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Immuno > Immunomodulating Drugs > Flashcards

Immunomodulating Drugs Flashcards

1
Q

Aim of recombinant cytokines as Rx

A

to boost the immune system to cancers, some pathogens

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2
Q

Why do we use IVIG?

A

used as antibody replacement in pts with
- primary ab deficiencies = CVID, Brutons
- secondary ab def = CLL, MM, post-BMT
- passive vaccination
Taken from >1000 donors, contains prefromed IgG to many main pathogens. Give 1/mo, IV/SC

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3
Q

Specific Igs

A

VZV, Rabies, Hep B, Tetanus

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4
Q

Interferon Alpha

A

Hep B, Hep C, HHV-8

hairy cell leukaemia, CML, MM

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5
Q

Interferon Beta

A

was used for relapsing MS but not anymore

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6
Q

Interferon gamma

A

CGD

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7
Q

Ipilimumab

A

ab specific for CTLA4. blocks immune checkpoint.

Used in advanced melanoma.

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8
Q

Pembrolizumab

A

ab specific for PD-1. blocks immune checkpoint.

used in advanced melanoma

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9
Q

vaccines C/I in immunosuppressed patients

A

Yellow fever, VZV, BCG, Polio, typhoid, MMR

NB - can give MMR in HIV

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10
Q

Steroids - MOA

A
  • inhibit PG synthesis
  • inhibit phagocyte trafficking
  • inhibits phagocytosis
  • blocks cytokines
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11
Q

Steroids - Uses

A

autoimmune, autoinflamm, malignancy, prevent tx rejection

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12
Q

Steroids - SE

A

1) cushingoid sx
2) metabolic syndrome -DM, HTN, central obesity
3) transient neutrophilia - stuck in blood
4) OSTEOPOROSIS, peptic ulcer, avasc necrosis, pancreatitis

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13
Q

EBV-specific CD8 T cells use as immunomod agent

A

Post-transplant EBV-assoc lymphoproliferative disorder

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14
Q

Cytotoxic agents

A

Damage DNA to prevent cell replication and proliferation.

Include: Cyclophosphamide, Azathioprine, Mycophenate Mofetil, Methotrexate (CAMM)

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15
Q

Cytotoxic agent
Alkylates guanine -> DNA damage, prevents replication
Toxic to rapidly dividing cells - T>B
Used in:
Vasculitis with end organ damage - eGPA, GPA, SLE
Connective tissue disease
anti-cancer

A

Cyclophosphamide

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16
Q

side effects of cyclophosphamide

A

damages rapid div cells: sterility, hair loss, BM suppression
haemorrhagic cystitis - builds up toxic metabolites in the bladder –> can lead to bladder cancer
Infection with PCP

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17
Q

metabolised to 6-mercaptopurine which blocks purine sythesis –> stop dna replication
Inhibits T cell proliferation + some T cell

Used in:
autoinflammatory disease: Crohns, UC
Transplant
eGPA

A

Azathioprine

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18
Q

side effects of azathioprine

A

BM suppression
Infection
Check TPMT activity - polymorphisms can mean that some pts cannot metabolise
Hepatotoxic

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19
Q

Blocks de novo synthesis of nucleotides via blocking IM PDH
T>B
can be used in Tx as an alternative to Azathioprine
used in autoimmune/vasculitis as an alternative to Cyclo

A

Mycophenate Mofetil

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20
Q

Side effects of mycophenate mofetil

A

BM suppression
Infection - reactivation of HSV, JC virus - PML
teratogenic

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21
Q 
dihydrofolate reductase inhibitor - decreases DNA synthesis
Uses:
abortifacient
RA, psoriasis
chemotherapy
A

Methotrexate

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22
Q

Side effects of methotrexate

A

bone marrow suppression, infection,
teratogenic
LUNG - pulm fibrosis, pneumonitis (grandma was a smoker)
hepatotoxic
folate deficiency and all its problems - macrocytic megaloblastic anemia

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23
Q

Uses of plasmapheresis

A

severe ab-mediated disease: Goodpastures, MG, vascular rejection
ab-mediated rejection

24
Q

Inhibitors of cell signalling

A

Calcineurin inhibitors: Tacrolimus and Cyclosporin
Tofacitinib
Apremilast

25
Q

inhibit calcineurin which prevents transcription of IL-2 - stop lymphocyte proliferation
used for prophylaxis against rejection in Tx

