- inhibit PG synthesis - inhibit phagocyte trafficking - inhibits phagocytosis - blocks cytokines

Immunomodulating Drugs Flashcards by Ashlyn Stackhouse

Aim of recombinant cytokines as Rx

to boost the immune system to cancers, some pathogens

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Why do we use IVIG?

used as antibody replacement in pts with
- primary ab deficiencies = CVID, Brutons
- secondary ab def = CLL, MM, post-BMT
- passive vaccination
Taken from >1000 donors, contains prefromed IgG to many main pathogens. Give 1/mo, IV/SC

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Specific Igs

VZV, Rabies, Hep B, Tetanus

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Interferon Alpha

Hep B, Hep C, HHV-8

hairy cell leukaemia, CML, MM

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Interferon Beta

was used for relapsing MS but not anymore

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Interferon gamma

CGD

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Ipilimumab

ab specific for CTLA4. blocks immune checkpoint.

Used in advanced melanoma.

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Pembrolizumab

ab specific for PD-1. blocks immune checkpoint.

used in advanced melanoma

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vaccines C/I in immunosuppressed patients

Yellow fever, VZV, BCG, Polio, typhoid, MMR

NB - can give MMR in HIV

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Steroids - MOA

inhibit PG synthesis
inhibit phagocyte trafficking
inhibits phagocytosis
blocks cytokines

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Steroids - Uses

autoimmune, autoinflamm, malignancy, prevent tx rejection

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Steroids - SE

1) cushingoid sx
2) metabolic syndrome -DM, HTN, central obesity
3) transient neutrophilia - stuck in blood
4) OSTEOPOROSIS, peptic ulcer, avasc necrosis, pancreatitis

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EBV-specific CD8 T cells use as immunomod agent

Post-transplant EBV-assoc lymphoproliferative disorder

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Cytotoxic agents

Damage DNA to prevent cell replication and proliferation.

Include: Cyclophosphamide, Azathioprine, Mycophenate Mofetil, Methotrexate (CAMM)

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Cytotoxic agent
Alkylates guanine -> DNA damage, prevents replication
Toxic to rapidly dividing cells - T>B
Used in:
Vasculitis with end organ damage - eGPA, GPA, SLE
Connective tissue disease
anti-cancer

Cyclophosphamide

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side effects of cyclophosphamide

damages rapid div cells: sterility, hair loss, BM suppression
haemorrhagic cystitis - builds up toxic metabolites in the bladder –> can lead to bladder cancer
Infection with PCP

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metabolised to 6-mercaptopurine which blocks purine sythesis –> stop dna replication
Inhibits T cell proliferation + some T cell

Used in:
autoinflammatory disease: Crohns, UC
Transplant
eGPA

Azathioprine

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side effects of azathioprine

BM suppression
Infection
Check TPMT activity - polymorphisms can mean that some pts cannot metabolise
Hepatotoxic

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Blocks de novo synthesis of nucleotides via blocking IM PDH
T>B
can be used in Tx as an alternative to Azathioprine
used in autoimmune/vasculitis as an alternative to Cyclo

Mycophenate Mofetil

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Side effects of mycophenate mofetil

BM suppression
Infection - reactivation of HSV, JC virus - PML
teratogenic

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dihydrofolate reductase inhibitor - decreases DNA synthesis
Uses:
abortifacient
RA, psoriasis
chemotherapy

Methotrexate

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Side effects of methotrexate

bone marrow suppression, infection,
teratogenic
LUNG - pulm fibrosis, pneumonitis (grandma was a smoker)
hepatotoxic
folate deficiency and all its problems - macrocytic megaloblastic anemia

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Uses of plasmapheresis

Study These Flashcards

severe ab-mediated disease: Goodpastures, MG, vascular rejection
ab-mediated rejection

Inhibitors of cell signalling

Study These Flashcards

Calcineurin inhibitors: Tacrolimus and Cyclosporin
Tofacitinib
Apremilast

inhibit calcineurin which prevents transcription of IL-2 - stop lymphocyte proliferation used for prophylaxis against rejection in Tx

