Immunomodulary drugs/ anti-inflammatory drugs

Question 0

BCG

Answer 0

Live attenuated bacillus calmette-guerin
pamp on APC increased activity
some CA and TB vaccine
Septic shock

Question 1

Alum

Answer 1

Adjuvant
in must us vaccines
Form deposits -> prolonged exposure
May increase APC activity
Few Side effects

Question 2

IL-2

Answer 2

Increases cytotoxicity of killer cells
metastatic melanoma tx
Renal carcinoma tx
AE serious capillary leak syndrome, hypotension, death

Question 3

IFN-gamma

Answer 3

for treating severe infection

Question 4

IFN alpha and beta

Answer 4

Not Immunomodulary agents; endogenous antivirals by tissue
tx viral hepatitis
tx hairy cell leukemia, melanoma, lymphoma
tx MS

Question 5

Cyclophosphamide

Answer 5

DNA alkylating agent (nitrogen mustard)
kills all proliferating cells
tx auto immune diseases
tx bone marro transplant
AE Myelosuppresion, n/v, infertility

Question 6

azathioprine

Answer 6

purine antimetabolite
prodrug-> 6-mercaptopurine
inactivated by xanthine ocidase
tx renal and other transplant
tx lupus and RA
AE myelosuppression, n/v

Question 7

mycophenolate mofetil

Answer 7

prodrug-> mycophenolic acid
inhibits inosine monophosphate dehydrogenase
-> blocks purine syntheis
tx solid organ txpt (alternative tx to cyclosporine)
Some auto immune disease
AE Myelosuppression, N/V

Question 8

Methotrexate

Answer 8

anti folate
drug of choice for RA
Some autoimmune diseases
AE Nausea, mucosal ulcers, hepatotoxicity, myelosuppression

Question 9

Leflunomide

Answer 9

prodrug
inhibits dihydroorate dehydrogenase
tx RA and some autoimmune diseases
AE diarrhea, hepatotoxicity, Myelosuppression

Question 10

Prednisone

Answer 10

first line immunosuppressant for solid organ transplant and hematopoietic stem cell transplant
some autoimmune diseases, asthma, allergic reactions
no Myelosuppression
AE (tx longer than 2 weeks): Cushing’s syndrome, glucose intolerance, ocular issues, GI ulcerations, osteoporosis, HTN, psychiatric issues

Question 11

Cyclosporine

Answer 11

binds to cyclophilin to inhibit calcineurin (T cell receptor pathway)
tx kidney, liver and heart transplant
tx RA, IBD, Asthma
can be effective by itself but often in combinations
AE Nephrotoxicity, HTN, Hyperglycemia, liver dysfunction, increased CA risk

Question 12

Tacrolimus

Answer 12

binds with FKBP12 to inhibit calcineurin activity
more potent than cyclosporine but not more effective
tx kidney, liver and heart transplant
tx RA, IBD, Asthma
can be effective by itself but often in combinations
AE Nephrotoxicity, HTN, Hyperglycemia, liver dysfunction, increased CA risk

Question 13

Sirolimus

Answer 13

IL-2 receptor pathway inhibitor (mtor)
used alone or combination
tx solid organ transplant, steroid resistant GVHD, Hematopoietic stem cell transport
antagonizes tacrolimus but not clinically important
AE myelosuppression, hyperlipidemia, HTN, edema, hepatotoxicity

Question 14

Rh(D)

Answer 14

Rh- mother
IV
prevents fetal hemolytic disease

Question 15

Anti T cell Globulin (ATG)

Answer 15

Animal antibodies
prolonged T cell Depletion 
tx late rejection
AE cytokine release syndrome: fever, chills, HA, N/V, mailase
Serum sickness, Anaphylaxis

Question 16

belatacept

Answer 16

Fusion protein (Fc bount to B7 binding ligand)
blocks coactivation (B7 of APC with CD28 of T cell) of T cells
tx kidney transplants
->comparable to calcineurin in efficacy
AE anemia, neutropenia, edema, increased risk of infection/CA, PTLD (contraindicated in EBV- patients)

Question 17

Muromonab

Answer 17

anti CD3 (T-cell receptor component)
prolonged T cell depletion 
AE cytokine release syndrome: fever, chills, HA, N/V, malaise
serum sickness, anaphylaxis
discontinued due to economic reasons

Question 18

Alemtuzamab

Answer 18

anti CD52 (T, B, monocytes, macrophages, NK cells)
Prolonged T cell depletion
AE Myelosuppression, flu like symptoms

Question 19

Basiliximab

Answer 19

anti CD25 (IL-2r)
blocks clonal expansion of T-cells
well tolerated
moderate effect compared to ATG
reduced immune depletion-> decreased infection risk

