Immunosuppression & Disease Modifying Therapy Flashcards
Name the 4 features of RA on x-rays.
- joint space narrowing
- juxta-articular bony erosions
- sublaxation and gross deformity
- periarticular osteopenia
What is methotrexate used for?
- Rheumatoid arthritis
- Crohn’s disease
- malignancy
- abortion of ectopic pregnancies
What is the MOA of methotrexate in malignancy?
Competitively inhibits dihydrofolate reductase, inhibiting DNA, RNA and protein synthesis.
What is the MOA of methotrexate in non-malignant disease?
- inhibition of T cell activation
- inhibition of accumulation of adenosine
- deactivation of enzymes involved in immune system function
Name some side effects of methotrexate.
- hepatitis
- cirrhosis
- infection risk
- highly teratogenic - can’t get pregnant on methotrexate
What are ciclosporin and tacrolimus used for and what is their MOA?
Calcineurin inhibitors - immunosuppressants.
Prevent production of IL-2 via calcineurin inhibition, therefore inhibiting helper T-cells.
What are azathioprine, mycophenolate mofetil and cyclophosphamide used for?
Antiproliferative immunosuppressants - decrease DNA, RNA, T cell and B cell synthesis.
What is azathioprine used for?
What is important about its pharmacodynamics?
- anti-rejection drug in transplant, maintenance therapy for SLE and vasculitis
- metabolised by TPMT - TPMT gene is highly polymorphic therefore TPMT activity can vary in individuals, before prescribing this drug a TPMT test should be done
What is significant about the immunosuppressant cyclophosphamide?
Excreted by the kidneys, but one of its metabolites is toxic to bladder epithelium and can lead to haemorrhagic cystitis. This can be prevented by giving Mesna.
What is a ‘steroid-sparing’ drug?
Helps reduce the amount of steroid that is needed, helping to reduce side effects from steroids.
How often should methotrexate be given?
Weekly NOT DAILY, since it has such a long half-life.
How is methotrexate excreted?
Renally - kidney function should be monitored by regular blood tests.
What is sulfasizine used for and what is its MOA?
Non-biologic DMARD used for RA, Crohn’s.
MOA-inhibits proliferation of T cells.
What is the MOA of anti-TNF agents used as DMARDs?
TNF-alpha inhibitors - decreases inflammation and joint destruction.
What is rituximab used for and what is its MOA?
Used for RA
Depletes B-cells
