Immunosuppressive drugs Flashcards
is azathioprine a drug or prodrug
prodrug (activated in the body)
what should you not prescribe with azathioprine?
allopurinol because allopurinol inhibits xanthine oxidase, the enzyme that metabolises azathioprine. This leads to toxicity of azathioprine and bone suppression
what are the SEs of azathioprine?
• Bone marrow suppression • Anaemia • Nausea and vomiting • Alopecia Pancreatitis
what is a characteristic of azathioprine that you need to consider?
carcinogen/teratogen
what would you see in a patient who is on immunosuppressive drug?
may see signs such as ulcers as immunosuppressive drugs slow cell turnover. So you are worried about the mouth ulcers or mucositis, and GIT tract disturbances
since immunosuppressive drugs suppress the bone marrow, what would you want to ask about?
platelet function, immunity and blood count.
how would you ask about platelet function?
bleeding gums from brushing teeth, and epistaxis
what skin infections might you see in immunocompromised patients?
boils, folliculitis, abscess
what do we use methotrexate for?
RA, crohn’s, psoriasis, cancer
what are the two types of calcineurin inhibitors? How do they work?
Cyclosporin and tacrolimus. They both inhibit IL2 production and action, consequently reducing Tcell proliferation
SE of calcineurin inhibitors?
alopecia, tremor, hirustism, nephrotoxicity
what do you need to monitor with tacrolimus?
BP BSL Potassium levels Cholesterol levels LFTs
how do glucocorticoids mediate immunosuppression?
Glucocorticoids are immunosuppressant chiefly because, they restrain the clonal proliferation of Th cells, through decreasing transcription of the gene for IL-2. However, they also decrease the transcription of many other cytokine genes (including those for TNF-α, IFN-γ, IL-1 and many other interleukins) in both the induction and effector phases of the immune response. The synthesis and release of anti-inflammatory proteins (e.g. annexin 1, protease inhibitors, etc.) is also increased.
prior to commencing immunosuppressive therapy- you would want to do a screen for TB. What Ix would you order?
Interferon gold and CXR
SE of azathioprine (Imuran)?
Nausea, vomiting, rash, fever, pancreatitis, immunosuppression, photosensitivity, lymphoma