Immunology pharm

Question 1

Oral Fe

Answer 1

FeSO4

Fe Fumarate

Question 2

Intravenous iron

Answer 2

Ferrisig (Fe-polymaltose)

Ferrinject (Fe-carboxymaltose)

Question 3

Which reaction does Vitamin B12 catalyse

Answer 3

Homocysteine ——–> Methionine

As Methylcobalmin

Question 4

Replacing Vitamin B12

Answer 4

As hydroxycobalmin

Question 5

TPO

Answer 5

Romiplostin

Question 6

Classification of immunosuppressants

Answer 6

1) Inhibitors of lymphocyte gene expression
- Corticosteroids

2) Inhibitors of lymphocyte signalling
- Cyclosporins
- Tacrolimus
- Sirolimus

3) Inhibitors of lymphocyte proliferation
- MTX
- Azathioprine
- Alkylating agent

4) Monoclonal Abs
- Rituximab
- Adalimumab

Question 7

Steroids

Answer 7

Broad immunosuppressant activity
Potent and fast-acting
Doesn’t remit the disease rather controls it

Needs to be tapered off as sudden withdrawal can result in drop in BP and can be fatal

Binds to NFkB to inhibit pro-inflammatory genes

Question 8

Side-effects of steroids

Answer 8

Weight gain
Chest infections
Osteoporosis

Question 9

Azathioprine

Answer 9

Inhibits lymphocyte proliferation
Can have toxic metabolites (metabolised by Xanthine oxidase) hence should not be given with Allopurinol which can lead to overwhelming AZA side-effects

Question 10

Side effects of AZA

Answer 10

BM toxicity
Hepatotoxicity
GI upset
Infection

Question 11

Methotrexate

Answer 11

Prevents lymphocyte proliferation

Acts on Dihydrofolate reductase to prevent synthesis o folic acid which is needed for DNA synthesis

Question 12

Cyclophosphamides

Answer 12

Alkylating agent

Cross-links DNA double helix

Question 13

Side-effects of Rituximab

Answer 13

Hypogammagloblinaemia

Infusion related

Question 14

TNFa inhibitors

Answer 14

Adalimumab

Etarnecept

Question 15

What is the main target of immunosuppressant drugs (cytokines) in terms of T-cell proliferation

Answer 15

IL-2

Question 16

Calcineurin inhibitors

Answer 16

Cyclosporin

Tacrolimus

Question 17

What do calcineurin inhibitors do?

Answer 17

Bind to cyclophilin to stop IL-2 trancscription

Hence, stop T-cell proliferation

Question 18

Anti-proliferative drugs

Answer 18

Mycophenolate
Azathioprine
Sirolimus

Question 19

Mycophenolate

Answer 19

Inhibits GMP synthesis (guanosine monophosphate)

Inhibition of RNA and DNA synthesis in B and T cells (as they cannot depend on the salvage pathway)

Question 20

Azathioprine

Answer 20

Purine analogue

Interferes with DNA replication of T and B cells

Question 21

Sirolimus

Answer 21

Reduces IL-2 translation

Question 22

Which two biologics are used for severe acute rejection to cause depletion of lymphocytes?

Answer 22

Thymoglobulin

OKT3 (against TCR)

Question 23

Belatacept

Answer 23

Binds to CD80/86 and prevents co-stimulation through CD-28

Question 24

Which two signalling pathways are affected in cancers

Answer 24

Ras/Raf/MAPK

PI3K/Akt

Question 25

Side-effects of anti-cancer drugs

Answer 25

GI toxicity Hair loss Myelosuppression

Question 26

How do you manage the side-effects of anti-cancer drugs?

Answer 26

1) Use different drugs with different mechanisms and targets | 2) Different doses to avoid side-effects

Question 27

Chemotherapy terminology

Answer 27

Induction- aimed for complete or partial remission Consolidation- after induction Adjuvant- following surgery or chemo Neoadjuvant- prior to local therapy

Question 28

AML treatment procedure

Answer 28

1) Induction- decrease AML cells (cytarabine + Anthracycline) 2) Consolidation 3) HSCT 4) Supportive

Question 29

Trastazumab

Answer 29

Herceptin (breast cancer)

Question 30

Vemurafenib

Answer 30

Braf mutation

Question 31

Side-effects of targeted therapies

Answer 31

``` Cutaneous effects (Acne-like rash) GI Skin/hair Hepatitis Thrombosis, ischaemia ```

Question 32

Immune checkpoint inhibitor drugs

Answer 32

Ipilumimab | Nivolumab