Immune System And Malignant Disease Drugs

Question 1

Corticosteriods example

Answer 1

Dexamethasone

Hydrocortisone

Prednisolone

Question 2

Corticosteriod mechanism of action

Answer 2

Corticosteriods prevent interleukin IL-1 and IL-6 production by macrophages. This causes inhibiton of all stages of T cell activation.

Question 3

Corticosteriods indications

Answer 3

Urticaria

RA

SLE

Polymyalgia Rheumatica

Question 4

Corticosteriods ADRs

Answer 4

Hypertension

Hyperkalaemia

Increased risk of osteoporosis

Question 5

Corticosteriods drug interactions

Answer 5

Diuretics

Anti-epileptic drugs

Rifampicin

Question 6

Azathioprine indications

Answer 6

IBD

RA

SLE

Question 7

Azathioprine mechanism of action

Answer 7

Azathioprine inhibits purine synthesis. This occurs as azathioprine is cleaved to from 6-MP which is an anti-metabolite that decreases DNA and RNA synthesis. This causes decreased whitr blood cell production.

Question 8

Azathioprine ADRs

Answer 8

Bone marrow supression

Increased risk of malignancy

Increased risk of infection

Hepatitis

Question 9

Azathioprine drug interactions

Answer 9

Other immunosuppressants

Question 10

Azathioprine pre-prescription test

Answer 10

TPMT activity test as the TPMT gene is highly polymorphic and in low levels of the gene there is a risk of myelosuppression.

Question 11

Calcineurin inhibitors example

Answer 11

Ciclosporin

Tacrolimus

Question 12

Calcineurin inhibitor indications

Answer 12

Used in transplantation

Atopic dermatitis

Psoriasis

Question 13

Calcineurin inhibitor contra-indications

Answer 13

Renal impairment due to toxicity

Check BP and eGFR regularly

Question 14

Calcineurin inhibitor drug interactions

Answer 14

Pomegranate juice

Question 15

Calcineurin inhibitor ADRs

Answer 15

GI upset

Anxiety

Headache

Question 16

Calcineurin inhibitor mechanism of action

Answer 16

The drugs bind to proteins and form complexes which bind to calcineurin. This inhibits production of IL-2 which works against helper T cell activation.

Question 17

Mycophenolate mofetil drug class

Answer 17

Immunosuppressant

Question 18

Mycophenolate mofetil indication

Answer 18

Used in transplantation

SLE

Vasculitis

Question 19

Mycophenolate mofetil mechansim of action

Answer 19

The drug inhibits inosine monophosphate dehydrogenase which is required for guanosine synthesis. This impairs B and T cell proliferation. However other rapidilt dividing cells are spared.

Question 20

Mycophenolate mofetil ADRs

Answer 20

GI upset

Bone marrow suppression

Headache

increased risk of infection

Question 21

Cyclophosphamide indications

Answer 21

Lymphoma

Leukaemia

SLE

Wegener’s granulomatosis

Question 22

Cyclophosphamide considerations

Answer 22

Significant toxicity -

Increased risk of bladder cancer

Infertility

Renal impairment

Question 23

Methotrexate indications

Answer 23

RA

Malignancy

Psoriasis

Crohn’s disease

Question 24

Methotrexate mechanism of action in malignancy

Answer 24

Methotrexate competitively and reversibly inhibits DHFR. This affects purine and thymidine synthesis and therefore inhibits synthesis of DNA, RNA and proteins.

Question 25

Methotrexate ADRs

Answer 25

Mucositis Marrow suppression Hepatitis - cirrhosis Infection risk

Question 26

Methotrexate considerations

Answer 26

Methotrexate is highly teratogenic and abortifacient- induces abortion

Question 27

Sulfasalazine indications

Answer 27

RA

Question 28

Sulfasalazine mechanism of action

Answer 28

Inhibiton of T cell proliferation and inhibition of IL-2 production Reduced chemotaxis and degranulation

Question 29

Sulfasalazine ADRs

Answer 29

Myelosuppression Hepatitis Rash Nausea an vomiting

Question 30

Anti-TNF therapy effects

Answer 30

Decreased inflammation, angiogenesis and joint destruction

Question 31

Anti-TNF therapy considerations

Answer 31

Risk of TB reactivation