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Immunopharmacology Flashcards

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1
Q

Uses of Immunosuppressives?

A

1) Autoimmune diseases
2) Isoimmune diseases
3) Organ transplantation
4) Prevention of cell proliferation

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2
Q

Classification of Immunosuppressive Agents?

A

1) Corticosteroids
2) Calcineurin inhibitors
3) Cytotoxic agents
4) Mycophenolate mofetil
5) Proliferative signal inhibitors
6) Biologicals (antibodies)

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3
Q

Steroids are used in the treatment of?

A 
RA
SLE
Psoriasis
Asthma
Inflammatory renal disease
Inflammatory opthalmic disease
Autoimmune hematological disease
MS
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4
Q

Immediate side effects of corticosteroids:

A 
Cushingoid features
Weight gain (ravenous appetite)
Diabetes (transient)
Hirsutism (especially pediatrics)
Cataracts
Mood changes
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5
Q

Corticosteroids are excreted via the ___ as the metabolite ____:

A

kidneys; dihydroxyketone (17-hydroxysteroids)

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6
Q

Longest acting, most potent corticosteroids?

A

Bethamethasone

Dexamethasone

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7
Q

Least potent corticosteroid?

A

Cortisone

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8
Q

Shortest acting corticosteroid?

A

Hydrocortisone

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9
Q

Long term effects of corticosteroids:

A

Osteoporosis
Avascular necrosis
Growth retardation

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10
Q

Effects of steroids?

A

Regulates numerous gene transcription
Curtail NF-KB activation
Downregulation of IL-1 and IL-6
T-cells are inhibited from producing IL-2
CD8 activation is inhibited
Increase in neutrophils, decrease in other leukocytes
Neutrophils and monocytes display poor chemotaxis

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11
Q

The CNI Cyclosporine A is derived from?

A

Tolypocladium inflatum

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12
Q

The CNI Tacrolimus is derived from?

A

Streptomyces tsukunbaensis

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13
Q

IC mediator of CsA?

A

Cyclophilin

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14
Q

IC mediator of TAC?

A

FKBP-12

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15
Q

Adverse effects unique to CsA?

A

Hirsutism
Gum hypertrophy
Hypercholesterolemia

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16
Q

Adverse effects unique to TAC?

A

Hair loss

GI side effects

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17
Q

Adverse effects common to both TAC and CsA?

A

Nephrotoxicity
Hyperkalemia
Hypomagnesemia

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18
Q

What are the cytotoxic agents?

A 
Azathioprine
Methotrexate
Cyclophosphamide
Leflunomide
Hydroxychloroquine
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19
Q

Uses of Azathioprine?

A 
Transplantation
RA
Crohn's disease
Ulcerative colitis
GVHD
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20
Q

Methotrexate inhibits____ which leads to ____.

A

Dihydrofolate reductase; cessation of nucleotide synthesis

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21
Q

Uses of methotrexate?

A

GVHD
RA
SLE
Psoriasis

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22
Q

Cyclophosphamide is an ____ that forms covalent bonds with DNA and suppresses ___, which inhibits ___ production.

A

alkylating agent; cellular immunity; Ab and autoAb

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23
Q

Adverse effects of cyclophosphamide:

Study These Flashcards
A 
Leukopenia
Sterility
Hemorrhagic cysts (hydrate patient before infusion)
Malignancy
Cardiac toxicity
N&V
24
Q

Uses of cyclophosphamide:

Study These Flashcards
A

Hematopoietic cell transplantation
SLE
Vasculitis
Wegener’s Granulomatosis

25
Leflunomide is a pro-drug inhibitor of ___ synthesis and indicated in cases of __:
Pyrimidine; Rheumatoid arthritis
26
Hydroxychlorine suppresses ___ by ____, which results in decreased ___.
APC processing and MHC II loading; increasing lysosomal pH; T-cell activation
27
Mycophenolate mofetil reversibly inhibits ____, thereby blocking:
IMDPH; de novo purine synthesis
28
What are the Proliferative signal inhibitors?
1) Sirolimus/Rapamycin/Rapammune 2) Everolimus 3) Temsirolimus
29
Sirolimus is a ____ derived from __.
Macrocylic lactone; streptomyces hygroscopicus
30
Azathiprine is metabolized to ___, which interrupts ___ and so reduces mitosis.
6-mercaptopurine; purine synthesis
31
Adverse effects of MMF:
GI disturbances | Suppression of bone marrow
32
Long term risks of Aza therapy:
Increased risk of squamous cell carcinoma Lymphoma Bacterial and opportunistic infections
33
MOA of Sirolimus?
1) Binds to FKBP 2) Blocks serine threonine kinase 3) Does not block IL production but lymphocytic response to them.
34
Everolimus is a ____ derived from naturally occurring ___.
Semi-synthetic proliferative signal inhibitor (PSI); rapamycin
35
TAC is 50 -100 more potent than ___; but ___ is 27x more potent than TAC
CsA; Sirolimus
36
Sirolimus is isolated from:
Streptomyces hygroscopicus
37
Sirolimus arrests malignant cell growth through it's ____ effect:
anti-angiogenesis
38
Mechanism of the ATGs?
Depletion of circulating t-cells Modulation of cell surface receptor molecule Induction of anergy Apoptosis of activated T-cells
39
MMF is not co-administered with:
Azathioprine
40
What is the first therapeutic monoclonal antibody? What is it's antigen?
OKT3, directed against CD3 receptor on T cells
41
Symptoms of cytokine release syndrome:
First dose effect Fever, chills, rigors, "shake and bake" Pulmonary edema
42
This drug has a low rejection rate and minimal side effects when used in kidney transplant:
Alemtuzumab
43
Chimeric mAb IL-2 Receptor antagonist:
Basiliximab
44
Humanized mAb IL-2 receptor antagonist:
Daclizumab
45
Rituximab is a ___ mAb specific for the B-cell marker ___, approved in the treatment of:
chimeric; CD20; refractory non-Hodgkins lymphoma
46
Alemtuzumab is a ___ mAb directed against the marker ___:
Humanized; CD52
47
Restores function of B & T lymphocytes, monocytes and macrophages:
Levamisole
48
Indicated in erythema nodosum leprosum multiple myeloma RA:
Thalidomide
49
Used in Ca in situ of the urinary bladder and primary recurrent papillary tumors:
Bacille-Calmette-Guerin
50
Indications for Interferon Alpha-2b:
Chronic Hep B and C Melanoma Lymphoma follicular Kaposi's sarcoma
51
Interferon indicated in multiple sclerosis:
Interferon Beta-1a
52
The Recombinant cytokines:
Hematopoietic growth factors Interferons Interleukin-2 (RCC)
53
The therapeutic Abs:
``` IVIG (polyclonal) Polyclonal Ab (directed against cells) Hyperimmune globulins (polyclonal and monoclonal) ```
54
Used to treat Rh disease:
Polyclonal Ab, RhD immunoglobulin against the D blood group Ag
55
The hyperimmuneglobulins:
``` Hep B Immuneglobulin Rabies Tetanus Varicella CMV RSV ```
56
Immunomodulator used in metastatic renal cell carcinoma?
IL-2

Pharmacology (14 decks)

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