Question 20

infliximab

Answer 20

anti TNFalpha
Humanized antibodies
blocks from interacting with receptor, lowers circulating levels
tx RA (usually with methotrexate)
tx Crohns (with azathrioprine)
AE increased uri and uti

Question 21

adalimunab

Answer 21

anti TNFalpha
human antibodies
blocks from interacting with receptor, lowers circulating levels
tx RA (usually with methotrexate)
tx Crohns (with azathrioprine)
AE increased uri and uti

Question 22

Etanercept

Answer 22

anti TNFalpha
Fusion protein (Fc and binding thing)
blocks from interacting with receptor, lowers circulating levels
tx RA (usually with methotrexate)
tx Crohns (with azathrioprine)
AE increased uri and uti

Question 23

anakinra

Answer 23

Anti IL-1
competitive antagonist on IL-1r
tx RA and other inflammatory diseases 
daily injection
AE increased risk of infection

Question 24

tofacitinib

Answer 24

General Jak kinase inhibitor po tx RA (second line after failing methotrexate) Comparable to TNFalpha inhibitors AE anemia, neutropenia, general myelosupperession

Question 25

cromolyn and nedocromil

Answer 25

``` antihistamine inhibits degranulation and inhibit cough poorly soluble salt, inhaled long term asthma well tolerated ```

Question 26

diphenhydramine

Answer 26

first gen antihistamine motion sickness AE sedation, anticholinergic (dry mouth, urinary retention, tachycardia), anti adrenergic (orthostatic hypotension), anti seritonin r (increased appetite), local anesthesia (blocks Na channels)

Question 27

dimenhydrinate

Answer 27

first gen antihistamine motion sickness AE sedation, anticholinergic (dry mouth, urinary retention, tachycardia), anti adrenergic (orthostatic hypotension), anti seritonin r (increased appetite), local anesthesia (blocks Na channels)

Question 28

cyclinzine

Answer 28

first gen antihistamine motion sickness AE sedation, anticholinergic (dry mouth, urinary retention, tachycardia), anti adrenergic (orthostatic hypotension), anti seritonin r (increased appetite), local anesthesia (blocks Na channels)

Question 29

promethazine

Answer 29

first gen antihistamine anti-emetic AE sedation, anticholinergic (dry mouth, urinary retention, tachycardia), anti adrenergic (orthostatic hypotension), anti seritonin r (increased appetite), local anesthesia (blocks Na channels)

Question 30

loratidine, cetrizine, fexofenadine

Answer 30

2nd gen antihistamine fewer anti-cholinergic effects (dry mouth, urinary retention, tachycardia) less sedation

Question 31

NSAID tx target

Answer 31

``` antipyretic analgesia muscle px, tendonitis, bursitis RA and OA ASA for cardio prophylaxis (the rest raise cardio risk) ```

Question 32

Ketorolac

Answer 32

NSAID | post surgical analgesic

Question 33

Indomethacin

Answer 33

NSAID RX arthritis/anti inflammatory AE high risk of intolerance

Question 34

aspirin (ASA)

Answer 34

NSAID OTC analgesic cardio prophylactic AE Salicyslism: hyperventilation, tinnitus, vertigo, emesis, sweating Reye's syndrome: (children with viral illness) acute encephalopathy, fatty liver degeneration.

Question 35

Naproxen

Answer 35

NSAID OTC analgesic RX anti inflammatory

Question 36

Ibuprofen

Answer 36

NSAID | OTC analgesic

Question 37

Diclofenac

Answer 37

NSAID | RX arthritis

Question 38

Etodolac

Answer 38

NSAID | RX arthritis

Question 39

meloxicam

Answer 39

NSAID | RX arthritis

Question 40

NSAIDs AE

Answer 40

increased Cardio risk (except ASA) GI toxicty: dysplasia, ulceration, GI bleeds Renal toxicity NSAID induced asthma

Question 41

acetaminophen

Answer 41

OTC analgesic/antipyretic non-selective COX inhibitor (deactived by peroxides of inflammation) lacks effects on platelets, CV and GI systems well tolerated AE hepatoxicity on OD

Question 42

Celecoxib, Rofecoxib, Valdecoxib

Answer 42

COX-2 selective tx chronic Arthritis reduced GI effects significant increased CV risk

Question 43

Zileuton

Answer 43

Leukotriene synthesis inhibitor PO tx asthma AE liver toxicity

Question 44

Zafirlukast, montelukast

Answer 44

``` LTD4 (leukotriene) receptor inhibitor PO tx asthma permits use of less corticosteroids decreases bronchoconstriction and edema ```