Immunosupression Flashcards
Corticosteroids
Prednisolone, Hydrocortisone, Dexamethasone
Giant cell Arteritis, IBD, SLE, MS
Prevent IL-1 & IL-6 production by macrophages
Treatment for temporal arteritis?
Prednisolone + aspirin
(max dose - if vision effected)
Calcineurin Inhibitors
Ciclosporin, Tacrolimus
Organ transplants
Prevent IL-2 production
Renal toxicity (eGFR), hypertension
Metabolised by CYP 450
Dihydrofolate Reductase Inhibitor
Methotrexate
RA (gold standard), Chemotherapy
Weekly dose - long t1/2
In chemo: No folate = no thymidine/purine synthesis
In RA: Inhibit T cell activation?
Methotrexate side effects?
Teratogenic - folate
Myelosupression - FBCs
Hepatitis - LFTs
Megaloblastic anaemia - folate reduced
Azathioprine
Anti proliferative immunosuppressant
SLE, Crohn’s, Vasculitis
Cleaved to 6-mp by TPMT
6-mp decreases DNA synthesis
(TMPT enzyme test needed)
Azathioprine side effects?
Myelosupression - FBCs
Cancer risk
Hepatitis - LFTs
Immunosuppressed
Cyclophosphamide - main ADR?
Anti proliferative immunosuppressant
Lymphoma/leukaemia, SLE, Vasculitis
Alkylating agent - crosslinks DNA so it can’t replicate
Bladder cancer or haemorrhagic cystitis
(prevent w/ mensa and aggressive hydration)
Pro-drug - metabolised by CYP450
Mycophenolate Mofetil
Anti proliferative immunosuppressant
Transplants, SLE
Inhibits guanine synthesis
Sulfasalzine
Inhibits T cells & neutrophils
RA, IBD (main activity in gut)
SAFE IN PREGNANCY
Hydroxychloroquine
RA, SLE, Malaria
^pH in macrophages
TNF-a Inhibitors - what to check before prescribing?
Infliximab, Adalimunab
RA, Chron’s, Psoriasis
Blocks TNF-a (pro-inflammaatory)
CHECK FOR LATENT TB - TNF-a important for granuloma maintenance
Rituximab
Lymphoma
Binds to CD20 on B cells for apoptosis
