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308: Clinical Pharamacology & Therapeutics > Immunosuppressive and disease modifying drugs > Flashcards

Immunosuppressive and disease modifying drugs Flashcards

1
Q

Give three examples of DMARDs

A
  • Methotrexate
  • Penicillamine
  • Gold
  • Hydroxychloroquine and chloroquine
  • Salazopyrine
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2
Q

What are corticosteroids used for?

Give 5 conditions they are used to treat

A

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
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3
Q

Which diseases indicate the use of DMARDs

A
  • Rheumatoid and sero-negative arthritis
  • Psoriasis (methotrexate)
  • Lupus (hydroxychloroquine)
  • IBD (sulphasalazine)
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4
Q

Azathioprine is used as a steroid sparing agent in which conditions. What are these?

Side effects?

A
  • Rh arthritis (psoriatic arthritis)
  • SLE and vasculutides
  • IBD and CAH
  • Myaesthenia
  • Transplant patients

Nausea, vomiting, diarrhoea

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5
Q

Why is cyclophosphamide used?

For which diseases?

Risks?

A

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)

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6
Q

Why is cyclosporin used?

For which diseases?

Risks?

A

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

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7
Q

Which conditions are treated with chlorambucil?

A
  • Severe Rh arthritis
  • Vasculitides
  • Amyloid
  • Membranous nephritis
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8
Q

Which conditions are treated with colchine?

Side effects?

A
  • Gout
  • Behcets
  • Serositis (pericarditis, SLE, familial mediterranean fever)

Diarrhoea

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9
Q

What are the concerns of using thalidomide?

When might it be used?

A
  • Teratogenicity
  • Requires hospital monitoring
  • behcets
  • SLE
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10
Q

What are the short term risks of corticosteroid treatment?

A
  • hypokalaemia
  • fluid retention (prednisolone, dexamethasone, betamethasone)
  • glucose intolerance
  • mood disturbance
  • hypertension
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11
Q

What are the long term risks of corticosteroid treatment?

A
  • osteoporosis
  • diabetes and HTN
  • accelerated atherosclerosis
  • increased risk of infection, poor healing
  • steroid dependency
  • growth retardation (children)
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12
Q

Ocular toxicity is a side effect of which DMARDs?

A
  • Hydroxychloroquine and chloroquine
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13
Q

GI intolerance is a side effect of which DMARDs?

A
  • oral gold

- Sulphasalazine (SZP)

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14
Q

State the side effects of methotrexate?

A
  • Pulmonary fibrosis

- Renal toxicity

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15
Q

A rash is a side effect of which DMARDs?

A
  • Gold

- Penicillamine

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16
Q

What are the risks associated with immunosuppressive drugs?

A
  • increased susceptibility to infection
  • Bone marrow suppression (also in DMARDs)
  • Renal toxicity
  • Haemorrhagic cystitis
  • Nausea, vomiting, diarrhoea
17
Q

How should you start a patient on a prescription of these drugs?

A
  • Give two weeks supply to be collected from hospital pharmacy
  • Allows clear explanation of drug, risks and side effects
  • Ensured effective monitoring
18
Q

What monitoring is needed for patients on corticosteroids?

A
  • High doses (>40mg Prednisolone) should be given in hospital
  • Monitor electrolytes, fluid balance, BP, glucose
  • On low doses monitor BP and glucose
19
Q

What monitoring is needed for patients on DMARDs?

A
  • 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
20
Q

What monitoring is needed for patients on Chloroquine and hydrochloroquine?

A
  • Ocular examination required before treatment and 6 months and 1 year, then yearly
  • G6PD screening before start
21
Q

What monitoring is needed for patients on colchicine?

A
  • Not usually used long term
22
Q

What monitoring is needed for patients on thalidomide?

A
  • 6 monthly electomyogram studies

- contraceptive advice

23
Q

Are any of the following drugs safe for use in pregnancy/breastfeeding?

  • Antimalarials
  • Dapsone
  • Cyclosporin
  • Chlorambucil and cyclophosphamide
  • Thalidomide
  • Methotrexate
  • Gold
  • Prednisolone
  • Penicillamine
  • Sulphasalazine
A
  • 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

308: Clinical Pharamacology & Therapeutics (10 decks)

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