Anti-inflammatory and Immune drugs

Question 1

Immunostimulant

Answer 1

Given to boost immunity

Recombinant cytokines

Question 2

Immunosuppressant

Answer 2

Given to treat inflammatory diseases

Atopy, autoimmune disease, prevent transplant rejection

Question 3

What can alpha-IFN be used to treat?

Answer 3

Warts from papilloma and Kapsoi’s sarcoma

Question 4

What can beta-IFN be used to treat?

Answer 4

Therapy for Multiple sclerosis

Question 5

What can gamma-IFN be used for?

Answer 5

Boost phagocyte NADPH oxidase system in pts with chronic granulomatous disease

Question 6

What agents stimulate leukocyte production from bone marrow?

Answer 6

Recombinant G-CSF, GM-CSF

Pts with secondary neutropenia secondary to chemotherapy

Question 7

What are the steps in inflammation?

Answer 7

Activation of innate immune cells
Release of inflammatory mediators
B and T cells become activated

Question 8

What types of drugs interfere with arachidonic acid metabolites?

Answer 8

Non-steroidal anti-inflam (NSAIDS)
Leukotriene inhibitors
Corticosteroids

Question 9

What types of drugs interfere with cytokines?

Answer 9

Corticosteroids
Cytokine inhibitors (monoclonal antibodies)

Question 10

What drugs are used to inhibit T and B cell responses?

Answer 10

Corticosteroids
Cytotoxic drugs
Cyclosporine
Cytokine inhibitor 
Biological inhibitors of lymphocyte activation/inducers of apoptosis

Question 11

What drug blocks phopholipases?

Answer 11

Steroid inhibit (corticosteroid)

Question 12

What drug blocks cyclooxygenase?

Answer 12

Non-steroidal inhibitors

Question 13

What are leukotriene inhibitors used for?

Answer 13

Mild or moderate asthma since leukotrienes cause bronchoconstriction and eosinophil attraction

Question 14

Which leukotriene inhibitor inhibitors lipoxygenase?

Answer 14

Zileuton

Question 15

Which leukotriene inhibitors are receptor antagonists?

Answer 15

Zafirlukast

Montelukast

Question 16

What is the mechanism of action for corticosteroids?

Answer 16

GSC enters cell binds to GCSR
Complex binds to DNA
Up regulates lipocortins which block AA metabolism
Inhibits transcription of cytokine genes by blocking NFKB and up-regulating transcription factor inhibitors

Question 17

Glococorticoids block the action of ______ inhibiting the formation of ______.

Answer 17

Phospholipase A2, Free arachidonic acid

Question 18

What is the action of Cytotoxic drugs?

Answer 18

Kill rapidly dividing cells

Lymphocyte proliferation in clonal expansion, bone marrow cells

Question 19

What are cytotoxic used for treatment of?

Answer 19

Autoimmunity or to prevent grapft rejection

Question 20

What drugs are cytotoxic?

Answer 20

Azathiprine (purine analogue - nucleic acid synth)
Cyclophosphamide (Alkylating agent - DNA binding)
Methotrexate (Folic acid antagonist - DNA + RNA)

Question 21

What drugs inhibit cytokine secretion and T cell proliferation?

Answer 21

Cyclosporine and Tacrolimus

Question 22

What were cyclosporin and tacrolimus used for?

Answer 22

Prevent transplant rejection and now used for moderate to severe psoriasis

Question 23

How do cyclosporin and tacrolimus work?

Answer 23

T cell activation leads to an influx of Ca++ and in combination with calmodulin they bind to calcinerin which activates NFAT to transcribe IL-2 and other
The drugs block calcineurin from activating NFAT

Question 24

What are the biologicals?

Answer 24

Monoclonal antibodies against cytokines or cytokine receptors
Small molecule inhibitors of cytokine signaling

Question 25

Murine monoclonal antibody

Answer 25

Entire antibody of mouse origin Recognized as foreign in human No long-term treatment use

Question 26

Chimeric monoclonal antibody

Answer 26

Monoclonal antibody that has human Fc mouse Fab | Have -ximab in name

Question 27

Humanized monoclonal antibody

Answer 27

Parts of Fab are human | Have -umab in name

Question 28

Human monoclonal antobody

Answer 28

Entire molecule is human

Question 29

What are anti-TNF drugs used for?

Answer 29

Rheumatoid arthritis, psoriasis and Chron's disease

Question 30

What is the anti-TNF drug which uses chimeric monoclonal antibodies?

Answer 30

Infliximab (Remicade)

Question 31

Which anti-TNF drug uses chimeric monoclonal antibodies?

Answer 31

Adalimumab (Humira)

Question 32

Which anti-TNF drug uses recombinant TNF receptors fused to immunoglobulin?

Answer 32

Etanercept

Question 33

What is Etanercept?

Answer 33

Human soluble TNF receptor fused to the Fc segment of human IgG

Question 34

How does Ustekinumab work?

Answer 34

The ustekinumab binds to the p40 which is bound to either p35 or p19 It is kept from binding with the IL-12 (p35), IL-23 (p19)

Question 35

What interleukin does Tocilizumab go after?

Answer 35

IL-6

Question 36

What does IL-6 do?

Answer 36

Activates T and B cells, macrophages, chronodrocytes and synovial fibroblasts, and osteoclasts

Question 37

What is Anakinra?

Answer 37

Recombinant IL-1 receptor antagonist

Question 38

Which disease does IL-1 play a role in?

Answer 38

Rheumatoid arthritis pathogenesis

Question 39

How does Toficitinib (Xeljanz) work and what is it used for?

Answer 39

Inhibits JAK kinases which is involved for cytokine signaling Rheumatoid arthritis

Question 40

Which drug blocks T cell activation?

Answer 40

Abatacept - used for Rheumatoid Arthritis

Question 41

Which drug inhibits LFA-3/CD2 interaction, thus inhibits T lymphocyte activation?

Answer 41

Alefacept

Question 42

Which drug causes the death of the B cell upon binding?

Answer 42

Rituximab

Question 43

What type of hypersensitivity is asthma and explain how it works.

Answer 43

Type 1 | Inflammation in bronchial walls

Question 44

What drugs are used for asthma?

Answer 44

Bronchodilators Leukotriene inhibitors Corticosteroids

Question 45

Explain psoriasis

Answer 45

T-cell induced proliferation of keratinocytes leading to unsightly plaques of red, raised, rough areas of skin

Question 46

What are the drug used to treat psoriasis?

Answer 46

Methotrexate Corticosteroids Cytokine inhibitors Biologicals

Question 47

Explain rheumatoid arthritis

Answer 47

T-cell mediated inflammation of joints with resoprtion of bone and joint deformity

Question 48

What drugs are used to treat rheumatoid arthritis?

Answer 48

Nonsteroidal anti-inflammatory drugs (NSAIDS) Cytotoxic drugs (methotrexate) Cytokine inhibitors and other biologicals (anti-TNF, rituximab) Corticosteroids

Question 49

What are the key cells and cytokines involved in the pathogenesis of rheumatoid arthritis?

Answer 49

``` T cells B cells Macrophages Neutrophils TNF IL-1 IL-6 ```

Question 50

What are the key cells and cytokines involved int he pathogenesis of psoriasis?

Answer 50

``` Th1 Th17 TNF IL-1 IL-23 IL-12 ```