A

Tacrolimus

Cyclosporin

26
Q

Side effects of Tacrolimus

A

Diabetes (tic tacs are sugary)

27
Q

side effects of Cyclosporin

A

gum hypertrophy

dysmorphism

28
Q

JAK inhibitor

Used in RA

A

Tofacitinib

JAK likes Tofu but he cant eat it cus he has RA

29
Q

PDE4 inhibitor

used in PA/psoriasis

A

APremilast

I pray itll last - Pde4, Psoriasis

30
Q

Anti-thymocyte globulin

A

specific rabbit anti-thymocyte Igs against cell surface antigens i.e CD2, CD8…
Used in allograft rejection (kidney, heart) - need daily IV infusion

31
Q

Agents directed at cell surface antigens

A

Aim to block cell signalling and cause cell depletion

32
Q

anti-CD25 (IL-2Ra), inhibits T cell proliferation
Used in allograft rejection
given IV before and after surgery

A

Basilixumab

33
Q

side effects of basilixumab

A

Infusion reactions
Infection
malignancy

34
Q

anti-CTLA-Ig fusion protein - blocks CTLA4, prevents T cell activation
Used in RA

A

Abatacept

AbataCept intercepts at Ctla4

35
Q

anti-CD20, depletes mature B cells

used in lymphoma, RA, SLE

A

Rituximab

lived with Rita when I was 20

36
Q

SE of Rituximab

A

infections - JC virus - PML (gave me a brainache)

exacerbates CVS disease - (gave me stress and HTN)

37
Q

SE of Abatacept

A

Cough - TB
HCV HBV

AbataCept Ctla4 Cough hepC and might as well have hepB too

38
Q

anti-alpha4 integrin ab - inhibits T cell migration

Used in relapsing MS, Crohns disease

A

Natalizumab

Natalie is an alpha female but she has MS and Crohns which stops her from travelling

39
Q

Side effects of Natalizumab

A

Infections - PML (alpha female gives people headache)

hepatotoxic (boozer)

40
Q

anti-IL-6R. reduces activation of macrophages, t cells, b cells and PMNs
Used in RA, Castlemans disease

A

Tocilizumab

i want to-Cil you in my castle (but i cant cus i got RA)

41
Q

side effects of tocilizumab

A

infection
hepatotoxic
dyslipidaemia
big fat drunk man saying ‘i want toCil you in my castle’

42
Q

anti-CD3 on T cells, mouse monoclonal ab (OKT3)

Used in active allograft rejection

A

Muromumab

you would be a moron to reject someone when you first meet them!

43
Q

SE of muromumab

A

fever
leucopenia
(dont reject them because they might make you feel HOT …or reduce your white cell count?)

44
Q

Efalizumab

A

A failure

anti CDII-a - inihibts migration. Psoriasis rx, but stopped using it because it caused fatal PML.

45
Q

anti-CD52, results in lymphocyte depletion
Uses:
MS
CLL

A

Alemtuzamab
S looks like 5 - MS
CLL = lots of lymphocytes. want to deplete them

46
Q

Infliximab
Certolizumab
Adalimumab
Golimumab

A

anti-TNFa

47
Q

anti-TNFa uses

A

RA
Ank Spond
Psoriasis/PA
IBD

48
Q

side effects of TNFa inhibitors

A
  • can treat all the other inflamm conditions but can give you LUPUS-like condition (the one it cant treat)
    Infections - HBV HCV TB
    demyelination
    malignancy - lymphoma
49
Q

TNFa antagonist
inhibits TNFa and B
uses:
RA, PA, psoriasis, ankspond

A

Etanercept

50
Q

SE of Etanercept

A 
same as TNFa inhibitors
- can treat all the other inflamm conditions but can give you LUPUS-like condition (the one it cant treat)
Infections - HBV HCV TB
demyelination
malignancy - lymphoma
51
Q

ant-IL12 and IL-23 - binds p40 protein

A

Ustekinumab

52
Q

Uses of Ustekinumab

A

Psoriasis/PA

53
Q

SE of Ustekinumab

A

TB, malignancy

54
Q

anti-IL17A

Uses: Psoriasis, PA, Ank Spond

A

Secukinumab

55
Q

anti RANKL

used for osteoporosis, MM, bone mets

A

Denosumab

SE - avasc nec of jaw (dinosaur jaw)

56
Q

Dacilizumab

A

anti-IL2R, anti CD25. same as Basilixumab.

Immuno (8 decks)

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