2: Immunosuppression in autoimmune shit Flashcards Preview

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Flashcards in 2: Immunosuppression in autoimmune shit Deck (31):
1

what happens in Ab-mediated disease?

specific Ab exists which is targeted against a particular Ag (protein) and leads to clinical sx upon the protein's destruction

2

examples of Ab-mediated disease

-hemolytic anemia (target on surface of RBCs)
-myasthenia gravis (AChR in NMJ)
-hypoadrenocorticism (adrenal cells)

3

what happens in immune complex mediated disease?

Abs are produced against proteins in body and combine into large complexes that circulate throughout the body and get stuck

4

examples of immune complex mediated disease

-SLE (Ab's against components of cell nucleus)
-rheumatoid arthritis

5

what happens in Ab and T cell mediated diseases?

exposure to a particular Ag will program for the search and destruction of that particular Ag in the future

6

examples of Ab and T cell mediated diseases

thyroiditis
autoimmune hypothroidism (targets thyroglobulin)

7

what are the primary drugs used to treat any autoimmune disorder?

corticosteroids - prednisone, prednisolone

8

how are corticosteroids given?

very high dose initially to induce remission, then slowly lowered dose to a low maintenance dose

9

why should corticosteroids be avoided long term?

increases risk of infections, ulcers, hyperglycemia, osteoporosis

10

what do you use if corticosteroids are insufficient?

cyclophosphamide or azathioprine may be added- but must be monitored closely for side effects

11

cyclophosphamide MOA

interferes w/ DNA synthesis/fxn by alkylation - affects B cells more than T cells

12

azathioprine MOA

purine antimetabolite that interferes with DNA synthesis - affects rapidly growing cells, such as bone marrow and GI

13

how long does it take to see results of azathioprine?

several weeks

14

SE of azathioprine

-leukopenia
-thrombocytopenia
-GI dysfunction
-higher susceptibility to infection and hepatic lesions

15

azathioprine metabolism

metabolized to give mercaptopurine

16

MOA of mercaptopurine

interferes with RNA/DNA synthesis after conversion into purine antagonist inside cells - mainly focused on humoral immunity

17

SE of mercaptopurine

due to bone marrow and GI cell depletion - need regular assessment of possible bone marrow suppression, and liver and pancreatic diseases

18

MOA of leflunomide

prodrug of an inhibitor of pyrimidine synthesis

19

uses of leflunomide and PK of it

rheumatoid arthritis

long half life of several weeks

20

what is it important to measure during cyclosporine therapy?

blood cyclosporine levels b/c varies in absorption and saturates tissues, so doses may need adjusting sometimes
-also interacts with other drugs frequently
-needs a strict diet and dosing schedule

21

what happens in the allergic state?

immune system overreacts to foreign substances (allergens/antigens) to which it is exposed, resulting in release of histamine and production of lesions in targeted organs

22

three ways in which allergies manifest

-itching skin (local or generalized) and swelling (esp. face)
-resp: coughing, wheezing, sneezing
-GI: vomit, diarrhea

severe can cause anaphylactic shock

23

what percent of allergies can be effectively controlled?

90% -topical and systemic treatments

24

systemic treatment of allergies

includes fatty acids (linoleic, gamma-linolenic) that work in the skin to help reduce the amount and effects of histamine

25

SE of fatty acids for allergy tx

very few
can be enhanced by antihistamines and biotin

26

why is it common for a person to have to try multiple antihistamines before they find one that works?

every patient responds differently to each of the antihistamines

27

MOA of antihistamines

H1 blockers - outcompete histamine for binding site on target

28

what are common H1 blockers? which ones do not cause drowsiness?

diphenhydramine (benadryl)
promethazine
chlorpheniramine

no sedation:
-rupatadine
-cetirizine
-fexofenadine

29

what is the most intense allergy therapy?

weekly or montyly injections with allergens to induce desensitization

30

how can corticosteroids be used for allergies?

SC, IM, or PO but only to treat severe symptoms or after all other options have been exhausted

31

what corticosteroids are available for injection for allergies?

betamethasone
dexamethasone
methylprednisolone
triamcinolone