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Immunomodulators Flashcards

1
Q

What are immunomodulators?

A

Drugs that modify immune system activity by either stimulating or suppressing it.

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2
Q

What types of immunity can immunomodulators target?

A

Both innate and adaptive immunity.

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3
Q

What are the steps that immunomodulators can act on?

A
  • Antigen recognition and phagocytosis
  • Release of mediators due to immune response
  • Lymphocyte proliferation/differentiation
  • Antibody synthesis
  • Ag-Ab interaction
  • Modification of target tissue response
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4
Q

What are general immunosuppressants?

A

Drugs that inhibit cellular/humoral or both types of immune responses, mainly used in autoimmune diseases and organ transplant.

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5
Q

What are common side effects of immunosuppressants?

A
  • Infection
  • Cancers
  • Nephrotoxicity
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6
Q

Name a type of general immunosuppressant.

A

Steroids

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7
Q

What are examples of steroids used as immunosuppressants?

A
  • Prednisone
  • Methylprednisolone
  • Dexamethasone
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8
Q

What is the mechanism of action of steroids?

A
  • Inhibit cytokines that cause inflammation
  • Decrease peripheral blood lymphocyte count
  • Inhibit T cell proliferation
  • Enhance destruction of lymphoid cells
  • Increase RBCs, platelets & neutrophils in circulation
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9
Q

What are some uses of steroids?

A
  • Autoimmune diseases
  • Asthma
  • RA
  • SLE
  • Psoriasis
  • IBD
  • Eye conditions
  • Transplant rejection
  • GVH-BM transplantation
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10
Q

What are common side effects of long-term steroid use?

A
  • Avascular necrosis of bone
  • High blood pressure
  • Hyperglycemia
  • Cataracts
  • Risk of infections
  • Growth retardation
  • Poor wound healing
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11
Q

What is colchicine and its primary use?

A

A plant-sourced alkaloid used to suppress inflammation, primarily for gout flares.

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12
Q

What are the mechanisms of action of colchicine?

A
  • Suppresses inflammation in WBCs
  • Inhibits activation and migration of neutrophils
  • Binds tubulin protein, inhibiting mitosis
  • Interrupts mast cells and lysosome degranulation
  • Inhibits release of superoxide anions
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13
Q

What are common side effects of colchicine?

A
  • Diarrhea
  • Stomach pain
  • Nausea
  • Vomiting
  • Headache
  • Fatigue
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14
Q

What is the mechanism of action of hydroxychloroquine?

A

Interrupts signaling in the immune system, reducing the inflammatory response.

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15
Q

What are some uses of hydroxychloroquine?

A
  • Malaria
  • RA
  • SLE
  • Prophyria cutanea tarda
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16
Q

What are common adverse effects of hydroxychloroquine?

A
  • Diarrhea
  • Nausea
  • Vomiting
  • Abdominal pain
  • Headache
  • Muscle weakness
  • Rash
  • Vision changes
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17
Q

What is sulfasalazine and its mechanism of action?

A

A DMARD metabolized into sulfapyridine & 5-aminosalicylate, which have immunosuppressive effects.

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18
Q

What are the uses of sulfasalazine?

A
  • RA
  • Psoriatic arthritis
  • Ulcerative colitis
  • Crohn’s disease
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19
Q

What are common side effects of sulfasalazine?

A
  • Nausea
  • Headache
  • Severe cutaneous reactions
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20
Q

What is dapsone primarily used for?

A

An antibiotic used for leprosy and autoimmune conditions.

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21
Q

What are common adverse effects of dapsone?

A
  • Gastrointestinal upset
  • Rash
  • Headache
  • Blurred vision
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22
Q

What is the mechanism of action of methotrexate?

A

Inhibits DHFR enzyme, interrupting the use of folic acid and inhibiting DNA, RNA & protein synthesis.

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23
Q

What are the uses of methotrexate?

A
  • Rheumatoid arthritis
  • Psoriasis
  • Ectopic pregnancies
  • Certain cancers
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24
Q

What are common adverse effects of methotrexate?

