Infection: Immune response Flashcards
Azathioprine, ciclosporin, mercaptopurine and methotrexate all have a role in the treatment of what?
Inflammatory bowel disease
Antiproliferative drugs used to prevent organ rejection include:
Solid organ transplant patients are maintained on drug regimens, which may include antiproliferative drugs (azathioprine or mycophenolate mofetil), calcineurin inhibitors (ciclosporin or tacrolimus), corticosteroids, or sirolimus.
Calcineurin inhibitors used to preven organ rejection include:
Solid organ transplant patients are maintained on drug regimens, which may include antiproliferative drugs (azathioprine or mycophenolate mofetil), calcineurin inhibitors (ciclosporin or tacrolimus), corticosteroids, or sirolimus.
What is sirolimus?
Rapamycin is a macrolide used to coat coronary stents, prevent organ transplant rejection and to treat a rare lung disease called lymphangioleiomyomatosis.
Corticosteroids may suppress clinical signs of infection and allow disease such as septiceamia or tuberculosis to reach an advanced stage before being recognised. What should be considered for administration to a patient who is immuosuppressed as soon as possible after measles exposure?
Corticosteroids may suppress clinical signs of infection and allow diseases such as septicaemia or tuberculosis to reach an advanced stage before being recognised—important: normal immunoglobulin administration should be considered as soon as possible after measles exposure, and varicella–zoster immunoglobulin (VZIG) is recommended for individuals who have significant chickenpox (varicella) exposure.
Azathioprine is used usually when corticosteroid therapy alone provides inadequate control. What is it metabolsied to?
mercaptopurine - doses should be reduced to one quarter when allopurinol is given concurrently.
Doses of azathioprine should be reduced to 1/4 when given concurrently with what drug?
Manufacturer advises reduce dose to one-quarter of the usual dose with concurrent use of allopurinol.
Why would thiopurine methyltransferase (TPMT) defiency impact treatment with thiopurine drugs like azathioprine, mercaptopurine, tioguanine?
The enzyme thiopurine methyltransferase (TPMT) metabolises thiopurine drugs (azathioprine, mercaptopurine, tioguanine); the risk of myelosuppression is increased in patients with reduced activity of the enzyme, particularly for the few individuals in whom TPMT activity is undetectable. Consider measuring TPMT activity before starting azathioprine, mercaptopurine, or tioguanine therapy. Patients with absent TPMT activity should not receive thiopurine drugs; those with reduced TPMT activity may be treated under specialist supervision.
Mycophenolate mofetil is an antiproliferative drug which is metabolised to what active?
What is the advantage of this over azathiopurine?
Mycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine.
Which corticosteroid is widely used in oncology?
Prednisolone.
It has a marked antitumour effect in acute lymphoblastic leukaemia, Hodgkin’s disease, and the non-Hodgkin lymphomas.
Why does prednisolone have a role in the palliation of symptomatic end-stage malignant disease?
It may enhance appetite and produce a sense of well-being.
What type of drug is ciclosporin?
Calcineurin inhibitor, a potent immunosuppressant which is virtually non-myelotoxic but markedly nephrotoxic.
What type of drug is tacrolimus?
It is also a calcineuin inhibitor which although not chemically related to ciclosporin it has a similar mode of action and side-effects, but the incidence of neurotoxicity appears to be greater; cardiomyopathy has also been reported.
Disturbance of glucose metabolism also appears to be significant.
What disadvantages does tacrolimus use have versus ciclosporin use? (3)
- Greater incidence of neurotoxicity.
- Reports of cardiomyopathy.
- Disturbance of glucose metabolism.
What type of drug is sirolimus?
Non-calcineurin inhibiting immunosuppressant licensed for renal transplantation.
