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CLIN PHARM > II - Immunosuppressants > Flashcards

II - Immunosuppressants Flashcards

(52 cards)

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1
Q

Glucocorticoids

A

Prednisone
Prednisilone
Dexamethasone

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2
Q

Calcineurin inhibitors

A

Cyclosporine
Tacrolimus

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3
Q

Janus kinase inhibitor

A

Apoquel
Oclacitinib

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4
Q

Caninized monoclonal antibody against IL-31

A

Cytopoint

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5
Q

Antimetabolite

A

Azathioprene

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6
Q

Alkylating agents

A

Cyclophosphamide
Chlorambucil

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7
Q

2nd/3rd line/new

A

Mycophenolate mofetil

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8
Q

Antihistamine

A

Diphenhydramine

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9
Q

What are the goals of immunosuppressant therapy?

A
  1. Decrease inflammation
  2. Modulate/suppress lymphocyte function
  3. Minimize adverse drug effects
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10
Q

What drugs are the first line of treatment in dogs and cats for inflammatory and immune-mediated disease?

A

Glucocorticoids
- prednisone
- prednisilone
- dexamethasone

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11
Q

What bloodwork changes are seen with glucocorticoid administration?

A

Increase: erythrocytes, platelets, neutrophils (EPN)

Decrease: eosinophils, macrophages, T-lymphocytes (EMT)

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12
Q

Low doses of glucocorticoids are ____________ and high doses are ____________.

A

Anti-inflammatory

Immunosuppressive

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13
Q

Glucocorticoids have a systemic impact on ________ and ________ immunity.

A

Innate and adaptive

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14
Q

Glucocorticoids inhibit release of ______, which decreases recruitment of inflammatory cells.

A

Cell adhesion molecules

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15
Q

Glucocorticoids prevent release of:

A

Cytokines: IL-1, IL-2, TNFa
Histamine
Serotonin
Lysosomal enzymes

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16
Q

Which glucocorticoids are shorter acting?

A

Prednisone and prednisilone

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17
Q

8 side effects of glucocorticoids

A

GI ulceration
Iatrogenic hyperadrenocorticism
Adrenal gland suppression
Insulin resistance and secondary diabetes mellitus
Muscle catabolism
Delayed wound healing
Opportunistic infections
Behavior changes

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18
Q

________ is a prodrug metabolized to ________ and used in dogs.

A

Prednisone, prednisilone

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19
Q

Which shorter acting glucocorticoid has better bioavailability in cats?

A

Prednisilone

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20
Q

Which glucocorticoid lacks mineralocorticoid activity (minimizing sodium and water retention) and is better for patients with underlying cardiovascular disease or diseases associated with fluid retention (hypoalbuminemia, portal hypertension)?

A

Dexamethasone

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21
Q

What drugs are the first line of treatment for perianal fistulas and keratoconjunctivitis?

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A

Calcineurin inhibitors
- cyclosporine
- Tacrolimus

22
Q

What drug is a substrate of the cytochrome P450 enzyme CYP3A?

23
Q

What are two drugs that interact with Calcineurin inhibitors to decrease efficacy?

Study These Flashcards
A

Azole antifungals
phenobarbital (cats)

24
Q

Which immunosuppressant has a narrow therapeutic window?

Study These Flashcards
A

Calcineurin inhibitor
- cyclosporine

25
Which immunosuppressant drug has a patient response that is difficult to predict (due to individual gastric contents, liver function, other meds)?
Calcineurin inhibitor - cyclosporine
26
With which immunosuppressant drug should generic/compounded formulas especially be avoided?
Calcineurin inhibitor - cyclosporine
27
__________ are frequently used as add-on drugs for IMHA and IBD.
Calcineurin inhibitors - cyclosporine - Tacrolimus
28
5 side effects of Calcineurin inhibitors
* Self-limiting GI upset; can give maropitant or frozen Immunosuppressive Gingival hyperplasia Hepatotoxicity Thromboembolism
29
MOA: Binds to a cytoplasmic receptor protein; the complex then binds and inhibits Calcineurin, decreasing expression of IL-2 and other cytokines necessary for T-cell activation.
Calcineurin inhibitors - cyclosporine - Tacrolimus
30
MOA: Inhibits activity of pro-inflammatory cytokines (IL-1, 4, 6, 13, 31)
Janus kinase inhibitor - Apoquel (Oclacitinib)
31
First choice drugs for fast relief of hypersensitivity-induced cutaneous pruritis.
Janus kinase inhibitor - Apoquel - Oclacitinib
32
Side effects of these immunosuppressants include vomiting, diarrhea, lethargy, anorexia, and bloodwork changes.
Janus kinase inhibitors - Apoquel - Oclacitinib
33
What populations of dogs should not use Apoquel?
- severe infection - breeding/pregnant/lactating
34
Is it ok to use Janus kinase inhibitors with vaccines, nsaids, and allergy shots?
Yes
35
What drug is used to manage allergic pruritic flares? How long does it last?
Cytopoint 4-8 weeks
36
MOA: Interferes with incorporation of purines/pyrimidines into DNA; prodrug metabolized to a purine analog (6-Mercapto purine); decreases synthesis of WBC
Antimetabolites - azathioprene
37
What drug is used to treat IBD, IMHA, or to decrease dose of glucocorticoids?
Antimetabolites - azathioprene
38
Toxicities for this drug include bone marrow suppression, hepatotoxicity, and GI
Antimetabolites - Azathioprene
39
Efficacy of this immunosuppressant is delayed for days to weeks, so should be used in conjunction with another drug initially.
Antimetabolites - Azathioprene
40
Where is Azathioprene oxidized?
In the liver and peripheral tissues via TPMT to an inactive metabolite
41
This drug is oxidized by TPMT, which increases risk for suppression of bone marrow (due to decreased TPMT).
Antimetabolites - Azathioprene
42
Azathioprene is contraindicated in which species?
Cats and horses
43
MOA: Alkylates DNA causing chemical cross-links to occur - interfering with DNA replication
Alkylating agents - cyclophosphamide - Chlorambucil
44
High doses of alkylating agents deplete ______.
T-cells
45
Low doses of alkylating agents enhance _______.
T-cell memory
46
This drug is used in cats in lieu of azathioprene.
Chlorambucil
47
Side effects of this drug include sterile hemorrhagic cystitis.
Cyclophosphamide *prednisone/furosemide to ensure frequent urination *monitor for Hematuria
48
This drug is used in cats as a second line of treatment for IBD and for those who do not respond to prednisilone.
Chlorambucil (Alkylating agent)
49
MOA: Mycophenolic acid inhibits the type II isoform of inosine-5’-monophosphate dehydrogenase; this enzyme is present in abundance in activated lymphocytes and is critical for the synthesis of guanosine nucleotides.
Mycophenolate mofetil
50
Indications for this drug include treatment of dogs for: - IMHA - IMPT - IMPA - IM skin disease - IM glomerulonephritis - myasthenia gravis - meningoencephalomyelitis
Mycophenolate mofetil
51
Side effects/cautions for Mycophenolate mofetil
GI upset Avoid use in pregnant patients (+ risk to owner) Increased susceptibility to infection/neoplasia Allergic reactions
52
MOA: inverse agonist (H1) - reverses effects of histamine on capillaries reducing allergic reaction symptoms
Antihistamines - diphenhydramine

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