Tacrolimus | Cyclosporin

Side effects of Tacrolimus

Diabetes (tic tacs are sugary)

side effects of Cyclosporin

gum hypertrophy | dysmorphism

JAK inhibitor | Used in RA

Tofacitinib | JAK likes Tofu but he cant eat it cus he has RA

PDE4 inhibitor | used in PA/psoriasis

APremilast | I pray itll last - Pde4, Psoriasis

Anti-thymocyte globulin

specific rabbit anti-thymocyte Igs against cell surface antigens i.e CD2, CD8... Used in allograft rejection (kidney, heart) - need daily IV infusion

Agents directed at cell surface antigens

Aim to block cell signalling and cause cell depletion

anti-CD25 (IL-2Ra), inhibits T cell proliferation Used in allograft rejection given IV before and after surgery

Basilixumab

side effects of basilixumab

Infusion reactions Infection malignancy

anti-CTLA-Ig fusion protein - blocks CTLA4, prevents T cell activation Used in RA

Abatacept | AbataCept intercepts at Ctla4

anti-CD20, depletes mature B cells | used in lymphoma, RA, SLE

Rituximab | lived with Rita when I was 20

SE of Rituximab

infections - JC virus - PML (gave me a brainache) | exacerbates CVS disease - (gave me stress and HTN)

SE of Abatacept

Cough - TB HCV HBV AbataCept Ctla4 Cough hepC and might as well have hepB too

anti-alpha4 integrin ab - inhibits T cell migration | Used in relapsing MS, Crohns disease

Natalizumab | Natalie is an alpha female but she has MS and Crohns which stops her from travelling

Side effects of Natalizumab

Infections - PML (alpha female gives people headache) | hepatotoxic (boozer)

anti-IL-6R. reduces activation of macrophages, t cells, b cells and PMNs Used in RA, Castlemans disease

Tocilizumab i want to-Cil you in my castle (but i cant cus i got RA)

side effects of tocilizumab

infection hepatotoxic dyslipidaemia big fat drunk man saying 'i want toCil you in my castle'

anti-CD3 on T cells, mouse monoclonal ab (OKT3) | Used in active allograft rejection

Muromumab | you would be a moron to reject someone when you first meet them!

SE of muromumab

fever leucopenia (dont reject them because they might make you feel HOT ...or reduce your white cell count?)

Efalizumab

A failure | anti CDII-a - inihibts migration. Psoriasis rx, but stopped using it because it caused fatal PML.

anti-CD52, results in lymphocyte depletion Uses: MS CLL

Alemtuzamab S looks like 5 - MS CLL = lots of lymphocytes. want to deplete them

Infliximab Certolizumab Adalimumab Golimumab

anti-TNFa

anti-TNFa uses

RA Ank Spond Psoriasis/PA IBD

side effects of TNFa inhibitors

- can treat all the other inflamm conditions but can give you LUPUS-like condition (the one it cant treat) Infections - HBV HCV TB demyelination malignancy - lymphoma

TNFa antagonist inhibits TNFa and B uses: RA, PA, psoriasis, ankspond

Etanercept

SE of Etanercept

``` same as TNFa inhibitors - can treat all the other inflamm conditions but can give you LUPUS-like condition (the one it cant treat) Infections - HBV HCV TB demyelination malignancy - lymphoma ```

ant-IL12 and IL-23 - binds p40 protein

Ustekinumab

Uses of Ustekinumab

Psoriasis/PA

SE of Ustekinumab

TB, malignancy

anti-IL17A | Uses: Psoriasis, PA, Ank Spond

Secukinumab

anti RANKL | used for osteoporosis, MM, bone mets

Denosumab | SE - avasc nec of jaw (dinosaur jaw)

Dacilizumab

anti-IL2R, anti CD25. same as Basilixumab.

Immunomodulating Drugs Flashcards

(56 cards)