A
  • Increased susceptibility to infections
  • Hepatotoxicity
  • Allergic reactions
  • Leukopenia
  • Kidney failure
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25
What is mycophenolate mofetil/sodium used for?
To prevent organ rejection and treat autoimmune diseases.
26
What is the mechanism of action of mycophenolate mofetil?
Blocks IMPDH enzyme, controlling immune responses in autoimmune conditions.
27
What are common adverse effects of mycophenolate mofetil?
* Increased risk of infections * Nausea * Diarrhea * GIT bleeding
28
What is azathioprine and its mechanism of action?
An immunosuppressive drug that inhibits purine synthesis, stopping nucleic acid production.
29
What are common adverse effects of azathioprine?
* High risk of infections * Nausea * Vomiting * Rashes
30
What is leflunomide used for?
Treatment of active RA, psoriatic arthritis, and organ rejection.
31
What is the mechanism of action of leflunomide?
Inhibits DHODH enzyme, affecting DNA and RNA synthesis.
32
What are common adverse effects of leflunomide?
* Diarrhea * UTIs * Allergic reaction rash
33
What are anti-IL-1 biologics?
Drugs that block IL-1α and IL-1β from binding to their receptors.
34
What are examples of anti-IL-1 biologics?
* Anakinra * Canakinumab * Rilonacept
35
What are common adverse reactions of anti-IL-1 biologics?
* Increased risk of infection * Injection site reactions * Headaches
36
What is TNF-α?
A cytokine used by the immune system for cell signaling.
37
What are the two receptors through which TNF signaling occurs?
* TNFR1 * TNFR2
38
What are anti-TNF biologics?
Monoclonal antibodies or fusion proteins that inhibit TNF-α.
39
What are some uses of anti-TNF biologics?
* RA * Psoriasis * Crohn’s disease
40
What are common adverse reactions of anti-TNF biologics?
* Higher risk of serious infections * Injection site reactions * Long-term risk of cancers
41
Name a natural anti-TNF agent.
Curcumin
42
What is the role of IL-6?
A cytokine produced by monocytes, macrophages, lymphocytes, and fibroblasts, important for mediating fever.
43
What are 5-HT2A receptor agonists known to inhibit?
TNF-α ## Footnote Includes Psilocybin found in many species of mushrooms.
44
What compound found in Nigella sativa has been studied for TNF-α inhibition?
Thymoquinone ## Footnote Related benefits for autoimmune disorder treatment.
45
What is IL-6 and which cells produce it?
A cytokine produced by monocytes, macrophages, lymphocytes, and fibroblasts.
46
What are two monoclonal antibodies that inhibit IL-6?
* Tocilizumab * Sarilumab
47
What are the indications for IL-6 inhibitors?
* RA * Giant cell arteritis * Juvenile idiopathic arthritis
48
What are common adverse reactions of IL-6 inhibitors?
* Higher risk of infections * Rashes * Transient elevation in liver enzymes * Rarely neutropenia and thrombocytopenia
49
What is Eculizumab and what does it target?
A monoclonal antibody that targets terminal complement component 5 (C5).
50
What conditions is Eculizumab used for?
* Paroxysmal nocturnal hemoglobinuria (PNH) * Atypical hemolytic uremic syndrome (a-HUS)
51
What are some adverse reactions of Eculizumab?
* Increased risk of infections caused by Neisseria * Headaches & severe anemia * Loss of white blood cells * Anaphylactic & hypersensitivity reactions
52
What is the mode of action of Rituximab?
Binds to CD20 protein on B cells, triggering cell death.
53
What are the indications for Rituximab?
* Non-Hodgkin’s lymphoma * Chronic lymphocytic leukemia * RA * MG * Vasculitis * Autoimmune skin disease
54
What are common adverse effects of Rituximab?
* Higher risk of infections * Re-activation of hepatitis B * Rash, itchiness * Increased risk of viral infections
55
What is Belimumab and what does it inhibit?
A monoclonal antibody that inhibits BLyS (B lymphocyte stimulator).
56
What are the indications for Belimumab?
Systemic lupus erythematosus (SLE)
57
What are the adverse reactions of Belimumab?
* Higher risk of skin infections * Nausea & diarrhea * Infusion site & hypersensitivity reactions
58
What is the role of calcineurin in T cell activation?
Activates T cells through increased cytoplasmic calcium levels.
59
What is Cyclosporine used for?
* Prevent organ transplant rejection * Graft versus host disease * RA * Psoriasis * Chronic urticaria
60
What are the adverse effects of Cyclosporine?
* High risk for infections * Headache * Vomiting * High blood pressure
61
What is the mechanism of action of Tacrolimus?
Immunosuppressive drug through inhibition of calcineurin.
62
What are the indications for Abatacept?
* RA * Juvenile idiopathic arthritis * Psoriatic arthritis
63
What is IL-17 and which cells produce it?
A family of pro-inflammatory cytokines produced by T helper 17 cells.
64
What are the uses of IL-17 inhibitors?
* Psoriasis * Arthritis * Ankylosing spondylitis
65
What is the function of IL-23?
Induces proliferation of CD4 memory T cells and supports Th17 cell survival.
66
What are the indications for Ustekinumab?
* Psoriasis * Psoriatic arthritis * Crohn’s disease * Ulcerative colitis
67
What are the adverse reactions of Anti-IL-5 Biologics?
* Headache * Injection site reactions * Muscle spasm * Increased risk of infection
68
What is the mechanism of Dupilumab?
