Immunosupression

Question 1

TPMT enzyme does what?

Answer 1

Inhibits repairment and making of DNA

Question 2

Why pre screen for TPMT levels?

Answer 2

To avoid under active TPMT leading to Myelosuppression

Question 3

Azathioprine report what?

Answer 3

Sore throat, Bruising, Bleeding

Neutropenia and Thrombocytopenia

Question 4

What side effect is common at start of Azathioprine use?

Answer 4

Nausea

Question 5

Other common side effect of Azathioprine?

Answer 5

Hypersensitivity Reactions

Malaise
Fever
Rash
Hypotension
Myalgia

Question 6

Monitor what for Azathioprine?

Answer 6

TPMT levels (enzyme)

Liver function test

FBC - first 4 weeks then atleast every 3 months

Question 7

2 key interactions with Azathiprine?

Answer 7

Ace inhibitors - Haematological toxicity

Allopurinol - Anaemia/Leucopenia

AVOID USE TOGETHER

Question 8

Ciclosporin prescribed by?

Answer 8

Brand name

Question 9

Ciclosporin causes hyper and hypo what?

Answer 9

Hyperglycaemia, Hyperkalaemia, Hyperuricaemia, Hyperlipidaemia, Hypertension

+ ONLY Hypomagnesium

Question 10

Ciclosporin can also cause what condition that CCB’s also cause?

Answer 10

Ginger Hyperplasia

Question 11

Visual disturbances can be caused by which immunosuppressive drug?

Answer 11

Ciclosporin topical

Question 12

Purple Grape fruit juice and Ciclosporin?

Answer 12

Decreases Ciclosporin exposure

Question 13

Grapefruit + Pomelo juice and Ciclosporin?

Answer 13

Increase Ciclosporin exposure

Question 14

Ciclosporin monitor?

Answer 14

LFT
MAGNESIUM!
Blood pressure
Potassium
Lipids
Crcl

MONITOR TROUGH LEVELS! (Lowest level of drug in pt body)

Question 15

Ciclosporin counselling?

Answer 15

Avoid Expisure to UV light /Sunlight

Question 16

Tacroliumus side effects?

Answer 16

Hyperglycaemia, Hyperkalaemia, Hypertension, Hyperuricaemia

Hypotension

Blood Dyscrasia

Visual disturbances

CVD - QT PROLONGATION , Cardiomyopathy

Nervous system , peripheral neuropathy

Question 17

Tacrolimus interacts with what?

Answer 17

Grapefruit juice + Pomelo + Pomegranate

DO NOT USE if hypersensitive to Macrolides

Question 18

Tacrolimus monitor?

Answer 18

LFT
GLUCOSE LEVELS
ELECTROLYTES
ECG
CrCl

Question 19

Mycophenolate side effects?

Answer 19

Bone marrow suppression

Pure red cell aplasia

Hypogammaglobulinaemia

Bronchiectasis

Question 20

Hypogammaglubulinaemia - what would you have to do?

Answer 20

Measure immunoglobulin levels in recurrent infections

Question 21

When to consider if or taking mycophenolate pt has Bronchiectasis?

Answer 21

SOB
COUGH

Question 22

Mycophenolate MHRA warnings?

Answer 22

Teratogenic

Women - contraception during + 6wks after

Men - Contraceptiin during + 90 days after (for partner as well)

Question 23

In the case of Pure red cell aplasia in Mycophenolate - what should be done?

Answer 23

Reduce dose or discontinue

Question 24

Mycophenolate Mofetil works by?

Answer 24

Inhibiting purine synthesis

Question 25

Bone marrow suppression - What you expect to see symptoms wise ?

Answer 25

Sore throat, bruising , bleeding