Immunosuppression- Rheumatoid Arthritis and Transplants Flashcards by Shaquan Moore

BIOLOGICS?
Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept
Adalimumab
Infliximab

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TRADITIONAL

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Hydroxychloroquine
Sulfasalazine
Minocycline (a tetracycline)
Azathioprine/ Mercaptopurine

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Has two receptors which target and bind to TNF (Tumor Necrosis Factor) and neutralizes it

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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Treats
Rheumatoid Arthritis

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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Has two receptors which target and bind to TNF (Tumor Necrosis Factor) and neutralizes it

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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NURSING CONSIDERATION:
Monitor the site for redness, pain and swelling after administration
Report if doesn’t improve after a few days

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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Serious Infections (this drug suppresses the immune system

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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NURSING CONSIDERATION:
Monitor the site for redness, pain and swelling after administration
Report if doesn’t improve after a few days

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Serious Infections (this drug suppresses the immune system

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Higher risk for TB!

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS

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Higher risk for Fungal infections, Atypical bacteria (such as TB!)

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Higher risk for TB!

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Risk for
Legionella pneumophila, Mycobacterium tuberculosis

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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RISK FOR SERIOUS INFECTIONS

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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RISK FOR SERIOUS INFECTIONS◦Mostly seen when combined with other suppressing drugs
Etanercept + Steroids, or Etanercept+ Methotrexate

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Higher risk for infection with TB, HBV, bacterial, fungal, viral,

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Nursing should assess patient for infection prior to giving medication (CBC as well)

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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No live vaccines (just like no live vaccines with steroids!)

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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One of the requirements when using this medication is to check for latent TB and HBV

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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MALIGNANCIES◦We have seen lymphomas and other malignancies develop during use of this medication

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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NURSING CONSIDERATIONS:◦Assess for s/s of malignancy (splenomegaly, hepatomegaly, night sweats, weight loss, persistent fever)

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Periodic monitoring
◦Heart (Heart Failure)
◦Liver (Hepatotoxicity)
◦CBC (pancytopenia)

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Don’t forget the infection risk
◦Watch out with additive effects of immunosuppressant’s
◦No LIVE vaccines
◦Baseline screening for TB and HBV

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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Do NOT give in malignancies!

Etanercept
Tacrolimus
Methotrexate
Cyclosporine
Infliximab
Sulfasalazine
Hydroxychloroquine
Azathioprine/ Mercaptupurine
Mycophenolate
Cyclosporine
Minocycline ( a tetracycline)
Adalimumab

Etanercept-BIOLOGICS
Adalimumab- BIOLOGICS
Infliximab- BIOLOGICS

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``` BIOLOGICS: BICYCLE Blood Dyscrasias Infection Cardiac (heart failure) Yucky (injection site) CancerLiver Educate about SJS/TEN ``` ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Etanercept-BIOLOGICS Adalimumab- BIOLOGICS Infliximab- BIOLOGICS

Etanercept-BIOLOGICSAdalimumab- BIOLOGICS Infliximab- BIOLOGICS ``` BIOLOGICS: BICYCLE B- I- C- Y- C- E- ```

Etanercept-BIOLOGICS Adalimumab- BIOLOGICS Infliximab- BIOLOGICS ``` BIOLOGICS: BICYCLE Blood Dyscrasias Infection Cardiac (heart failure) Yucky (injection site) CancerLiver Educate about SJS/TEN ```

◦Watch out with additive effects of immunosuppressant's ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Etanercept-BIOLOGICS Adalimumab- BIOLOGICS Infliximab- BIOLOGICS

Treat Rheumatoid Arthritis Crohn’s Ulcerative Colitis ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Adalimumab- BIOLOGICS | Infliximab- BIOLOGICS

Which is the correct MAB ? = Human mab that works Immunomodulatory (RA, IBD= Crohn’s, Ulcerative Colitis) Inf-li-xi-mab, Ada-lim-u-mab

Ada-lim-u-mab= Human mab that works Immunomodulatory (RA, IBD= Crohn’s, Ulcerative Colitis)

?= Chimeric mab that works Immunomodulatory (RA, IBD) Inf-li-xi-mab, Ada-lim-u-mab

Inf-li-xi-mab= Chimeric mab that works Immunomodulatory (RA, IBD)

MECHANISM OF ACTION:◦Monoclonal Antibody that targets TNF of the immune system ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Adalimumab- BIOLOGICS | Infliximab- BIOLOGICS

? is given intravenously (IVPB), can see infusion reactions (flu-like, chills, headache, fever), rarely anaphylaxis Adalimumab, Infliximab

Infliximab- BIOLOGICS

? is also given subcutaneously (like Etanercept), so watch out for local reactions (20% of patients) Adalimumab, Infliximab

