Immunology: Immunosuppressants Flashcards
(85 cards)
A patient is given a recombinant form of IL-2. Which 2 types of cancer can this recombinant drug be used to treat?
Renal cell carcinoma, metastatic melanoma (both treated with aldesleukin)
Which 2 hematologic malignancies are glucocorticoids often used to treat?
Non-Hodgkin lymphoma and chronic lymphocytic leukemia
A patient with Crohn disease who is receiving natalizumab therapy develops rapidly progressive paralysis and hyperreflexia. What virus is the probable culprit?
JC virus, which can cause progressive multifocal leukoencephalopathy (PML); the risk of PML is increased in patients treated with natalizumab
Sirolimus (rapamycin) binds FKBP in the cell and subsequently inhibits what protein kinase?
mTOR (mechanistic target of rapamycin)
A man taking allopurinol for gout starts taking an immunosuppressive agent for Crohn disease. Pancytopenia develops rapidly. What happened?
Azathioprine’s metabolite, 6-MP, is metabolized by xanthine oxidase; allopurinol inhibits xanthine oxidase, resulting in toxic levels of 6-MP
Which 2 factors can amplify the nephrotoxicity of calcineurin inhibitors?
Administration at higher doses and poor baseline renal function
A patient scheduled for kidney transplantation receives a monoclonal antibody against IL-2R for immunosuppression. Which side effects should be monitored?
Edema, hypertension, tremor (the prescribed drug is basiliximab)
mTOR is responsible for driving the transcription of what types of genes?
Proliferation genes
An elderly patient is diagnosed with CLL. What are the 2 molecular targets of the therapeutic antibodies commonly used to treat this disease?
CD-20 (targeted by rituximab) and CD52 (targeted by alemtuzumab); think “alymtuzumab” for chronic lymphocytic leukemia and “ri2Ximab” to target CD20
6-Mercaptopurine (6-MP) inhibits what specific protein involved in nucleotide synthesis?
PRPP amidotransferase
A patient develops severe hirsutism while taking cyclosporine for post-transplant immunosuppression. Which alternative drug with a similar mechanism of action may be ideal for her?
Tacrolimus (which does not cause the hirsutism or gingival hyperplasia associated with cyclosporine)
What are the 2 main cancers that may be treated with trastuzumab?
Breast and gastric cancers (if positive for a HER2 mutation)
Long-term use of immunosuppressants increases the risk of which 2 conditions?
Cancers and infections (immunosuppressants such as cyclosporine disrupt lymphocyte activation and growth)
Apart from transplant rejection prophylaxis, what are the 3 main clinical indications for azathioprine?
Rheumatoid arthritis, glomerulonephritis, Crohn disease (and other autoimmune conditions)
A patient is receiving long-term prednisone therapy for severe SLE. What are 2 potential effects of this medication on the bone?
Osteoporosis (predisposing to vertebral fracture), avascular/ischemic osteonecrosis (often of femoral head)
Azathioprine inhibits proliferation of lymphocytes by blocking nucleotide synthesis. For which antimetabolite is azathioprine a precursor?
6-Mercaptopurine; “azathiopurine” interferes with nucleic acid synthesis (toxic to proliferating lymphocytes)
With which 2 CD markers is the T-helper cell receptor associated?
CD3 and CD4
Which 2 recombinant cytokines could be used to treat chemotherapy-induced leukopenia?
Filgrastim (G-CSF) and sargramostim (GM-CSF), which aid in the recovery of granulocyte and monocyte counts
Which immunosuppressant medication is synergistic with cyclosporine?
Sirolimus (rapamycin); although cyclosporine can be used alone, sirolimus is not nephrotoxic (the kidney “sirvives”) and can enhance its efficacy
A patient with NADPH oxidase deficiency has recurrent bacterial infections. What cytokine can be used to treat his condition?
IFN-γ (used to treat chronic granulomatous disease or CGD)
What 3 types of cancer is bevacizumab commonly used to treat?
Renal cell carcinoma, non–small cell lung cancer, and colorectal cancer
What recombinant antibody mimics the function of osteoprotegerin to prevent further bone loss in osteoporosis?
Denosumab (which, like osteoprotegerin, targets RANKL and inhibits osteoclast maturation)
What is the molecular target of abciximab?
Abciximab targets platelet glycoproteins IIb/IIIa (ABC is as easy as 123), preventing platelet aggregation
Both mycophenolate mofetil and azathioprine inhibit the de novo production of what type of nucleotides?
Purines (adenine, guanine)