Immunosuppression Therapy Flashcards
(21 cards)
What is Azathioprine?
An antimetabolite that breaks down into mercaptopurine, which inhibits the repairment and making of DNA
What breaks down Azathioprine?
Thiopurine Methyltransferase (TPMT)
What are the side effects of Azathioprine and Mecaptopurine?
- Hypersensitivity - malasaie, dizziness, n&v, rash, hypotension, myalgia
- Neuropenia & Thrombocyptopenia - report sore throat, bruising, bleeding
- Nausea - more common at start of dose but resolves over time
- Teratogenic - avoid in pregnancy
What can low levels of Thiopurine Methyltransferase (TPMT) cause?
Myelosuppression
What must be monitored when taking Azathioprine?
- TPMT
- Regular LFT (liver function test) & FBC in pts with severe liver/renal impairment
- In regular pts, FBC weekly for first 4 weeks, then at least every 3 months
What are some interactions of Azathioprine?
- Allopurinol - increased risk of haematological toxicity. So reduce dose of azathioprine
- ACEi - increased risk of anaemia/leucopenia
What is ciclosporin?
Calcineurin inhibitor, that inhibits lymphokines & supresses cell-mediated response
They are prescribed and dispensed by brand name
What are side effects of ciclosporin?
- Hyper- glycaemia, lipidaemia, tension, uricemia & kalaemia
- Hypo-Mg
- Renal/liver impairment
- Skin reaction
- Gingival hyperplasia
- Hair changes
- Eye inflammation and visual disturbances
SO AVOID IN PREGNANCY AND BREASTFEEDING
What are some interactions of ciclosporin?
- Grapefruit + pomelo juice - increases ciclosporin exposure
- Purple grape juice - decreases ciclosporin exposure
- Avoid exposure to UV light/sunlight
What needs to be monitored for Ciclosporin?
LFT, Mg, K, Lipids, CrCl & blood pressure
What is Tacrolimus?
Calcineurin inhibitor, that inhibits lymphokines & supresses cell-mediated response
They are prescribed and dispensed by brand name
Side effect of Tacrolimus?
- Hyper- glycaemia, uricemia & kalaemia
- Hypo/hyper tension
- Renal/liver impairment
- Skin reaction
- Visual disturbances
- Blood dyscrasia
- Cardiovascular disease (QT prolongation, cardiomyopathy in children etc)
- Nervous system disorder
- Peripheral neuropathy
SO AVOID IN PREGNANCY AND BREASTFEEDING
- Can affect driving/performing skills
What is contraindicated for Tacrolimus?
- Pts that are allergic or sensitive to macrolides
Interactions for Tacrolimus?
- Grapefruit + Pomegranate + Pomelo juice = increases ciclosporin exposure
Avoid UV light and sunlight
What needs to be monitored for
Blood pressure, ECG, Blood Glucose, LFT, Electrolyte & CrCl
How do Mycophenolate Mofetil work?
Inhibits purine synthesis
What are the side effects of Mycophenolate Mofetil?
- Bone marrow suppression = report infection, or bruising or bleeding
- Pure red blood aplasia = reduce dose or discontinue
- Hypogammaglobulinemia = measure immunoglobulin levels in recurrent infections
- Bronchiectasis = persistent cough / SOB
MHRA warning for Mycophenolate Mofetil?
Because the drug is teratogenic :
Women should have at least 1 effective contraception during & 6 weeks after (wait 2 months)
Men should use an effective contraception during and 90 days after (for partner as well)
What needs to be known when handling cytotoxic drugs?
- Wear protective clothing - gloves, gowns & masks
- Use eye protection
- Avoid in pregnancy staff or female of child bearing age
- Monitor staff exposure to cytotoxins
- Trained personnel should reconstitute
What are the drug Cytotoxic drug classes?
- Alkylating agents = Cyclophosphamide, Ifosfamide, Melphalan
- Anthracyclines = Daunorubicin, Doxorubicin, Epirubicin, Idarubicin
- Antimetabolites = Cytarabine, Fluorouracil, Methotrexate, Mercaptopurine
- Cytotoxic antibiotics = Bleomycin Mitomycin
- Platinum compounds = Carboplatin, cisplatin, oxaliplatin
Taxanes = Cabazitaxel, docetaxel, Paclitaxel
Vinca Alkaloids = Vinblastine, Vincristine, Vindesine
