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Immunotherapy Flashcards

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1
Q

What is rituxumab (MOA, use, risk)

A

Monoclonal antibody against B cell CD20, leading to apoptosis of B-cells

Use: B cell malignancy, RA, ANCA vasculitis etc

Risks: infusion reaction, infection, PML, hypogammaglobulinaemia

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2
Q

What is Eculizumab?

A

Anti-C5 which inhibits final stages of complement cascade. Used in PNH and atypical HUS. Risk meningitis

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3
Q

What is the MOA of vedolizumab?

A

IgG1 MAB against a4b7-integrin which is found on leucocytes. Inhibits adhesion of T cells to mucosal addressin-cell adhesion molecule-1 (MAdCAM-1). Used in IBD Main issues - infection, hypersensitivity and infusion reactions

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4
Q

What is the MOA of bevacizumab and what are it’s main issues?

A

MAB, anti-VEGF. Used for multiple cancers. SE - thrombosis (arterial and venous), pulmonary haemorrhage, HTN, CCF, impaired wound healing, GI perforation, fistula formation, pancytopenia, proteinuria

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5
Q

What is bezlotoxumab (MOA, use, risks)

A

Used for recurrent C. Diff with antibiotics to prevent relapse. MAB which binds to toxin. Risks - HF No mortality benefit. NNT 10 **-toxumab = toxin **

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6
Q

What is ustekinumab (MOA, use, risks)

A

Anti-IL12/IL23

Used for psoriasis, psoriatic arthritis and crohns disease

Risks - infections, injection site reactions, myalgia, rash, eosinophic pneumonia, interstitial pneumonia, allergy

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7
Q

What is adalimumab (MOA, use, risks)

A

An anti-TNF-alpha.

Used in IBD, RA, Ank spondylitis, JIA, Psoriasis, psoriatic arthritis, uveitis

Risks - demyelination, CCF, drug induced lupus, TB, lymphoma, melanoma, infusion reactions, aseptic meningitis, hepatitis, interstitial lung disease

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8
Q

What is golimumab (MOA, use, risks)

A

An anti-TNF-alpha. Used in UC, RA, axial spondyloarthritis, psoriatic arthritis, uveitis Risks - demyelination, CCF, drug induced lupus, TB, lymphoma, melanoma, infusion reactions, aseptic meningitis, hepatitis, interstitial lung disease

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9
Q

What is infliximab (MOA, use, risk)

A

An anti-TNF-alpha.

Used in IBD, RA, Ank spondylitis, Psoriasis, psoriatic arthritis

Risks - demyelination, CCF, drug induced lupus, TB, lymphoma, melanoma, infusion reactions, aseptic meningitis, hepatitis, interstitial lung disease

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10
Q

What is mepolizumab (MOA, use, risks)

A

This is an anti-IL5. IL-5 is secreted by activated Th2 cells which then recruit eosinophils. Use - refractory eosinophilic asthma, refractory eosinophilic granulomatosis with polyangiitis Risks - increased helminth infections, arthralgias, injection site reactions, allergy, herpes zoster.

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11
Q

What is benralizumab (MOA, use, risks)

A

This is a MAB against the IL-5 receptor which is found on eosinophils and basophils. This blocks IL-5 binding preventing their accumulation and also induces apoptosis. Use - refractory eosinophilic asthma Risks - helminth infections, injection site reactions, hypersensitivity, headache

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12
Q

What is omalizumab (MOA, use, risks)

A

This is an anti-IgE which reduces the immune response to allergen exposure. IgE normally activates mast cells. Use - moderate-severe asthma with raised serum IgE, chronic spontaneous urticaria Risks - thrombocytopenia and bleeding, rash, anaphylaxis, churg-strauss, serum sickness like illness

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13
Q

What is venetoclax (MOA, use, risks)

A

Inhibits BCL-2 which is commonly overexpressed in a number of haematological malignancies. BCL-2 is an anti-apoptotic protein. Use - CLL, trial phase in many other malignancies Risks - tumour lysis syndrome

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14
Q

How are monoclonal antibodies named?