Adalimumab- BIOLOGICS

``` USED TO TREAT Malaria Systemic Lupus erythematosus Sjorgen Syndrome Rheumatoid Arthritis ``` ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!)

Hydroxychloroquine - Traditional

Retinal damage ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

QT Prolongation ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

ALWAYS FINISH THE ENTIRE COURSE OF THERAPY (EVEN IF SYMPTOMS IMPROVE EARLY!) ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

Reports of Hypoglycemia ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

Contra-indicated in G6PD Deficiency ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Hydroxychloroquine - Traditional

Acne- topical and oral preparations ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Lyme Disease ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Chlamydia ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Anthrax ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline)- Traditional

Binds to calcium- bones, teeth, drugs (AVOID CHILDREN, PREGNANT PATIENTS) ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Photosensitivity\ ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

GI irritation ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Risk for suprainfection (C.diff, candida albicans) ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Hepatotoxicity ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline)- Traditional

Alternative Contraception needed ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Intended OutcomesResolve the infection (decreased WBC, decreased temperature/fever) ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

Take with FULL GLASS OF WATER, AVOID BEDTIME, AVOID CALCIUM! ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Minocycline ( a tetracycline) - Traditional

LIFE Lifelong therapy Immunosuppressed (infection and malignancy risk) Frequent monitoring of liver, kidneys , blood pressure and drug levels Electrolyte abnormalities ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Mycophenolate Tacrolimus Cyclosporine

``` Transplant Med Mycophenolate, Tacrolimus, Cyclosporine L I F E ```

Lifelong therapy Immunosuppressed (infection and malignancy risk) Frequent monitoring of liver, kidneys , blood pressure and drug levels Electrolyte abnormalities

Treats Rheumatoid Arthritis Transplants Ulcerative Colitis ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

Inhibition of production and release of interleukin II and inhibits interleukin II-induced activation of resting T-lymphocytes. ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND TRANSPLANTS ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant Tacrolimus - Transplant Mycophenolate Transplant

IMMUNOSUPPRESSION/ MALIGNANCY RISK ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant Tacrolimus - Transplant Mycophenolate Transplant

BIOAVAILABILITY (DO NOT SWITCH BRANDS) ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

HYPERTENSION/ NEPHROTOXICITY ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant Tacrolimus - Transplant Mycophenolate Transplant

ADVERSE EFFECTS:◦Hirsutism◦Gingival Hyperplasia ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

NARROW THERAPEUTIC DRUG We check trough levels ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant | Tacrolimus - Transplant

NO GRAPEFRUIT JUICE! ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant | Tacrolimus - Transplant

Just like with phenytoin, good oral hygiene ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

Monitor Blood Pressure Assess Renal and Hepatic Function ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant Tacrolimus - Transplant Mycophenolate Transplant

Monitor and Report Infection/Malignancy No LIVE vaccines, do not use in active/recent Herpes/Chickenpox infection ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant Tacrolimus - Transplant Mycophenolate Transplant

Treats Transplants ◦Lots of off label auto-immune uses ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Tacrolimus - Transplant | Mycophenolate Transplant

Suppresses cellular immunity (inhibits T-lymphocyte activation), by binding to an intracellular protein, FKBP-12 and complexes with calcineurin dependent proteins to inhibit calcineurin phosphatase activity ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Tacrolimus - Transplant

2 BOXED WARNINGS FROM THE FDA ◦ IMMUNOSUPPRESSION- INFECTION RISK ◦ MALIGNANCY RISK ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Tacrolimus - Transplant

Main= Hypertention ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Tacrolimus - Transplant

MPA exhibits a cytostatic effect on T and B lymphocytes. It is an inhibitor of inosine monophosphate dehydrogenase (IMPDH) which inhibits de novo guanosine nucleotide synthesis. T and B lymphocytes are dependent on this pathway for proliferation. ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Mycophenolate Transplant

``` 4 BOXED WARNINGS FROM THE FDA ◦PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND TRANSPLANTS ◦SERIOUS INFECTIONS/IMMUNOSUPPRESSION ◦MALIGNANCY RISK ◦FETAL TOXICITY ``` ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Mycophenolate Transplant

Box Warning ◦FETAL TOXICITY ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Mycophenolate Transplant

``` 4 BOXED WARNINGS FROM THE FDA ◦PROVIDER MUST BE EXPERIENCED IN IMMUNOSUPPRESSION AND TRANSPLANTS ◦IMMUNOSUPPRESSION/ MALIGNANCY RISK ◦BIOAVAILABILITY (DO NOT SWITCH BRANDS) ◦HYPERTENSION/ NEPHROTOXICITY ``` ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant

Administertion CONSISTENCY- SAME TIME DAILY- ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Mycophenolate Transplant

Administertion CONSISTENCY- SAME TIME DAILY- CHECK TROUGH LEVELS! ( DON’T CHANGE BETWEEN MANUFACTURERS!)- NO GRAPEFRUIT JUICE. ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Cyclosporine - Transplant | Tacrolimus - Transplant

Transplant ``` Etanercept Tacrolimus Methotrexate Cyclosporine Infliximab Sulfasalazine Hydroxychloroquine Azathioprine/ Mercaptupurine Mycophenolate Cyclosporine Minocycline ( a tetracycline) Adalimumab ```

Tacrolimus Cyclosporine Mycophenolate

Immunosuppression- Rheumatoid Arthritis and Transplants Flashcards

(80 cards)