Immunomodulatory Drugs (IMiDs) Flashcards Preview

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Flashcards in Immunomodulatory Drugs (IMiDs) Deck (10)
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1

What are the immunomodulatory drugs (IMiDs)?

-Lenalidomide
-Pomalidomide
-Thalidomide

2

What is Thalidomide and what is it used for?

-Developmental toxin approved for use in treatment of Hansen's disease and in multiple myeloma (it has sig. off-label use in AIDS treatment)

3

What is the bad side effect associated with Thalidomide?

-Significant teratogenic effects (esp. phocomelia) in the children and grandchildren of women who take the drug while pregnant.

4

How do immunomodulatory drugs work in Hansen's disease?

-Treats a complication of Hansen's disease called erythema nodosum leprosum (ENL) that is characterized by painful skin nodules and nerve damage
-It works by suppressing immune and inflammatory reactions, i.e. it doesn't function as an antibiotic - as soon as treatment is stopped, symptoms reappear

5

How do immunomodulatory drugs work as antineoplastics?

-Unknown, complex mechanism of action
-No cytotoxic effects on immune system cells, but does alter ratios of immune cells and changes the expression of molecular markers on their surfaces
--Antiangiogenic (dec. FGF) - also causes decreased cell movement (anti-metastatic?)
--Th2 response over Th1 ("more interleukins, less interferon and TNF") - perhaps the most effective anti-TNF agent known (which is why it's under investigation for use in inflammatory bowel disease)

6

How do immunomodulatory drugs work in morning sickness/pregnancy?

-Is sedating and improves well being - restores appetite and decreases wasting
---Originally developed as an antihistamine in the 1950s (sedation), and marketed as a "wonder drug for prevention of morning sickness" because of its ability to relieve the "anxiety and stress of pregnancy"

7

What are the pharmacokinetics of immunomodulatory drugs?

-Oral
-Renal excretion of metabolites

8

What are the side effects of immunomodulatory drugs in adult males and non-pregnant females?

-Nausea, rashes, constipation, peripheral neuropathy
-Increased risk of deep vein thrombosis, particularly in multiple myeloma patient s(most are placed on warfarin before thalidomide is started)

9

What are the teratogenic effects of immunomodulatory drugs?

Severe effects occur 3-4 wks post conception in both children and grandchildren of patients treated with thalidomide
--Defects include malformed intestines, hearing defects, absent ears, ocular and renal anomalies and phocomelia.
--40% of THALIDOMIDE victims die within a year of birth - there are ~5,000-20,000 survivors wold-wide, and new cases occur every year
-Prescription requires participation by the doctor and patient in an FDA oversight program

10

What is phocomelia?

-Congenital malformation in which the hands and feet are attached to abbreviated arms and legs
-The word phocomelia combines photo- (seal) and melia (limb) to designate a limb like a seal's flipper