Immune-mediated disease in clinical practice – treatment options Flashcards Preview

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Flashcards in Immune-mediated disease in clinical practice – treatment options Deck (10)
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Nursing care is vital

assess pain, comfort and general condition of the patient


Glucocorticoids - effects - cellular level

Associate with binding proteins - transcortin and albumin
after dissociation from binding proteins, passively diffuse into cell
Bind to a cytoplasmic receptor
Conformational change of receptor unmasks DNA binding domain - associates with GREs following nuclear translocation


Glucocorticoids - Potential adverse effects - body systems

Central nervous system
Musculoskeletal system
Gastrointestinal tract
Fluid, electrolyte balance
Immune system


Alkylating agents

Alkylate DNA, causing breaks in molecule and cross-linking of twin strands
Inhibit protein synthesis in resting cells, prevent
mitosis and kill dividing cells


Alkylating agents - examples

Cyclophosphamide, ifosfamide, chlorambucil
Melphalan, mechlorethamine, nitrosoureas
Procarbazine, dacarbazine


Alkylating agents - Chlorambucil

Rapidly metabolised to phenylacetic acid
Slowest acting, least toxic of all alkylating agents
Myelosuppression generally not observed until ≥ 1 month
Urinary and faecal excretion
Administered without food


Alkylating agents - Azathioprine

Greater ↓of cellular than humoral immunity
Hepatic metabolism to activate
Compete with endogenous adenine and guanine - non-functional nucleic acid strands
Slow immunosuppressive effect?
Haematological, gastrointestinal, hepatic ± neuromuscular toxicity


Alkylating agents - Vincristine, vinblastine

Bind to tubulin, blocking polymerisation
break down pre-formed microtubules – increased release of platelets (PLTs) from megakaryocytes
used in rx/ of ITP
Can be given as bolus IV, or to pre-load PLTs
Severe extra-vascular vesicants (irratation/blisters)
Haematological, GI, neurological toxicity


Alkylating agents - Ciclosporin

Isolated from Cylindrocarpon lucidium + Trichoderma polysporum
IV and oral forms
Large volume of distribution - 1° hepatic metabolism
Therapeutic drug monitoring – acute and chronic
GI, renal, hepatic toxicity + hirsutism, gingival
hyperplasia, papillomatosis ± diabetogenic



synthetic glucocorticoid
used to treat infl + auto-immune disease
immune suppressants