Table 1.
Attributes of medications
| THERAPEUTIC | MECHANISM OF ACTION (MOA) | ADVERSE EFFECTS | MONITORING |
|---|---|---|---|
| Glucocorticoids | Inhibition of proinflammatory cytokines | Increased risk of infections, osteoporosis, osteonecrosis, cushingoid fat redistribution, acid reflux disease, electrolyte imbalances, hyperglycemia, hypertriglyceridemia, proximal myopathy, hyperactivity, glaucoma, cataracts, HPA axis suppression | Baseline and annual bone densitometry tests, calcium and vitamin D supplements, bisphosphonates, blood pressure, blood glucose, triglycerides, electrolytes, tuberculin skin testing |
| Azathioprine | Purine analog that inhibits DNA replication | Gastrointestinal toxicity, hepatotoxicity, alopecia, pancreatitis, lymphoproliferative diseases, increased infection rates | CBC and LFT every two weeks, baseline TPMT levels |
| Mycophenolate mofetil | Inhibits purine synthesis during DNA replication | Gastrointestinal distress, anemia, leukopenia, thrombocytopenia, increased risk of infections | CBC, LFT monthly |
| Cyclophosphamide | Alkylating agent that binds DNA during cell cycle | Acute myelosuppression, mucosal ulcer, alopecia, nephrotoxicity, cardiotoxicity, hepatotoxicity, interstitial lung fibrosis, azoospermia, hemorrhagic cystitis | RFP, CBC with platelets, UA |
| Methotrexate | Inhibits dihydrofolate reductase required for DNA synthesis | Hepatotoxicity, bone marrow suppression, ulcers, alopecia, interstitial pneumonitis and fibrosis, nephrotoxicity | CBC, electrolytes, RFP, LFT |
| Cyclosporine | Suppresses T-cell proliferation by forming a complex with cyclophilin, which blocks calcineurin activation | Electrolyte abnormalities, renal toxicity, tremors, hirsutism, hyperlipidemia, hypertension, gingival hyperplasia | RFP, LFT, CBC, electrolytes, lipid profile, blood pressure |
| Dapsone | Sulfone antibiotic that inhibits neutrophil toxicity and chemotaxis | Hemolytic anemia, methemoglobulinemia, idiosyncratic peripheral motor neuropathy, psychosis, agranulocytosis, dapsone hypersensitivity syndrome | CBC weekly during first month, monthly during first 6 months, semiannually thereafter, LFT and RFP every three months |
| Tetracycline/niacinamide | Anti-inflammatory activity with unclear MOA | Tetracycline: gastrointestinal distress, pseudotumor cerebri, photosensitivity, permanent tooth discoloration in children. Niacinamide: pruritus, flushing, nausea, headache | |
| Intravenous immunoglobulin | Purified human IgG with unclear MOA | Renal failure, transfusion-related acute lung injury (TRALI), fever, headache, myalgia, nausea, tachycardia, hemolysis, aseptic meningitis, thrombotic event, anaphylaxis with IgA deficiency | Baseline IgA and LFT, CBC and CMP prior to each cycle |
| Rituximab | Chimeric, murine/human monoclonal activity against CD20 antigen on B cells | Black box warnings due to fatalities resulting from infusion reactions <24 hours of first infusion, acute renal failure from tumor lysis syndrome, severe mucocutaneous reactions, progressive multifocal leukoencephalopathy |