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Veterinary Clinical Pharmacology > Immunsuppressants Pharm > Flashcards

Immunsuppressants Pharm Flashcards

(50 cards)

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1
Q

Classes of immunsuppressants? (6)

A 
Glucocorticoids
Calcineurin Inhibitors
Purine Interferants
Pyrimidine interferants
JAK 1&3 inhibitors
Alkylating agents
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2
Q

define molecular mimicry

A

Similarity between foreign and self peptides resulting in cross-reactivity of B and T lymphocytes.

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3
Q

Conditions that could potentially lead to molecular mimicry & autoimmune disease in animals? (3)

A

Infection
Neoplasia
Immunization

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4
Q

list the 4 glucocorticoids in order from least potent to most potent

A

hydrocortisone
prednisone/olone
dexamethasone
budesonide

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5
Q

True or False?

Glucocorticoid receptors are present in almost every cell in the body?

A

true

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6
Q

anti-inflammatory dose of prednisone/olone (in mg/kg and dosing duration)

A

Anti-inflammatory
- 0.5-1 mg/kg SID

others...
Physiologic
   - 0.25-0.5 mg/kg SID
Immunosuppressive
   - 1-2 mg/kg SID
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7
Q

Half-life of Prednisone/olone?

A

24 hr

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8
Q

Maximum dose of pred per day?

A

60-80 mg regardless of body weight

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9
Q

_____ (a calcineurin inhibitor) is FDA approved for alleric dermatitis in dogs and cats.

A

cyclosporine

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10
Q

True or False?

Generic cyclosporines have decreased bioavailability.

A

True. Need unmodified form.

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11
Q

True or false?

Cyclosporine is an inexpensive drug.

A

False! Super spendy.

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12
Q

Cyclosporine can be combined with ____ (an anti-fungal drug) to increase it’s bioavailability.

A

ketoconazole 2.5 mg/kg BID

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13
Q

Mycophenolate mofetil can be administered by what routes?

A

PO, IV

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14
Q

True or false?

Mycophenolate mofetil is expensive.

A

False. Cheaper option for big dogs.

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15
Q

True or false?

Mycophenolate mofetil is toxic to cats.

A

False! Azathioprine is.

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16
Q

True or false? The active metabolite of leflunomide is highly protein bound.

A

True

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17
Q

True or false?

Leflunomide is the active form of the drug?

A

False. It is the prodrug form.

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18
Q

Mechanism of action/effects of:

Apoquel

A

JAK 1&3 inhibitor -> decreased synthesis of inflammatory cytokines ESPECIALLY IL-31 -> decreased pruritis in dogs

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19
Q

What are some DDX for allergic Dz with regaurds to immunosuppressant therapy

A
  • anti-inflammatory
  • RAD (reactive airway Dz)
  • atopy
  • mild IBD
  • mild CNS noninfectious inflammatory Dz
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20
Q

What are some immune mediated and autoimmune DDX with regards to immunosuppressant therapy

A
  • IMHA
  • ITP
  • severe IBD
  • Pemphigous
  • SLE
  • Severe CNS non infectious inflammatory Dz
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21
Q

T or F

in cats you should always use prednisolone as they don’t readily convert prednisone to it’s active form

22
Q

Mechanism of action/effects of:

Alkylating agents: (____ & ____)

Study These Flashcards
A

Chlorambucil & cyclophasphamide

Cross-link DNA resulting in altered protein synthesis. and Cytotoxic to proliferating leukocytes.

23
Q

Mechanism of action/effects of:

Leflunomide & Arava (human product)

Study These Flashcards
A

Pyrimidine interferant -> decreased DNA and RNA synthesis -> specifically affects B&T lymphocytes because they lack a salvage pathway.

