Immunosuppressive and disease modifying drugs Flashcards
(25 cards)
List the drugs classed as immunosuppressive/disease modifying
Corticosteroids Disease modifying anti rheumatic drugs Azathioprine Cyclosporin Chlorambucil Colchicine Thalidomide Dapsone
Name some disease modifying anti-rheumatic drugs
Salazopyrine, methotrexate, penicillamine, Gold, hydroxychloroquine, chloroquine
What are corticosteroids used for?
Used in the suppression of inflammatory or allergic disorders Asthma and allergic reactions IBD and CAH Rheumatic disease Inflammatory renal disease Immunosuppression in transplantation Neurological disease Cancer - lymphoma
Where are DMARDs used?
Rheumatoid and sero negative arthritis
Psoriasis - methotrexate
Lupus - hydroxychloroquine
IBD - Sulfasalazine
Where is azathioprine used?
Steroid sparing agent Rheumatoid arthritis - psoriatic agents SLE and vasculitides - wegener's and PAN IBD and CAH Myasthenia Transplant patients
Where is cyclophosphamide used?
Used mainly to suppress inflammation and harmful antibody production in patients with life threatening vasculitic illness
SLE
Vasculitis - wegener’s, PAN, behcet’s, Rheumatoid vasculitis
What is cyclosporin?
Fungal metabolite
Active at suppressing the cell mediated T cell immune response
Where is cyclosporin used?
Renal, liver, marrow, pancreas and heart transplant patients
Prophylaxis of graft vs host disease
Psoriasis and atopic dermatitis
Rheumatoid arthritis
Where is Chlorambucil used?
Rheumatoid arthritis in severe disease
Vasculitides
Amyloid
Membranous nephritis
Where is colchicine used?
Gout
Behcets
Serositis - pericardis, SLE, FMF
Where is thalidomide used?
Behcets
SLE - especially chilblain lupus and other cutaneous manifestations of disease
What is required before starting thalidomide treatment?
EMG
Effective contraception
What are the short term risks of corticosteroid use?
Hypokalemia Fluid retention - prednisolone, dexamethasone, betamethasone Glucose intolerance Mood disturbance Hypertension
What are the long term risks of corticosteroid use?
Osteoporosis Diabetes and hypertension Accelerated atherosclerosis Increased risk of infection Poor healing Steroid dependency Growth retardation
What are the risks of hydroxychloroquine and chloroquine?
Ocular toxicity
What are the risks of Sulphasalazine, methotrexate, penicillamine and gold?
Rashes - gold and penicillamine GI intolerance - gold, SZP Renal toxicity - methotrexate Pulmonary fibrosis - Methotrexate Marrow toxicity - may occur early or late and needs regular monitoring
What are the risks of immunosuppressive treatment?
Increased susceptibility to infection
Marrow suppression
Renal toxicity - cyclosporin
Haemorrhagic cystitis - cyclophosphamide
Nausea, vomiting, diarrhea - azathioprine
Where should the first prescription of these drugs come from?
Provide 1st two weeks of drug from the hospital pharmacy - increases probability the patient will take the drugs and be monitored effectively
How should high doses of corticosteroids be monitored?
Given in hospital - U&Es, fluid balance, BP, glucose
How should low doses of corticosteroids be monitored?
BP and glucose
How should patients on Methotrexate, SZP, Gold, Penicillamine and Azathioprine be monitored?
FBC, profile and urinalysis at 1,2,4 and 8 weeks then at 4 weekly intervals for 3/12
Patients who are well, with no side effects, on standard doses, can then be seen 6-10 weekly
How should patients on Chloroquine and hydroxychloroquine be monitored?
Ocular examination required before treatment and at 6 months and 1 year; then yearly
G6PD screening before treatment
How should patients on Colchicine be monitored?
Generally not used long term
BNF dose (1mg, then 500µg every 2-3 hours) is ridiculously high! [diarrhoea]
1g, then 500µg 4 hours later, then 500µg tds for 3-4 days, is adequate for the treatment of gout
Very poorly tolerated with misoprostol (NB arthrotec)
How should patients on Cyclophosphamide, Chlorambucil and Cyclosporin be monitored?
Early monitoring as for DMARD’s - FBC, profile and urinalysis at 1,2,4 and 8 weeks
Most patients with conditions needing therapy of this type will be seen in the hospital OPD on a monthly basis, and the responsibility for haematological and biochemical monitoring is that of the specific physician seeing the patient
