Immunomodulatory Agents

Question 1

Alum

Answer 1

• # 1 adjuvant in vaccines
• Directly increases activity of APCs
• Combines with antigen to prolong its exposure to the immune system

Question 2

BCG is a vaccine against…

Answer 2

Tuberculosis

Question 3

What type of vaccine is BCG

Answer 3

Live attenuated (reduced virulence)

Question 4

MOA of BCG

Answer 4

interact directly with PRR of APCs to increase inflammatory response

Question 5

BCG can be used to treat what cancer

Answer 5

Bladder

Question 6

IL-2 function

Answer 6

Tcell proliferation
IFN-gamma production
Tkiller activity

Question 7

IL-2 therapy is good for…

Answer 7

Metastatic Carcinoma

Renal Carcinoma

Question 8

Side effects of IL-2 therapy…

Answer 8

capillary leak–> hypotension–> decreased organ perfusion

Question 9

Interferons produce…

Answer 9

Anti-viral responses

Question 10

4 drugs that can be given to increase efficacy of APCs (immunostimulants)

Answer 10

Alum
BCG
IL-2
Interferons

Question 11

Uses for Immuno-suppressants

Answer 11

Organ transplant
Inflammatory Disease
Autoimmune disorders
Selective suppression

Question 12

2 main risk with using immunosuppressants

Answer 12

Infection

Cancer

Question 13

Cyclophosphamide

Answer 13

Targets proliferating cells
Chemotherapy medication
(Bischloroethylamine like Mechlorethamine)
Alkylating agent

Question 14

Side effects of cyclophosphamide

Answer 14

Myelosuppression

also hemorrhagic cystitis

Question 15

Azathioprine

Answer 15

Targets proliferating cells
Metabolized to 6-mercaptopurine (Antimetabolite)
Purine inhibitor

Question 16

Side effect of Azathioprine

Answer 16

Myelosuppression

Question 17

Use of Cyclophosphamide (alkylator)

Answer 17

Autoimmune disorders

Marrow transplant

Question 18

Use of Azathioprine (purine inhibitor)

Answer 18

Lupus
Arthritis
IBS

Question 19

Mycophenolate Mofetil

Answer 19

Targets proliferating cells

Purine inhibitor

Question 20

2 drugs that are purine inhibitors

Answer 20

Cyclophosphamide

Mycophenolate Mofetil

Question 21

Methotrexate

Answer 21

Targets proliferating cells
Inhibits DHFR–> No Tetrahydrofolate
Antitumor Antimetabolite
DRUG OF CHOICE FOR R.A.

Question 22

Drug of choice for R.A.

Answer 22

Methotrexate

Question 23

Leflunomide

Answer 23

Targets proliferating cells

Pyrimidine inhibitor via dihydroorotate dehydrogenase (antimetabolite)

Question 24

Prototype glucocorticosteroid

Answer 24

Prednisone

Question 25

Dual action of glucocorticosteroids

Answer 25

Anti-inflammatory | Immuno-suppressive

Question 26

MOA of glucocorticosteroids

Answer 26

Affect gene transcription | Primary effect is inhibition of IL-2 and IFN-gamma

Question 27

1st line immunosuppressant for ORGAN and STEM CELL transplants

Answer 27

glucocorticosteroids

Question 28

Effects of chronic glucocorticosteroids

Answer 28

``` Cushing's Glucose intolerance Ocular probs GI probs Ostereoporesis HTN ```

Question 29

Do glucocorticosteroids cause myelosuppression

Answer 29

Noper

Question 30

TCR activation signalling pathway

Answer 30

TCR activation--> CALCINEURIN activation--> dephosphorylation of NFAT--> CYTOKINE transcription

Question 31

Cyclosporin

Answer 31

TCR inhibitor | Combines with CYCLOPHILIN proteins--> inhibit calcineurin

Question 32

Tacrolimus

Answer 32

TCR inhibitor Combines with FKB12--> inhibit calcineurin Higher potency than Cyclosporin but not really clinically significant I think

Question 33

Side effect of cyclosporin

Answer 33

NEPHROTOXICITY, HTN, hyperglycemia

Question 34

Sirolimus

Answer 34

IL-2 signalling pathway inhibition aka Rampamycin targets mTOR using FKB12 proteins--> like Tacrolimus

Question 35

2 drugs that use FKB12 proteins in their MOA

Answer 35

Sirolimus (to inhibit mTOR) | Tacrolimus (to inhibit calcineurin)

Question 36

Sirolimus is an agonist with ..... and an antagonist to .....

Answer 36

Cyclosporin | Tacrolimus (both compete for FKB12 proteins)

Question 37

Side effects of Sirolimus

Answer 37

POTENT myleosupression | HTN, edema, hyperlipids

Question 38

Use of sirolimus

Answer 38

Combo or solo- Organ transplant suppression

Question 39

mTOR

Answer 39

Kinase required in IL-2 mediated proliferation signalling | mTOR inhibition is the target of Sirolimus

Question 40

Therapeutic Abs have ..... half-lives

Answer 40

Loooooooong

Question 41

Therapeutic Abs can

Answer 41

Provide passive immunity Be made for disease specific antigens Immunosuppression

Question 42

Rh(D) immune globulin

Answer 42

IgG's that opsonize and clear fetus's Rh+ RBCs so that Rh- mother doesn't make antibodies against the Rh protein

Question 43

Belatacept

Answer 43

Therapeutic Ab--> ligand is B7 (of APC) | Prevents activation of Tcells--> become ANERGIC

Question 44

Adverse effects of Belatacept

Answer 44

PTLD--> post-transplant lympho-proliferative disorder | Anemia, neutropenia, edema, increased infection risk

Question 45

Use of Belatacept

Answer 45

Prevents tissue rejection

Question 46

PTLD is associated with what therapeutic Ab

Answer 46

Post-transplant lympho-proliferative disorder | Belatacept

Question 47

ATG

Answer 47

Anti-Tcell Globulin--> opsonizes/kills Tcells

Question 48

Side effects of Anti-Tcell Globulin

Answer 48

Cytokine release syndrome from all the Tcells dying | Prolonged Tcell depletion (kinda the goal though)

Question 49

Alemtuzumab

Answer 49

Immune Depleter: Targets CD52 on Ts and Bs (also Mono, Macro, NK) MYELOSUPPRESSION

Question 50

Basiliximab

Answer 50

Immune depleter: Targets CD25--> ACTIVATED Tcells More selective than Belatacept (targets all Tcells) Recover faster with Basiliximab