Immunology

Question 1

Cyclosporine

• MOA
• Use
• Toxicity

Answer 1

MOA: binds to cyclophilins
- Complex blocks the differentiation + activation of T cells 
- inhibit calcineurin --> no NFAT dephosphorylation --> no production of IL-2 + receptor
Use:
- suppress organ rejection after transplantation (Acute)
- selecte autoimmune diseases
Toxicity
- nephrotoxicity
- HTN
- hyperlipidemia
- hyperglycemia
- tremor
- gingival hyperplasia
- hirsutism

Question 2

Tacrolimus (FK-506)

• MOA
• Use
• Toxicity

Answer 2

MOA: binds FK-binding protein
- inhibit calcineurin* --> no NFAT dephosphorylation --> no secretion of IL-2 or other cytokines
Use:
- organ transplant recipients to suppress immune system
Toxicirt
- nephrotixicity
- HTN
- hyperlipidemia
- hyperglycemia
- tremor

Question 3

Sirolimus (rapamycin)

• MOA
• Use
• Toxicity

Answer 3

MOA: inhibit mTOR
- inhibit T-cell proliferation in response to IL-2
Use
- immunosuppression after kidney transplant (use w/ cyclosporine + corticosteroids)
- used with drug eluting stents 
Toxicity
- hyperlipidemia
- thrombocytopenia
- leukopenia

Question 4

Azathioprine

Answer 4

MOA: antimetabolite
- precursor of 6-mercaptopurine
- interferes with nucleic acid metabolism + synthesis
- toxic to proliferating lymphocytes
Use:
- kidney transplant
- autoimmune disorders (glomerulonephritis + hemolytic anemia)
Toxicity
- bone marrow suppression
- active metabolite mercaptopurine is metabolized by xanthine oxidase –> toxicity with allupurinol

Question 5

Muromonac- CD3 (OKT3)

• MOA
• Use
• Toxicity

Answer 5

MOA: monoclonal antibody
- binds CE3 (epsilon chain) on surface of T-cells
- blocks cellular interaction with CD3 protein responsible for T-cell signal transuction
Use:
- immunosuppression after kidney transplant
- cytokine release syndrome
- hypersensitivity rxn

Question 6

Aldesleukin

Answer 6

Recombinant interleukin-2

• -> increases activity of T cells and NK cells
• renal cell carcinoma, metastatic melanoma

Question 7

Epoetin alda

Answer 7

Recombinant erythropoietin

- anemias (esp in renal failure)

Question 8

Filgrastim

Answer 8

Recombinant granulocyte colony stimulating factor

- recovery of bone marrow

Question 9

Sargamostim

Answer 9

Recombinant granulocyte- macrophage colony stimulating factor)
- recovery of bone marrow

Question 10

Alpha interferon

Answer 10

• Hep B, C
• Kaposi’s sarcoma
• Leukemia
• Malignant melanoma

Question 11

B- interferon

Answer 11

• MS

Question 12

Gamma- interferon

Answer 12

• Chronic granulomatous disease

Question 13

Oprelvekin

Answer 13

Recombinant interleukin 11

- Thrombocytopenia

Question 14

Thrombopoietin

Answer 14

Thrombocytopenia

Question 15

Muromonab-CD3

Answer 15

• target: CD3

- prevent acute transplant rejection

Question 16

Infliximab

Answer 16

• target: TNF-alpha
• crohn’s disease
• RA
• Psoriatic arthritis
• Ankylosing spondylitis

Question 17

Adalimumab

Answer 17

• target: TNF- alpha
• crohn’s disease
• RA
• psoriatic arthritis

Question 18

Abciximab

Answer 18

• target: GP IIb/IIIa

- prevent cardiac ischemia in unstable angina and in patients treated w/ percutaneous coronary intervention

Question 19

Tratuzumab

Answer 19

• Target: HER2

- HER-2 breast cancer

Question 20

Rituximab

Answer 20

• Target: CD20

- B- cell non hodgkin’s lymphoma

Question 21

Omalizumab

Answer 21

• Target: IgE

- asthma