A
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15
Q

What is abciximab (MOA, use, risks)

A

Anti- platelet gpIIb/IIIa

Use - ACS

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16
Q

What is alemtuzumab (MOA, use, risks)

A

Anti-CD52 which is found on most immune cells including B and T cells. Causes cell lysis.

Uses: CLL, MS

Risks: profound immunosupression, MI, infusion reactions, pancytopenia, PML, pneumonitis, Graves disease (can occur late after ceasing drug), ITP, anti-GBM nephropathy

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17
Q

What is basiliximab (MOA, use, risk)

A

Blocks IL-2 receptors on T cells (CD25a). This prevents T cell proliferation

Use: anti-rejection, uveitis, GVHD

Risks: hypersensitivity reactions, infections

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18
Q

What is belimumab (MOA, use, risks)

A

Anti-BLyS (B lymphocyte stimulator protein), this reduces B cell survival and differentiation into plasma cells.

Use: SLE (BLyS overexpressed)

Risks: hypersensitivity, infection, depression, bradycardia

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19
Q

What is canakinumab (MOA, use, risks)

A

Anti-IL1

Use: Cryopyrin-associated periodic syndromes. In liturature for gout

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20
Q

What is cetuximab (MOA, use, risk)

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A

Anti-EGFR

Use: colorectal, head and neck cancer

Risks: red meat allergy/previous tick bite, acne-form rash, interstitial lung disease, electrolyte derrangement

21
Q

What is certolizumab (MOA, use, risk)

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A

Anti-TNFa

Use: RA, psoriatic arthritis, ankylosing spondylitis

Risks: demyelination, CCF, drug induced lupus, TB, lymphoma, melanoma, infusion reactions, aseptic meningitis, hepatitis, interstitial lung disease

22
Q

What is denosumab (MOA, use, risk)

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A

Anti-RANKL

Use: osteoporosis, bone metastasis, myeloma, malignancy hypercalcaemia

Risks: hypocalcaemia, osteonecrosis of the jaw, vasculitis, atypical femoral fractures, eczema

23
Q

What is ixekizumab (MOA, use, risk)

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A

Anti-IL17a

Use: psoriasis, psoriatic arthrtitis

Risks: IBD, infections, neutropenia

** other anti-IL17 is secukinumab

24
Q

What is natalizumab (MOA, use, risk)

