Immunosuppression

Question 1

What drugs are used as immunosuppressants?

Answer 1

Corticosteroids
Methotrexate
Azathioprine
Ciclosporin 
Tacrolimus 
Mycophenolate mofetil 
Cyclophosphamide

Question 2

What is the mechanism of corticosteroids?

Answer 2

Prevent IL-1 + IL-6 production by macrophages

Inhibit all stages of T-cell activation

Question 3

What drugs are DMARDs?

Answer 3

Sulphasalazine 
Hydroxychloroquine
Anti-TNF agents
Rituximab 
IL-6 inhibitors 
JAK inhibitors

Question 4

What is methotrexate?

Answer 4

Anti-metabolite

Question 5

What are the indications for methotrexate?

Answer 5

RA
Crohn’s
Psoriasis
Malignancy

Question 6

What is the route of administration of methotrexate?

Answer 6

Oral
IM
SC
IV

Question 7

What is the mechanism of action of methotrexate?

Answer 7

Inhibits dihydrofolate reductase

Reduces synthesis of purines + pyrimidines
Inhibit accumulation of adenosine
Inhibit T-cell activation

Question 8

What are the side effects of methotrexate?

Answer 8

Mucositis 
Marrow suppression 
Hepatitis 
Pneumonitis 
Increased infection risk 

Teratogenic

Question 9

What is azathioprine?

Answer 9

Antiproliferative immunosuppressant

Question 10

What are the indications for azathioprine?

Answer 10

Crohn's 
UC
RA
SLE
Suppress transplant rejection

Question 11

What are the routes of administration of azathioprine?

Answer 11

Oral

IV

Question 12

What is the mechanism of azathioprine?

Answer 12

Cleaved to 6-MP

Inhibits DNA/RNA synthesis

Question 13

What are the side effects of azathioprine?

Answer 13

Bone marrow suppression 
Increased risk of malignancy 
Increased infection risk 
Hepatitis 
Thrombocytopenia

Question 14

What is ciclosporin?

Answer 14

Calcineurin inhibitor

Question 15

What are the indications for ciclosporin?

Answer 15

UC
RA
Atopic dermatitis 
Psoriasis 
Transplantation
Nephrotic syndrome

Question 16

What are the routes of administration of ciclosporin?

Answer 16

Oral

IV

Question 17

What is the mechanism of ciclosporin?

Answer 17

Inhibits calcineurin - binds to cyclophilin protein

Prevents production of IL-2

Question 18

What are the side effects of ciclosporin?

Answer 18

Eye inflammation 
D+V
Fever
Fatigue 
Hepatic dysfunction

Question 19

What is tacrolimus?

Answer 19

Calcineurin inhibitor

Question 20

What are the indications for tacrolimus

Answer 20

Eczema
Psoriasis
Transplant

Question 21

What are the routes of administration for tacrolimus?

Answer 21

Topical
Oral
IV

Question 22

What is the mechanism of tacrolimus?

Answer 22

Inhibits calcineurin - binds to tacrolimus-binding protein

Prevents production of IL-2

Question 23

What are the side effects of tacrolimus?

Answer 23

Infection risk
Abnormal sensation
Skin reactions

Question 24

What is mycophenolate mofetil?

Answer 24

Antiproliferative immunosuppressant

Question 25

What are the indications for mycophenolate mofetil?

Answer 25

Transplant

Question 26

What are the routes of administration of mycophenolate mofetil?

Answer 26

Oral | IV

Question 27

What is the mechanism of mycophenolate mofetil?

Answer 27

Inhibits inosine monophosphate dehydrogenase - required for guanosine synthesis Impairs B + T cell proliferation

Question 28

What are the side effects of mycophenolate mofetil?

Answer 28

Nausea D+V Myelosuppression

Question 29

What is cyclophosphamide?

Answer 29

Cytotoxic agent

Question 30

What are the indications for cyclophosphamide?

Answer 30

``` RA Leukaemia Lymphoma Solid cancers Lupus nephritis ANCA vasculitis ```

Question 31

What is the route of administration of cyclophosphamide?

Answer 31

Oral | IV

Question 32

What is the mechanism of cyclophosphamide?

Answer 32

Alkylating agent - cross links DNA Suppresses T-cell activity Suppresses B-cell activity

Question 33

What are the side effects of cyclophosphamide?

Answer 33

Bone marrow suppression | Fever

Question 34

What is sulphasalazine?

Answer 34

Amino salicylate

Question 35

What are the indications for sulphasalazine?

Answer 35

UC Crohn's RA

Question 36

What are the routes of administration of sulphasalazine?

Answer 36

Oral | Per rectum

Question 37

What is the mechanism of sulphasalazine?

Answer 37

T cell - inhibit proliferation - inhibit IL-2 production Neutrophil - reduced chemotaxis - reduced degranulation

Question 38

What are the side effects of sulphasalazine?

Answer 38

``` Myelosuppression Hepatitis Rash Nausea Vomiting Abdo pain ```

Question 39

What monoclonal antibodies are used for immunosuppression?

Answer 39

Rituximab Infliximab Adalimumab

Question 40

What are the indications for rituximab?

Answer 40

RA | Lymphoma

Question 41

What is the route of administration of rituximab?

Answer 41

IV

Question 42

What is the mechanism of rituximab?

Answer 42

Binds to unique cell marker CD20 on B cells - causes B cell apoptosis

Question 43

What are the side effects of rituximab?

Answer 43

Fever Hypersensitivity Infection risk

Question 44

What are the indications for infliximab?

Answer 44

``` Crohn's UC RA AS Psoriatic arthritis ```

Question 45

What is the route of administration of infliximab?

Answer 45

IV

Question 46

What is the mechanism of infliximab?

Answer 46

TNF-α inhibitor - reduces inflammation - reduces joint destruction

Question 47

What are the side effects of infliximab?

Answer 47

Fatigue GI disorders infection risk Myalgia

Question 48

What are the indications for adalimumab?

Answer 48

``` RA Psoriatic arthritis AS Crohn's UC ```

Question 49

What is the route of administration of adalimumab?

Answer 49

SC

Question 50

What is the mechanism of adalimumab?

Answer 50

TNF-α inhibitor - reduces inflammation - reduces joint destruction

Question 51

What are the side effects of adalimumab?

Answer 51

``` Pain/swelling at injection site Infection risk Headache Nausea Rash ```