Immunosuppressive Therapy (Marsella) Flashcards
Medications & biopsy of autoimmune diseases
- Address 2º infections 1st
- Do not admin steroids prior to biopsy
Are abx during immunosuppressive therapy ok?
Yes, abx therapy is necessary in the 1st few months of therapy w/ autoimmune dz
Differentials to consider if skin lesions worsen w/ immunosuppression therapy
- Demodicosis
- Dermatophytosis
- Bacterial infection
- Calcinosis cutis (dog)
Immunotherapy and relapse of autoimmune dz
- After relapse, resistance to previously used glucocorticoids may be observed
- Most animals require therapy for life
Immunosuppressive drugs
- Glucocorticoids
- Azathioprine
- Chlorambucil
- Gold
- Tetracycline-niacinamide
How to use steroids for immunosuppression
- Oral steroids
- Induction 10-14 days
- Once no new lesions, taper to alternated day dose
- Maintenance dose acheived ~8-10 wks
Side effects of steroid therapy
- GI ulcers (help w/ famotidine, sucralfate)
- PU/PD
- Polyphagia
- Panting
- Behavioral changes
- Diabetes
- Hepatopathy
- Muscle weakness
- Osteoporosis
- Redistribution of body fat
- Decr. synthesis of thyroid hormones
- Incr. risk of infection (skin, urinary tract)
Dermatologic specific side effects of steroid therapy
- Thin skin
- Comedones
- Demodicosis
- Calcinosis cutis (dogs)
- Skin fragility (cats)
- Incr. risk of skin infections
Azathioprine (Imuran)
Suppresses cell mediated & humoral immunity
Azathioprine (Imuran) side effects
- Bone marrow suppression
- Pancreatitis
- Hepatitis
- Vomiting
- Hemorrhagic diarrhea
- DO NOT USE IN CATS
Chlorambucil (Leukeran)
- Immunosuppressive drug
- Safe for cats
Chlorambucil (Leukeran) side effects
- Bone marrow suppression
- Vomiting
- Diarrhea
Gold salts
- Suppress antibody synthesis
- Inhibits phagocytosis
- Suppresses PG synthesis
Gold salts side effects
- Bone marrow suppression
- Nephrotoxcity
- Hepatic necrosis
- Drug eruption (EM, TEN)
Cyclophasphamide (Cytoxan) side effects
- Bone marrow suppression
- Hemorrhagic cystitis
- Bladder fibrosis
- Teratogenesis
Tetracycline & Niacinamide side effects
- Vomiting
- Diarrhea
- Anorexia
- Incr. liver enzymes
- Seizures
Cyclosporine
- Adjunctive therapy - used to decr. glucocorticoid needs
- Suppresses T cells
- Metabolized by cytochrome P450 (decr. w/ liver dz)
Cyclosporin side effects
- GI upset
- Nephrotoxicity
- Papillomatous dermatitis
- Gigival hyperplasia
Dapsone
- Use in conjunction w/ glucocorticoids
- Decr. complement, antibody produciton, PMN chemotaxis
Dapsone side effects
- Bone marrow suppression
- Hepatotoxcity
- GI upset
- Drug eruptions (EM, TEN)
