Immunosuppressive and DMDs Flashcards
Corticosteroids indications
Suppression of inflammatory/ allergic disorders.
- Asthma
- IBD
- CAH
- Rheumatic disease
- Immunosuppression in transplantation
- Neurological disease
- Cancer
DMARDs exampes
Methotrexate
Penicillamine
Salazopyrine
Hydroxychloroquine/ chloroquine
Azathioprine
- Mechanism/ drug class
- Indications
- Side effects
DMARD
- Purine inhibitor= stops DNA, RNA synthesis for WBCs.
Indications
- RA (not responding to other DMARDs)
- SLE
- Vasculitidies
- MG
- IBD, CAH
- Transplant
Side effects
- Nausea, vomiting and diarrhoea
- BM suppression, increased infection risk, thrombocytopenia
Cyclophosphamide
- Mechanism/ drug class
- Indications
- Side effects
Chemotherapy agent/ Immunosuppression
Indications
- Severe vasculitis (Wegner’s, Behchet’s, RA)
- SLE
- Leukaemia, lymphoma
Side effects
- Haemorrhagic cystitis
- BM suppression
- Increased infection risk
- Not suitable for pregnancy
Cyclosporin
- Mechanism/ drug class
- Indications
- Side effects
Immunosuppressant
- suppresses T cell activity
Indications
- Transplant patients: renal, liver, marrow, pancreas
- Graft vs host prophylaxis
- Psoriasis, atopic dermatitis
- RA
Side effects
- Renal toxicity
- BM suppression
- Increased risk of infection
- Not suitable for pregnancy
Chlorambucil
- Mechanism/ drug class
- Indications
Chemotherapy
- Interrupts DNA replication
- Immunosuppression
Indications
- Severe RA
- Vasculitis (cyclophosphamide replacement)
- Not suitable for pregnancy
Colchicine
- Mechanism
- Indications
Anti-inflammatory/ immunosuppresant
- Decreases inflammatory processes
Indications
- Gout
- Bechet’s
- Serositis
Thalidomide
- Indications
- Myeloma
- Graft v host disease
- SLE
- Bechet’s
Not suitable for pregnancy
Short term side effects of corticosteroids
Hypokalaemia
Fluid retention
Glucose intolerance
Mood disturbance
Hypertension
Long term side effects of corticosteroids
Osteoporosis
DM and HTN
Increased risk of infection/ poor healing
Growth retardation in children
Methotrexate
- Mechanism/ drug class
- Indications
- Side effects
Chemotherapy/ immunosuppressant
- Inhibition of DNA synthesis
Indications
- RA
- Crohn’s
- Cancer
- Psoriasis
Side effects
- Not suitable for pregnancy
- Renal toxicity
- pulmonary fibrosis
- BM suppression
Hydroxychloroquine and chloroquine adverse effects
Ocular toxicity
Monitoring of corticosteroids
For high doses (>40)
- U+Es
- Fluid balance
- BP
- Gucose
Low doses
- BP
- Glucose
Monitoring of DMARDs and aziathioprine
At weeks 1, 2, 4, 8 then 4 weekly for 3 months.
- FBC
- Bone profile?
- Urinalysis
If well, seen 6-10 weekly
Monitoring of chloroquine and hydroxychloroquien
Ocular examination before treatment
- G6PD screening
after treatment
- 6 months
- 1 year
- The yearly
