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Romesh Path COPY > Immuno 10: Immuno Modulating Therapies 2 > Flashcards

Immuno 10: Immuno Modulating Therapies 2 Flashcards

1
Q

How do Corticosteroids inhibit Prostaglandins and hence have an anti-inflammatory effect ?

A

Corticosteroids INHIBIT Phospholipase A2

(Normaly)
Phospholipase A2 converts phospholipids into Arachidonic acid
Arachidonic acid is converted to Prostaglandins or leukotrienes by COX enzymes.
Prostaglandins cause Inflammation

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2
Q

Give 2 examples of Eicosanoids ?

A

Prostaglandins

Leukotrienes

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3
Q

Give 3 examples of immune modulating functions of corticosteroids ?

A 
Inhibit Prostaglandin synthesis 
Inhibit Phagocyte entry into inflamed tissues 
Causes lymphopenia (Lymphocytes sequester in lymphoid tissues)
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4
Q

Give 3 examples of Anti-proliferative agents ?

A

Cyclophosphamide
Azathioprine
Methotrexate

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5
Q

What is the mechanism by which cyclophosphamide inhibits lymphocyte proliferation?

A

Cyclophosphamide alkylate guanine bases on DNA

Prevents cell replication particularly in rapidly dividing cells (cancer, lymphocytes)

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6
Q

Give 3 examples of diseases in which Cyclophosphamide is indicated ?

A

SLE
GPA (granulomatosis with polyangitis) (wegner’s granulomatosis)
Cancers- Hodgkin’s lymphoma

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7
Q

Suggest 3 side effects of cyclophosphamide ?

A

Hair loss
Sterility
Haemorrhagic cystitis

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8
Q

Describe the mechanism by which azathioprine inhibits DNA replication ?

A

Metabolised to 6-mercaptopurine which blocks synthesis of adenine and guanine

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9
Q

Give 3 indications for azathioprine ?

A

Transplantation
auto-immune diseases
Crohn’s and UC

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10
Q

Which genetic polymorphism contraindicates the use of azathioprine because of risk of bone marrow suppression ?

A

Thiopurine methyl transferase (TPMT)

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11
Q

What is an alternative to azathioprine used in transplantation ?

A

Mycophenolate Mofetil

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12
Q

Which virus can cause Multifocal leukoencephalopathy infection in the immunocompromised patient ?

A

JC virus

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13
Q

How does plasmapheresis work ?

A

Patients blood is separated and the plasma is treated to remove immunoglobulins and is then re-infused

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14
Q

When is Plasmaphoresis indicated ?

A

Severe transplant rejection
Severe acute myasthenia gravis
Goodpasture’s syndrome

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15
Q

What is the role of IL2 in the T cell response ?

A

IL2 causes T cell proliferation

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16
Q

How does cyclosporin inhibit T cell proliferation ?

A

Cyclosporin is a calcineurin inhibitor.
It blocks IL2 production
Thereby inhibiting T cell proliferation

17
Q

How do Anti-thymocyte globulins cause T cell depletion ?

A

Thymocytes (lymphocytes from human thymus) were injected into rabbits
Rabbits produced antibodies to the thymocytes
The antibodies are retrieved and injected into humans to cause a non-specific immune response against T cells

18
Q

Which cells are affected by Rituximab ?

A

B cells

Rituximab targets CD20 a B cell marker

19
Q

Name a drug that inhibits leukocyte binding to VCAM1 and is used to treat relapsing-remitting Multiple sclerosis ?

A

Natalizumab

20
Q

Which disease is characterised by a IL6 producing tumour

A

Castleman’s disease

21
Q

List 4 diseases in which anti-TNF alpha antibodies (infliximab) is indicated ?

A

Rheumatoid arthritis
Ankylosing spondylitis
Psoriasis/psoriatic arthritis
IBD

22
Q

Explain what effect RANK L binding to RANK receptors has on bone ?

A

RANKL produced by Osteoblasts binds to RANK receptor on osteoclast precursors causing them to differentiate into Osteoclasts.
This causes increased bone resorption

23
Q

What is Osteoprotegrin (OPG) and what role does it have in controlling bone resorption ?

A

OPG is secreted by Osteoblasts and is a decoy receptor for RANKL to reduce activation and differentiation of Osteoclasts.
Hence inhibiting bone resorption

24
Q

What is the mechanism by which Denosumab works in Osteoporosis treatment ?

A

Monoclonal antibody to RANKL so that it cant bind to RANK receptor on osteoclast precursors.
This reduces Osteoclast resorption of bone

25
Q

What is a complication of osteoporosis treatment with denosumab ?

A

Avascular necrosis of the jaw

26
Q

Name a drug that prevents DNA replication especially of T cells

A

Mycofenylate mofetil

27
Q

Which immuno modulating drug causes a transient increase in neutrophil count ?

A

Prednisolone

28
Q

Which immuno modulating drug can cause gingival hypertrophy as a side effect?

A

Ciclopsporin

29
Q

List 3 side effects of methotrexate ?

A

Pneumonitis
pulmonary fibrosis
cirrhosis

30
Q

A patient with signs of severe myasthenia gravis requires ventilation. Which one of the following would be the most suitable treatment ?

A) Corticosteroids
B) Ciclosporin
C) Tacrolimus
D) Plasmapheresis

A

D) Plasmapherisis

can remove the Ach receptor antibodies in the blood so is useful initially. Later needs acetylcholinesterase inhibitors.

31
Q

Name a monoclonal antibody drug that targets IL-2 to prevent T cell proliferation. This drug is used prophylactically in allograft transplant.

A

Basiliximab

Targets CD25 on the alpha chain of IL-2 which stops T-cell proliferation if they are presented with donor HLA.

32
Q

Name a drug that is a CTLA4- IgG fusion protein and is used in the treatment of rheumatoid arthritis resistant to DMARDs ?

A

Abatacept

A fusion protein between CTLA4 and Immunoglobulin IgG.
Binds to APCs to prevent them from stimulating T cells.

33
Q

Name 2 drugs used to treat malignant melanoma ?

A

Ipilimumab

Pembrolizumab

34
Q

Which drug works by inhibiting phospholipase A2 ?

A

Prednisolone

35
Q

Which mutation if present can cause severe neutropenia with azathioprine treatment ?

A

TPMT

can’t metabolise azathioprine

36
Q

Which 2 drugs can be used in transplant rejection ?

A
  • OKT3 Muromonab (CD3 inhibitor mouse monoclonal antibody)
  • ATG (anti thymocyte globulin)

(can also do plasmapheresis if antibody mediated rejection or IVIG)

37
Q

List 2 drugs that can be given before transplant

A
  • Basiliximab

- Alemtuzumab (anti CD52)

38
Q

What is Ustekinumab used for ?

A

Psoriasis

-Targets IL12 and IL23

39
Q

List 4 drugs given as maintenance therapy post transplantation ?

A
  • Cyclosporin
  • Mycofenolate mofetil
  • Azathioprene
  • Prednisolone

Romesh Path COPY (97 decks)

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