Immunosupression Therapy Flashcards
(23 cards)
What is the mechanism of action of azathioprine?
Metabolised into mercaptourine
- this inhibits making and repair of DNA
What enzyme is azathioprine broken down by?
TPMT
Why are people screened for TPMP levels before starting treatment with azathioprine?
Under active TPMT -> Myelosupression with azathioprine
what are the side effects of azathioprine?
- Neutropenia and thrombocytopenia (Blood dyscrasia)
- Nausea
- Hypersensitivity: dizziness, fever, rash, hypotension
what are the signs of blood dyscrasia that the patient should be counselled to know?
- sore throat
- bruising
- bleeding
Can azathioprine be used in pregnancy?
NO- it is teratogenic
What are the monitoring requirements for azathioprine?
FBC
- Weekly for first 4 weeks
- then at least every 3 months
Interaction between azathioprine and allopurinol
Increases risk of haematological toxicity
- if used together = reduce azathioprine dose TO 25% of normal
Interaction Between azathioprine and ACE-inhibitors
Increase risk of ANAEMIA and leukopenia
- AVOID
What are ciclosporin and tacrolimus examples of?
Immunosuppressants
- calcineurin inhibitors -> suppresses cell-medicated immune response
How must ciclosporin and tacrolimus be prescribed?
BY brand
What are the main side effects of ciclosporin?
- think HYPER
HYPER- glycaemia, lipidaemia, tension, uricemia and kalaemia
HYPO- magnesia
- skin reactions
- gingival hyperplasia
- hair change
Monitoring requirements for ciclosporin
Monitor the TROUGH levels (changes on indication)
- LFTs
- Magnesium levels
- Potassium
- Lipids
- CrCl
- Blood pressure
what should should someone taking ciclosporin and tacrolimus avoid?
UV/ Sunlight
What are the side effects of tacrolimus?
- HYPER (3)
HYPER- glycaemia, urine is and kalaemia
- renal/ liver impairment
- skin reactions
- visual disturbances
- blood dyscrasia
- QT prolongation
- peripheral neuropathy
What can tacrolimus cause if used in children?
Cardio myopathy
How does grapefruit juice interact with ciclosporin and tacrolimus?
Increases exposure of the drug -> toxicity
Tacrolimus should be avoided in patients who have a sensitivity to…
Macrolides
How does mycophenolate mofetil work?
Inhibits purine synthesis
What are the side effects of mycophenolate?
- Bone marrow supression
- Pure red cell aphasia (bone marrow stops producing RBCs) -> anaemia
- Hypogammaglobulinaemia
- Bronchiectasis
Signs of bone marrow supression and bronchiectasis in treatment with mycophenolate?
Bone marrow suppression: bruising or bleeding
Bronchiectasis: SOB or persistent cough
what is the MHRA warning surrounding mycophenolate and contraception?
It is Teratogenic
Women: 1 effective contraceptive during and 6 weeks after treatment
- 2 methods preferred
Men: effective contraception during and 90 days after