24
Q

Mechanism of action/effects of:

mycophenolate mofetil

Study These Flashcards
A

non-competitive, reversible inhibitor of inosine-5-monophosphate dehydrogenase (IMPDH) -> decreased synthesis of DNA, RNA, & glycoproteins

25
Mechanism of action/effects of: | Azathioprine
purine interferant -> inhibits incorporation of purines into DNA -> decreased proliferation of lymphocytes
26
what are common clinical uses for calcineurin inhibitors
- allergic dermatitis - perianal fistulas - KCS (ophthalmic drops) - IMHA - ITP - IMPA
27
Mechanism of action/effects of: | glucocorticoids (4 main effects with respect to the immune system)
o decreased capillary permeability ->decreased migration of neutrophils. o decreased lymphocyte production o decreased cytokine release o Stabilization of lysosomes (decreased release of free radicals?)
28
clinical uses for: | apoquel
atopic dermatitis in dogs | IBD?
29
``` clinical uses for: Alkylating agents (chlorambucil & Cyclophosphamide) ```
Chlorambucil: - Feline - IBD - GI lymphoma - K9 - IBD - oncology Cyclophosphamide: oncology (k9 and feline)
30
clinical uses for: | leflunomide
immune mediated polyarthropathy (IMPA) ITP (immune mediated thrombocytopenia maybe) IMHA +/- colorectal polyps
31
clinical uses for: | mycophenolate mofetil
IMHA ITP Derm conditions IBD?
32
true or false? | azathioprine is FDA approved for use in dogs and cats.
false. FDA approved in humans. TOXIC IN CATS!
33
clinical uses for: | azathioprine
Dogs only! IBD, IMHA, ITP can use with glucocorticoids to reduce dose.
34
calcineurin inhibitors: ____ is used for systemic disease; ____ is used for focal disease
cyclosporine for systemic, | tacrolimus for focal (topical)
35
adverse effects of: | apoquel
- can develop serious infections - NOT sufficient studies done on concurrent use with other immune suppressants - GI signs - vomiting, diarrhea
36
``` adverse effects of: alkylating agents (chlorambucil and cyclophosphamide) ```
- GI - vomiting, diarrhea, anorexia - bone marrow suppression - neurotoxicity (rare)
37
adverse effects of: | leflunomide
* **Bone marrow suppression!!! - GI: vomiting, diarrhea - Severe idiosyncratic reactions: seen in dogs with poor liver function or skin issues - hepatotoxicity - ***toxic epidermal necrolysis
38
adverse effects of: | mycophenolate mofetil
GI - diarrhea, anorexia, vomiting | bone marrow suppression
39
adverse effects of: | azathioprine
* ** ACUTE hepatotoxicity - monitor liver enz. frequently! - bone marrow suppression - delayed, reversible - GI - vomiting, diarrhea - immune suppression
40
Never use azathioprine in what species?!
MEE-MOWS
41
adverse effects of: | glucocorticoids
``` PUPD polyphagia? panting immune suppression dysregulation of glucose alopecia weakness muscle wasting suppression of HPA axis ```
42
``` adverse effects of: calcineurin inhibitors (5 things) ```
immune suppression -> give killed vaccines hepatotoxicity -> monitor! thromboembolism ***Gingival hyperplasia drug interactions! inhibition of CYP450 and P-gp!
43
how does the dosing interval of dexamethasone differ from other glucocorticoids and why?
Dexamethasone is ~7 x's as potent as pred and the half life is ~48 hours!
44
What is the max dose of pred per day?
60-80 mg
45
what are some adverse effects of glucocorticoid administration
- muscle catabolism - PU/PD - Panting - Weakness - Alopecia - Suppression of HPA axis - immune suppression - dysregulation of glucose
46
what clinical scenero would be a good use for tacrolimus
- it is a calcineurin inhibitor which is an enzyme crucial for T cell activation. - it is generally used for peri-anal fistulas
47
what are common clinical uses for calcineurin inhibitors
- allergic dermatitis - perianal fistulas - KCS (ophthalmic drops) - IMHA - ITP - IMPA
48
what advantage would you get from combinding a Cyclosporine, a calcineurin inhibitor with ketoconazole
it increases the oral bioavailability of the cyclosporine by inhibiting CYP 450 thereby increasing efficacy of the drug, and lowering cost.
49
what are some adverse effects of calcineurin inhibitors
- *gingival hyperplasia* - immunosuppression - hepatotoxicity - thromboembolism - drug interactions - inhibits CYP 450 - inhibits P-glp
50
why should you NEVER used mycophenolate mofetil concurrently with azathioprine?
they both inhibit purine synthesis!

Veterinary Clinical Pharmacology (6 decks)

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