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A

Targets a4 integrin reducing lymphocyte migration from the blood into the CSF

Use: MS

Risk: PML, arthralgias, rash, depression, hypersensitivity, hepatotoxicity

25
What is panitumumab (MOA, use, risk)
Anti-EGFR Use: metastatic colorectal cancer Risks: acne-form rash, pneumonitis, electrolyte disturbances, ocular distubance, peripheral oedema
26
What is tocilizumab (MOA, use, risk)
Anti-IL-6 receptor Use: RA, JIA, temporal arteritis Risks: pancytopenia, GI perforation, hepatitis, hypertension, infections
27
What is trastuzumab (MOA, use, risk)
Anti-HER2, inhibits proliferation of cancer cells which overexpress HER2 Use: breast cancer, gastric cancer Risks: cardiomyopathy, peripheral oedema, pneumonitis, immune thrombocytopenia
28
What is secukinumab (MOA, use, risk)
Anti-IL17a Use: psoriasis, ankylosing spondylitis, psoriatic arthritis Risks: IBD, menstrual dysfunction, infection, hypersensitivity \*\* the other anti-IL17a is ixekizumab
29
What is Guselkumab (MOA, use, risk)
Anti-IL-23 Use: psoriatic arthritis Risks: Infections, hypersensitivity, headache
30
What is evolocumab (MOA, use, risk)
Anti-PCSK9. Inhibits PCSK9 degredation of the LDL receptor which leads to increased receptor numbers, increased hepatic uptakes and decreased serum LDL Use: With conventional therapy for herreditary hypercholesterolaemia, or primary hypercholesterolaemia with CVD Risks: nasopharyngitis, URTI, raised CK, injection site reactions, neurocognitive events
31
What is abatacept (MOA, use, risk)
Anti-CD80/86 co-stimulator molecules. This prevents full activation of CD28 T cells. It is a fusion protein. Use: RA, psoriatic arthritis, JIA Risks: Infections, autoimmune conditions, paraesthesia, LFT derrangement
32
What is etanercept (MOA, use, risk)
Anti-TNF IgG1 fusion protein Use: RA, ankylosing spondylitis, spondyloarthropathies, psoriasis, psoriatic arthritis, JIA Risks: infection, lupus-like, psoriasis, cytopenias, demyelination, ILD, HF, seizures
33
What is romosuzumab (MOA, use, risk)
Inhibits sclerostin, an osteocyte secreted glycoprotein that inhibits the Wnt and BMP signalling pathways. This leads to osteoblast proliferation Uses: Osteoporosis Risks: cardiovascular disease
34
What is dupilumab (MOA, use, risk)
Anti-IL4 receptor. Use: dermatitis RIsks: injection site reactions, herpes, conjunctivtis, keratitis
35
What is idarucizimab (MOA, use, risk)
Antidote to dabigatran. Binds to dabigatran creating an inactive complex. Use: dabigatran reversal Risks: headache, transient proteinuria
36
What is obinutuzumab (MOA, use, risk)
Anti-CD20 causing B cell lysis Use: B cell malignancy Risks: cytopenia, infection, PML, infusion reactions
37
What is inotuzumab ozogamicin (MOA, use, risk)
A conjugate drug with an anti-CD22 MAB paired with a cytotoxic agent Use: B Cell ALL Risks: hepatic sinusoidal obstruction syndrome
38
What is brentuximab vedotin (MOA, use, risk)
A mab-drug conjugate. Anti-CD30 with a MMAE toxin Use: anaplastic large cell lymphoma, CD30+ T cell lymphoma and hodjkin lymphoma Risks: periperhal neuropathy, pancreatitis, PML, SJS/TENs
39
What is blinatumomab (MOA, use, risk)
Anti-CD19 and anti-CD3. A bspcific antibody which binds to CD19 on B cells and CD3 on T cells. This forms a link, activating the T cell and causing B cell death Use: B ALL Risks: pancytopenia, infection, LFT derrangement, cytokine release syndrome, TLS, pancreatitis
40
What is ocrelizumab (MOA, use, risk)
Anti-CD20, unclear MOA in MS Use: relapsing and primary progressive MS Risks: Increased malignancy risk, infusion reactions
41
What is erenumab (MOA, use, risk)
Inhibits CGRP receptor causing vasodilation Use: migraines
42
What is atezolizumab (MOA, use, risk)
Anti-PDL1 Use: NSCLC, urothelial ca Risks: autoimmune reactions
43
What is durvalumab (MOA, use, risk)
Anti-PDL1 Use: urothelial ca Risks: autoimmune reactions
44
What is avelumab (MOA, use, risks)
Anti-PDL1 Use: Merkle cell, urothelial ca Risks: autoimmune reactions
45
What is pertuzumab (MOA, use, risks)
Binds to HER2 preventing receptor joining with other members of the HER family. This leads to cell growth arrest and apoptosis. Also activates an immune response Use: HER2 positive breast cancer Risks: cardiotoxicity
46
What is tofacitinib (MOA, use, risks)
A JAK 1,2,3 inhibitor which down regulates gene transcription in response to cytokines Use: RA, psoriatic arthritis Risks: shingles, GI perforation, LFT derrangement, thrombosis, cytopenia, hyperlipidaemia
47
What is baricitinib (MOA, use, risks)
A JAK 1,2,3 inhibitor which down regulates gene transcription in response to cytokines Use: RA Risks: shingles, GI perforation, LFT derrangement, thrombosis, cytopenia, hyperlipidaemia
48
What is anakinra (MOA, use, risk)
Recombinant IL-1 receptor antagonist Use: Rheumatoid arthritis, autoinflammatory conditions, JIA Risks: infection, cytopenias, increased lipids

Pharmacology (4 decks)

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