Immunosupression Therapy Flashcards
Azathioprine
Antimetabolite which breaks down into mercaptopurine which inhibits the repairment and making of DNA
Azathioprine broken down by TPMT
-pre screening TPMT levels is advice as under active TPMT = myelosupression
Side effects
Hypersensitivity- malaise , dizziness, d+V, fever rash hypotension and ayalgia
Neutropenia and thrombocytopenia- report sore throat bruising and bleeding
Nausea- more common at start of dose but resolves over time
Teratogenic- avoid in pregnancy
What are the monitoring requirements of azathioprine
TPMT
Regular LFT and FBC in severe liver/ renal impairment
FBC weekly for the first 4 weeks then at least every 3 months
What are the interactions of azathioprine
Azathioprine + allopurinol - increased risk of haematological toxicity
Reduce dose of azathioprine
Azathioprine + ace-i- increased risk if anaemia/ leucopenia
-avoid concomitant use of
Ciclosporin
Calcineurin inhibitor inhibiting lymphokines- suppresses cell mediated response
Prescribed and dispensed as brand name
Ciclosporin
Calcineurin inhibitor inhibiting lymphokines- suppresses cell mediated response
Prescribed and dispensed as brand name
What are the side effects of ciclosporin
-Hyper-
Glycaemia
Lipidaemia
Tension
Uricemia
Kalaemia
Hypo-mg
- rental and liver impairment
Skin reactions
Gingival hyperplasia - enlarged gums
Hair changes
Eye inflammation and visual disturbance (in topical use of eyes
Avoid in breastfeeding and pregnancy
What are the interactions of ciclosporin
Grapefruit juice +pamelo juice- increases the closure of ciclosporin
Purple grape juice- decreases ciclosporin exposure
Pre screening: exclude malignancies before systemic use
Monitor : LFTS, MG, K, lipids , CRCL, BP
-trough levels need to be monitored (range depends on indication)
Avoid exposure to uv light/sunlight
Topical eye use may affect driving/performance skilled tasks
Tacrolimus
Calcineurin inhibitor inhibiting lymphokines- suppresses cell mediated response
Prescribed and dispensed by brand name
Side effects
Hyper- glycaemia, uricemia and kalcaemia
HYPO/HYPERtension
Rentals and liver impairment
Skin reactions
Visual disturbances
Blood dyscrasia
CVD d(QT prolongation, cardiomyopathy in children )
Nervous system disorder, peripheral neuropathy
Avoid in pregnancy and breastfeeding
What are the interactions of tacrolimus
Grapefruit juice and pomegranate and pomelo juice- increases tacrolimus exposure
Do not use if patient has sensitivity to macrolides
Monitor BP,ECG, blood glucose, LFT, electrolytes and CRCL
Avoid exposure to uv light and sunlight
May effect driving and performed skilled tasks
What is mycophenolate mofetil
Inhibits purine synthesis
Bone marrow suppression- report infection or bruising or bleeding
Pure red call aplasia- reduce dose or discontinue
Hypogammaglobulinaemia- measure immunoglobulins levels in recurrent infections
Bronchiectasis: consider if persistent cough or SOB develops
What is the MRHA warning. About mycophenolate mofetil
Teratogenic - conception advised
-women- 1 effective contraception during and 6 weeks after (2 methods preferred)
Men : effective contraception during and 90 days after (for partner as well)
