Immune System

Question 1

Red Flags by condition and drug induced conditions: Autoimmune disease

INT CYCLOSPORINE (imm suppressant, RA)

Answer 1

● Metabolized by P450 enzyme system → MANY interactions
● Causes elevated BP
● Very narrow therap window, Therapeutic Drug Monitoring
● S/E: chronic interstitial nephritis, hypertrichosis, gum hyperplasia, burning hands and feet

Question 2

Red Flags by condition and drug induced conditions: Autoimmune disease

METHOTREXATE

Answer 2

CI in liver disease

Question 3

Red Flags by condition and drug induced conditions: Autoimmune disease

INT Methotrexate

Answer 3

● Ethanol and acitretin may ↑ risk of liver injury
● Cholestyramine and colestipol may bind in the gut
* ● Trimethoprim may ↑ bone marrow suppression
● USE w/FOLIC ACID

Question 4

Red Flags by condition and drug induced conditions: Autoimmune disease

Drugs that cause psoriasis

Answer 4

● lithium
● beta blockers
● anti malarials
● NSAIDs (indomethacin)
● ACEI
● Terbinafine
● Abrupt w/d of oral corticosteroids or high potency topicals
● alcohol abuse

Question 5

Red Flags by condition and drug induced conditions: Autoimmune disease

Cyclosporine INTX WITH RIFAMPIN (AB)

Answer 5

● rifampin will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative

Question 6

Red Flags by condition and drug induced conditions: Autoimmune disease

Methotrexate INTX WITH Trimethoprim

Answer 6

• ● trimethoprim, methotrexate. Either increases toxicity (FOLATE inhibitors) of the other by pharmacodynamic synergism. Serious - Use Alternative. Due to an additive antifolate effect, trimethoprim has been shown to rarely increase bone marrow suppression in patients receiving methotrexate