Immunosuppressive and disease modifying drugs Flashcards
Give three examples of DMARDs
- Methotrexate
- Penicillamine
- Gold
- Hydroxychloroquine and chloroquine
- Salazopyrine
What are corticosteroids used for?
Give 5 conditions they are used to treat
Used in the suppression of inflammatory or allergic disorders
- Asthma and acute allergic reaction
- IBD
- Congenital adrenal hyperplasia (CAH)
- Rheumatic disease: RA, PMR, SLE, Vasculitis, Myositis
- Inflammatory renal disease: antiGBM, ANCA+, nephrotic syndrome
- Immunosuppression in transplantation
- Neuro disease: tumours, MS, myaesthenia
- Lymphomas, ITP, haemolytic anaemia, pemphigus and exfoliative
Which diseases indicate the use of DMARDs
- Rheumatoid and sero-negative arthritis
- Psoriasis (methotrexate)
- Lupus (hydroxychloroquine)
- IBD (sulphasalazine)
Azathioprine is used as a steroid sparing agent in which conditions. What are these?
Side effects?
- Rh arthritis (psoriatic arthritis)
- SLE and vasculutides
- IBD and CAH
- Myaesthenia
- Transplant patients
Nausea, vomiting, diarrhoea
Why is cyclophosphamide used?
For which diseases?
Risks?
To suppress inflammation and harmful antibody-production in patients with life threatening vasculitic illnesses
- SLE
- Vasculitis: Wegeners PAN, Behcets, Rh arth
Bone marrow suppression (just 10 days after IV use)
Why is cyclosporin used?
For which diseases?
Risks?
It is a fungal metabolite used to actively suppress the cell-mediated T cell immune response
- Transplant patients
- Prophylaxis of Graft v host
- Psoriasis and atopic dermatitis
- Rh arthritis
Renal toxicity
Which conditions are treated with chlorambucil?
- Severe Rh arthritis
- Vasculitides
- Amyloid
- Membranous nephritis
Which conditions are treated with colchine?
Side effects?
- Gout
- Behcets
- Serositis (pericarditis, SLE, familial mediterranean fever)
Diarrhoea
What are the concerns of using thalidomide?
When might it be used?
- Teratogenicity
- Requires hospital monitoring
- behcets
- SLE
What are the short term risks of corticosteroid treatment?
- hypokalaemia
- fluid retention (prednisolone, dexamethasone, betamethasone)
- glucose intolerance
- mood disturbance
- hypertension
What are the long term risks of corticosteroid treatment?
- osteoporosis
- diabetes and HTN
- accelerated atherosclerosis
- increased risk of infection, poor healing
- steroid dependency
- growth retardation (children)
Ocular toxicity is a side effect of which DMARDs?
- Hydroxychloroquine and chloroquine
GI intolerance is a side effect of which DMARDs?
- oral gold
- Sulphasalazine (SZP)
State the side effects of methotrexate?
- Pulmonary fibrosis
- Renal toxicity
A rash is a side effect of which DMARDs?
- Gold
- Penicillamine
What are the risks associated with immunosuppressive drugs?
- increased susceptibility to infection
- Bone marrow suppression (also in DMARDs)
- Renal toxicity
- Haemorrhagic cystitis
- Nausea, vomiting, diarrhoea
How should you start a patient on a prescription of these drugs?
- Give two weeks supply to be collected from hospital pharmacy
- Allows clear explanation of drug, risks and side effects
- Ensured effective monitoring
What monitoring is needed for patients on corticosteroids?
- High doses (>40mg Prednisolone) should be given in hospital
- Monitor electrolytes, fluid balance, BP, glucose
- On low doses monitor BP and glucose
What monitoring is needed for patients on DMARDs?
- FBC, lipid profile and urinalysis ay 1,2,4 and 8 weeks then every month for 3 months
- Patients who are well with no side effects on standard disease can be seen every 6-10 weeks
What monitoring is needed for patients on Chloroquine and hydrochloroquine?
- Ocular examination required before treatment and 6 months and 1 year, then yearly
- G6PD screening before start
What monitoring is needed for patients on colchicine?
- Not usually used long term
What monitoring is needed for patients on thalidomide?
- 6 monthly electomyogram studies
- contraceptive advice
Are any of the following drugs safe for use in pregnancy/breastfeeding?
- Antimalarials
- Dapsone
- Cyclosporin
- Chlorambucil and cyclophosphamide
- Thalidomide
- Methotrexate
- Gold
- Prednisolone
- Penicillamine
- Sulphasalazine
- Avoid Dapsone in 3rd trimester –> haemolysis
- oral gold is teratogenic
- avoid >10mg doses of prednisolone
- Avoid sulphasalazine in 3rd trimester (risk of neonatal haemolysis)
- Thalidomide and penicillamine are both teratogenic
