Immune system and malignancy

Question 1

What is azathioprine broken down into?

Answer 1

Mercaptopurine which inhibits the repairment of DNA

Question 2

What is azathioprine broken down by?

Answer 2

TPMT

Question 3

Side effects of azathioprine

Answer 3

Hypersensitivity: malaise, dizziness, diarrhoea, vomiting, rash, hypotension, myalgia
Neutropenia and thrombocytopenia: report sore throat, brusing, bleeding
Nausea: more common at the start of dose but resolves over time
Teratogenic : avoid in pregnancy

Question 4

Monitoring requirements for azathioprine

Answer 4

TPMP
Regular LFT and FBC in severe liver / renal impairment
FBC weekly for first 4 weeks, then at least every 3 months

Question 5

What is the interaction between azathioprine and allopurinol

Answer 5

Increases risk of haematological toxicity - reduce dose of azathioprine

Question 6

What is the interaction between azathioprine and ace inhibitors

Answer 6

Risk of anaemia and leucopenia- avoid concomitant use

Question 7

Whats the mechanism of action of ciclopsorin?

Answer 7

Calcineurin inhibitor inhibiting lympkines: suppress cell-mediated response

Question 8

What two drugs need to be prescribed by brand?

Answer 8

Ciclosporin and tacrolimus

Question 9

Side effects of ciclosporin

Answer 9

• Hyperglycaemia, hyperlipidaemia, hypertension, hyperuricemia, kyperkalaemia
• Hypomagnesemia
• Renal / Liver impairment
• Skin reactions
• Gingival hyperplasia
• Hair changes
• Eye inflammation and visual disturbances (in topical use with eyes)

Question 10

What drug does grapefruit juice, pomelo juice and purple grape fruit juice interact with?

Answer 10

Ciclosporin
Grapefruit juice and Pomelo juice  increases ciclosporin exposure
Purple grape juice  decreases ciclosporin exposure

Question 11

What must you do before giving ciclopsorin?

Answer 11

Exclude malignancies

Question 12

Monitoring requirements of ciclosporin

Answer 12

LFT
Magnesium
Potassium
Lipids
CrCL
Blood pressure
Trough levels need to be monitored (range depends on indication)

Question 13

What advice must you give to patients when they take ciclosporin and tacrolimus ?

Answer 13

Avoid UV light / sunlight
Tacrolimus use and Topical (eye) use with ciclosporin may affect driving/ skilled tasks

Question 14

What are the side effects of tacrolimus?

Answer 14

• Hyperglycaemia, hyper uricemia, hyperkalaemia
• Hypo/hyper tension
• Renal / Liver impairment
• Skin reactions
• Visual disturbances
• Blood dyscrasia
• Cardiovasuclar disease (QT prolongation, cardiomyopathy in children)
• Nervous system disorder, peripheral neuropathy

Question 15

What drug interacts with Grapefruit, pomegranate and pomelo juice?

Answer 15

Tacrolimus
Grapefruit, pomegranate and pomelo juice  increases tacrolimus exposure

Question 16

What drug can you not use if they have a hypersensitivity to macrolides?

Answer 16

Tacrolimus

Question 17

What are the monitoring requirements for tacrolimus?

Answer 17

BP, ECG, Blood glucose, LFT, electrolytes and CrCL

Question 18

Whats the mechanism of action of mycophenolate?

Answer 18

Inhibits purine synthesis

Question 19

What is the MHRA warning associated with mycophenolate

Answer 19

Contraception advice as it is teratogenic

Question 20

What is the contraception advice with myclophenolate?

Answer 20

Women: 1 effective contraception during and 6 weeks after (2 methods preferred)
Men: effective contraception during and 90 days after (for partner as well)

Question 21

What is