immuno

Question 1

Romiplostim

Answer 1

TPO analog - treats thrombocytopenia

Question 2

Aldesleukin

Answer 2

IL-2) Renal cell carcinoma, metastatic melanoma

Question 3

Alemtuzumab

Answer 3

targets CD52
CLL, MS “Alymtuzumab”—chronic
lymphocytic leukemia

Question 4

Bevacuzimab

Answer 4

TargetsVEGF Colorectal cancer, renal cell
carcinoma, non-small cell
lung cancer
Treats wet macular degeneration
can cause bleeding, increases risk of thrombotic events

Question 5

Cetuximab

Answer 5

EGFR- Stage IV colorectal cancer,
head and neck cancer
Can cause a papulopustular acneiform rash

Question 6

Adverse effects of trastuzumab

Answer 6

causes cardiotoxicity -decreased LVEF, heart failure

Question 7

Daclizumab

Answer 7

Daclizumab targets CD25 (switched from alemtuzumab) (part of IL-2 receptor) Relapsing multiple sclerosis

Question 8

Eculizumab

Answer 8

Eculizumab Complement protein C5

Paroxysmal nocturnal hemoglobinuria

Question 9

Natalizumab

Answer 9

targets α4-integrin Multiple sclerosis, Crohn
disease
α4-integrin: WBC adhesion
Risk of PML in patients with
JC virus

Question 10

Ustekinumab

Answer 10

Ustekinumab

IL-12/IL-23 Psoriasis, psoriatic arthritis

Question 11

Denosumab

Answer 11

RANKL Osteoporosis; inhibits osteoclast
maturation (mimics
osteoprotegerin)
Denosumab affects osteoclasts

Question 12

Palivizumab

Answer 12

Targets RSV F protein
RSV prophylaxis for high-risk
infants

Question 13

Ranibizumab

Answer 13

targets VEGF 
Neovascular age-related
macular degeneration,
proliferative diabetic
retinopathy and macular
edema

Question 14

Tisagenlecleucel

Answer 14

CAR T-cell Therapy that is indicated for relapsed B-cell acute lymphoblastic leukemia by targeting the CD19 antigen
The way this drug works is that a patients T cells are extracted, genetically engineered to target CD19, then infused back into the patient

• Tisagenlecleucel has a 82% response rate

The main acute side effect of Tisagenlecleucel is Cytokine Release Syndrome while a potential long term risk is the potential for insertional mutagenesis

• the main symptoms of cytokine storm are a high fever, extreme fatigue, nausea; potential to be fatal; also occurs in GVHD, ARDS, Sepsis
• because Tisagenlecleucel is generated by using a retrovirus, concerns that it could modify a protoconcogene / tumor suppressor are warranted

Question 15

Pegademase

Answer 15

Pegademase is a recombinant Adenosine Deaminase used for treatment of the second most common form of SCID

Question 16

Ivacaftor

Answer 16

In the treatment of Cystic Fibrosis, Ivacaftor works by stimulating activity of the CFTR protein

• this opens Cl- channels to improve chloride transport (Ivacaftor invokes activity)
• this is for patients with two copies of the Phe508 deletion

Question 17

Dornase Alfa

Answer 17

cleaving DNA present in the mucus of Cystic Fibrosis patients thus reducing the visocity of lung secretions

Question 18

pancrelipase

Answer 18

mix of pancreatic enzymes used to restore pancreatic function

Question 19

Lumacaftor

Answer 19

Lumacaftor works by facilitating proper folding of the CFTR protein

• corrects misfolded proteins and improves transport to cell surface (lumacaftor lubricates proper folding)
• this is for patients with two copies of the Phe508 deletion

Question 20

Azithromycin in the tx of cystic fibrosis

Answer 20

In the treatment of Cystic Fibrosis, Azithromycin is used as an anti-inflammatory agent
Works by inhibiting phospholipase A2 in alveolar macrophages

Question 21

Cyclosporine

Answer 21

Cyclosporine - binds cyclophilin and this complex is a Calcineurin inhibitor (a transcription factor for IL-2).
Blocks T-cell activation by preventing IL-2 TRANSCRIPTION.
Tx for mainly acute transplant rejection and also Psoriasis, rheumatoid arthritis.
AE:
*Nephrotoxicity,
hypertension,
hyperlipidemia,
neurotoxicity,
gingival hyperplasia,
hirsutism.

Question 22

Tacrolimus

Answer 22

Tacrolimus binds to FK506 binding protein (FKBP). This complex inhibits calcineurin phosphatase. The drug inhibits calcium-dependent events, such as interleukin-2 gene transcription
Tx: only acute transplant rejection 
AE: 
*Nephrotoxicity,
hypertension,
hyperlipidemia,
**Increased risk of diabetes
and neurotoxicity;
no gingival
hyperplasia or
hirsutism.

Question 23

Sirolimus

Answer 23

Sirolimus (Rapamycin) mTOR inhibitor by binding FKBP which is same protein as tacrolimus but different results. {effects are more downstream]
Blocks T-cell activation and B-cell differentiation by
preventing RESPONSE to IL-2 (in addition to transcription).
Tx for Kidney transplant rejection prophylaxis
specifically.
AE:
“PanSirtopenia” (pancytopenia),
insulin resistance,
hyperlipidemia;
NOT nephrotoxic.
Kidney “sir-vives.”
Synergistic with cyclosporine.
**Also used in drugeluting
stents.

Question 24

Basiliximab

Answer 24

Basiliximab 
Monoclonal antibody blocks IL-2R.
Treats acute transplant rejection
AE: 
Edema 
hypertension, 
tremor.

Question 25

Azathioprine

Answer 25

``` Azathioprine Antimetabolite precursor of 6-mercaptopurine. Purine terminating analog that Inhibits lymphocyte proliferation Treats: Acute transplant rejection Rheumatoid arthritis, Crohn disease, glomerulonephritis, other autoimmune conditions. AE: Pancytopenia. 6-MP degraded by xanthine oxidase; toxicity decreased by allopurinol. Pronounce “azathiopurine.” ```

Question 26

Mycophenolate Mofetil

Answer 26

Mycophenolate Mofetil ``` Mech: Reversibly inhibits IMP dehydrogenase, preventing purine synthesis of B and T cells. Uses: Acute transplant rejection Lupus nephritis. AE: GI upset, pancytopenia, hypertension, hyperglycemia. Less nephrotoxic and neurotoxic. Associated with invasive CMV infection ```

Question 27

``` Glucocorticoids Inhibit NF-κB. Suppress both B- and T-cell function by decreasing transcription of many cytokines. and Induce T cell apoptosis. ``` USes: and AE

Answer 27

``` Adrenal insufficiency, asthma, CLL, non-Hodgkin lymphoma. Many autoimmune and inflammatory disorders, ``` ``` AE: -Cushing syndrome, -osteoporosis, -hyperglycemia, -diabetes, -amenorrhea, -adrenocortical atrophy, -peptic ulcers, -psychosis, -cataracts, -avascular necrosis (femoral head). Demargination of WBCs causes artificial leukocytosis. Adrenal insufficiency may develop if drug is stopped abruptly after chronic use. ```