Blocks IL-4 receptor alpha, thereby blocking IL-13 & IL-4 pathways.
69
What are the indications for Omalizumab?
* Allergic asthma * Chronic urticaria
70
What is Vedolizumab and what does it target?
A monoclonal antibody that binds α4β7 integrin for gut-selective anti-inflammatory activity.
71
What are the indications for JAK inhibitors?
* Rheumatoid arthritis * Psoriatic arthritis * Ulcerative colitis
72
What are the common adverse effects of JAK inhibitors?
Increased susceptibility to infections.
73
What is a monoclonal antibody?
An antibody produced from a cell line made by cloning a unique white blood cell.
74
What are the adverse effects of certain treatments?
An increased susceptibility to infections (herpes zoster). Live vaccines should not be given concurrently.
75
What are monoclonal antibodies (MAbs)?
Antibodies produced from a cell line made by cloning a unique white blood cell.
76
How do monoclonal antibodies differ from polyclonal antibodies?
Monoclonal antibodies have monovalent affinity, binding only to the same epitope, while polyclonal antibodies bind to multiple epitopes.
77
What are immunostimulants?
Drugs that energize the immune system when exhausted or when help is needed to fight a specific pathogen or cancer cell.
78
List the major factors that immunostimulants stimulate.
* Phagocytosis * Complement systems * Interferon release * T- and B-lymphocytes * Synthesis of specific antibodies and cytokines
79
What are the reasons for using immunostimulants?
* Antibiotic resistance of the bacteria * Allergic reactions to antibiotics * Poor effects of antibiotics in viral infections * Eradication of cancer cells
80
What are the two types of immunostimulants based on action?
* Specific Immuno stimulants * Non-specific Immuno stimulants
81
What are examples of specific immunostimulants?
Vaccines (e.g., vaccination).
82
What are examples of non-specific immunostimulants?
Immunoglobulins.
83
What is a vaccine?
A biological preparation that improves immunity to a particular disease.
84
What is active vaccination?
Injecting individuals with microbial antigens, heat-killed microbes, or attenuated living microbes to induce antibody production and memory B-cells formation.
85
What is passive vaccination?
Individuals are injected with preformed immunoglobulins from donors.
86
What is Bacillus Calmette-Guerin (BCG)?
A live, attenuated culture of BCG strain of Mycobacterium Bovis.
87
What is the mechanism of action (MOA) of BCG?
Induction of a granulomatous reaction at the site of administration, activating macrophages.
88
What are the therapeutic uses of BCG?
* Treatment and prophylaxis of carcinoma of the urinary bladder * Prophylaxis of primary and recurrent stage of papillary tumors
89
What are adjuvants?
Chemical or biological products that increase immune response to foreign antigen.
90
What is the mechanism of action of aluminum hydroxide as an adjuvant?
Formation of a depot at the injection site for slow antigen release and stimulation of antibody-producing plasma cells.
91
What are the adverse effects of aluminum hydroxide?
Pain at the site of injection and fever.
92
What is Isoprinosine?
A synthetic purine derivative with immunomodulatory and antiviral properties.
93
What are the therapeutic actions of Isoprinosine?
* Stimulating differentiation of T cells and B-lymphocytes * Enhancing NK cell activity * Inhibiting viral growth
94
What are the adverse effects of Isoprinosine?
* Nausea * Headache * Vomiting * Abdominal pain * Dizziness * Diarrhea
95
What are interferons?
Substances produced by human cells that have been invaded by viruses.
96
What are the therapeutic actions of interferons?
* Preventing virus replication * Stimulating antiviral protein production * Inhibiting tumor growth
97
What are the indications for using interferons?
* Hepatitis C * Multiple sclerosis * Leukemias * Kaposi sarcoma * Warts * AIDS * Melanoma
98
What are the adverse effects of interferons?
* Flu-like syndrome * Headache * Dizziness * Bone marrow depression
99
What are interleukins?
Cytokines that increase the number of natural killer cells and lymphocytes.
100
What are the indications for using interleukins?
* Treatment of specific renal carcinomas * Prevention of severe thrombocytopenia
101
What are the adverse effects of interleukins?
* Flu-like effects * CNS changes * Respiratory difficulties * Cardiac arrhythmia
102
What are colony-stimulating factors?
Substances that increase the production of white cells and activate mature granulocytes and monocytes.
103
What are the indications for using colony-stimulating factors?
* Reduction of infection incidence in bone marrow suppression * Neutropenia * Treatment of blood-related cancers
104
What are the adverse effects of colony-stimulating factors?
* Headache * Fatigue * Nausea * Vomiting * Alopecia
105
What is adoptive cell transfer?
Isolating immune cells, expanding them in culture, and re-infusing them to kill tumors.
106
What are tumor-infiltrated lymphocytes (TIL)?
A heterogeneous population including Th and CTLs that can recognize and kill tumors.
107
What is cell-based vaccination?
Preparing dendritic cells in vitro to show tumor antigens and re-injecting them.

Pharmacology (15 decks)

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