From Jen: Immuno

Question 1

Cyclosporine

Answer 1

MOA: Binds cyclophilins. Complex blocks differentiation and activation of T cells by inhibiting calcineurin, thus preventing production of IL-2 and its receptor

Use: Suppress rejection after transplantation; select autoimmune disorders

Toxicity: Predisposes patient to viral infections and lymphoma; nephrotoxic (prevent with mannitol diuresis)

Question 2

Tacrolismus

FK506

Answer 2

MOA: Binds FK binding protein, inhibiting secretion of IL-2 and other cytokines (similar to cyclosporin)

Use: Potent immunosuppressive in transplant recipients

Toxicity: Significant!! Nephrotoxic, peripheral neuropathy, HTN, pleural effusion, hyperglycemia

Question 3

Azathioprine

Answer 3

MOA: Antimetabolite precursor of 6-mercaptopurine that interferes with metabolism and synthesis of nucleic acids. Toxic to proliferating lymphocytes

Use: kidney transplantation, autoimmune disease (glomerulonephritis, hemolytic anemia)

Toxicity: Bone marrow suppression. Increased toxicity with allopurinol

Question 4

Muromonab-CD3 (OKT3)

Answer 4

MOA: Monoclonal Ab that binds CD3 on surface of T cells. Blocks cellular interaction with CD3 protein responsible for T cell signal transduction

Use: Immunosuppression after kidney transplantation

Toxicity: Cytokine release syndrome, hypersensitivity reaction

Question 5

Sirolimus

rapamycin

Answer 5

MOA: Binds mTOR. Inhibits T cell proliferation in response to IL-2

Use: Immunosuppression after kidney transplantation in combination with cyclosporine and corticosteroids

Toxicity: Hyperlipidemia, thrombocytopenia, leukopenia

Question 6

Mycophenolate mofetil

Answer 6

MOA: inhibits de novo guanine synthesis and blocks lymphocyte production

Question 7

Daclizumab

Answer 7

MOA: Monoclonal Ab with high affinity for IL-2 receptor on activated T cells

Question 8

Aldesleukin

Answer 8

recombinant IL-2: promotes differentiation of T cells

Use: renal cell carcinoma, metastatic melanoma

Question 9

Erythropoietin

Answer 9

Use: Anemias, especially in renal failure

Question 10

Filgastrim

Answer 10

Granulocyte colony stimulating factor

Use: Recovery of bone marrow

Question 11

alpha-interferon

Answer 11

Synthetic IFN-a: endogenously produced by leukocytes against viral infection

Use: HBV, HCV, Kaposi’s sarcoma, leukemias, malignant melanoma

Question 12

beta-interferon

Answer 12

endogenously produced by fibroblasts, antiviral activity in innate immune response

Use: multiple sclerosis

Question 13

gamma-interferon

Answer 13

Endogenously produced by to promote differentiation of Th1 cells, activate macrophages in presence of intracellular pathogen

Use: chronic granulomatous disease

Question 14

Oprelvekin

Answer 14

recombinant IL-11: thrombopoietic growth factor

Use: Thrombocytopenia

Question 15

Thrombopoietin

Answer 15

Use: Thrombocytopenia