Immunosupression Flashcards
TPMT enzyme does what?
Inhibits repairment and making of DNA
Why pre screen for TPMT levels?
To avoid under active TPMT leading to Myelosuppression
Azathioprine report what?
Sore throat, Bruising, Bleeding
Neutropenia and Thrombocytopenia
What side effect is common at start of Azathioprine use?
Nausea
Other common side effect of Azathioprine?
Hypersensitivity Reactions
Malaise
Fever
Rash
Hypotension
Myalgia
Monitor what for Azathioprine?
TPMT levels (enzyme)
Liver function test
FBC - first 4 weeks then atleast every 3 months
2 key interactions with Azathiprine?
Ace inhibitors - Haematological toxicity
Allopurinol - Anaemia/Leucopenia
AVOID USE TOGETHER
Ciclosporin prescribed by?
Brand name
Ciclosporin causes hyper and hypo what?
Hyperglycaemia, Hyperkalaemia, Hyperuricaemia, Hyperlipidaemia, Hypertension
+ ONLY Hypomagnesium
Ciclosporin can also cause what condition that CCB’s also cause?
Ginger Hyperplasia
Visual disturbances can be caused by which immunosuppressive drug?
Ciclosporin topical
Purple Grape fruit juice and Ciclosporin?
Decreases Ciclosporin exposure
Grapefruit + Pomelo juice and Ciclosporin?
Increase Ciclosporin exposure
Ciclosporin monitor?
LFT
MAGNESIUM!
Blood pressure
Potassium
Lipids
Crcl
MONITOR TROUGH LEVELS! (Lowest level of drug in pt body)
Ciclosporin counselling?
Avoid Expisure to UV light /Sunlight
Tacroliumus side effects?
Hyperglycaemia, Hyperkalaemia, Hypertension, Hyperuricaemia
Hypotension
Blood Dyscrasia
Visual disturbances
CVD - QT PROLONGATION , Cardiomyopathy
Nervous system , peripheral neuropathy
Tacrolimus interacts with what?
Grapefruit juice + Pomelo + Pomegranate
DO NOT USE if hypersensitive to Macrolides
Tacrolimus monitor?
LFT
GLUCOSE LEVELS
ELECTROLYTES
ECG
CrCl
Mycophenolate side effects?
Bone marrow suppression
Pure red cell aplasia
Hypogammaglobulinaemia
Bronchiectasis
Hypogammaglubulinaemia - what would you have to do?
Measure immunoglobulin levels in recurrent infections
When to consider if or taking mycophenolate pt has Bronchiectasis?
SOB
COUGH
Mycophenolate MHRA warnings?
Teratogenic
Women - contraception during + 6wks after
Men - Contraceptiin during + 90 days after (for partner as well)
In the case of Pure red cell aplasia in Mycophenolate - what should be done?
Reduce dose or discontinue
Mycophenolate Mofetil works by?
Inhibiting purine synthesis
Bone marrow suppression - What you expect to see symptoms wise ?
Sore throat, bruising , bleeding
