Immunosupression

Question 1

What is the pathogenesis of rheumatoid arthritis?

Answer 1

Imbalance of pro-infammatory cells to anti-inflammatory cells

Question 2

How is Rheumatoid arthritis diagnosed?

Answer 2

Mostly clinical, morning stiffness, at least three joints, symmetrical, rheumatoid nodules. High anti-CCP antibodies

Question 3

How do corticosteroids work?

Answer 3

prevent interleukin 1 and 6 production by macrophages, inhibit all stages of T-cell activation

Question 4

Name 3 side-effects of steroids

Answer 4

Weight gain, thrush, glaucoma/cataracts, mood changes, muscle weakness

Question 5

What is azathioprine used for?

Answer 5

Lupus and vasculitis as maintenance therapy, also IBD

Question 6

Which enzyme is used to metabolise azathioprine?

Answer 6

TPMT (tested before prescription)

Question 7

What are the adverse effects of immunosupressants?

Answer 7

bone marrow suppression, increased risk of malignancy, increased risk of infection, hepatitis

Question 8

What are calcineurin inhibitors used for?

Answer 8

Atopic dermatitis and psoriasis

Question 9

What is the mechanism of action of calcineurin inhibitors?

Answer 9

Prevents helper T cells producing IL-2

Question 10

What is mycophenolate mofetil used for?

Answer 10

Transplantation, Lupus and vasculitis maintenance

Question 11

What is the mechanism of action of Mycophenolate mofetil?

Answer 11

Prodrug derived from penicillium that impairs B and T cell proliferation

Question 12

How does Cyclophosphamide work?

Answer 12

prodrug alkylating agent that cross-links DNA stopping it replicating, suppresses B and T cell activity

Question 13

What is Cyclophosphamide used for?

Answer 13

`Lymphoma, leukaemia, solid cancers, Lupus

Question 14

What is the gold standard treatment for RA?

Answer 14

Methotrexate

Question 15

What is the mechanism of action of Methotrexate?

Answer 15

Reversibly inhibits DHFR, inhibiting DNA, RNA and protein synthesis (anti-folate action) ONLY WORKS THIS WAY IN MALIGNANCY

Question 16

How often should Methotrexate be dosed?

Answer 16

Weekly, long half life

Question 17

What else can methotrexate be used for?

Answer 17

Ectopic pregnancy

Question 18

When can sulfasalazine not be given?

Answer 18

Aspirin allergy

Question 19

How does sulfasalazine work?

Answer 19

Inhibits proliferation of T cells and IL-2 production. Reduced chemotaxis and degranulation of neutrophils

Question 20

Why is sulfasalazine used when it is not as effective as methotrexate?

Answer 20

Very few drug interactions and it is safe in pregnancy

Question 21

Which drugs block TNF-alpha?

Answer 21

Biologicals

Question 22

What are the effects of blocking TNF-alpha?

Answer 22

Reduced inflammation, reduced angiogenesis, and reduced joint destruction

Question 23

What must be screened for before giving Anti-TNF therapy?

Answer 23

Latent TB (reactivation risk)