4)
Antiproliferative immunosuppressant that inhibits an enzyme used in guanine synthesis, so impairs B and T cell proliferation, but spares other cells due to their guanine salvage pathways.
Describe the common uses for mycophenolate mofetil. Explain why is might not be first choice. (3)
Induction therapy in SLE and vasculits.
Takes 6 weeks to kick in fully.