pharm - immunosuppressants and stimulants

Question 1

rituximab binds to which protein on B cells to provoke an immune response?
a. CD20
b. tumour necrosis factor
c. CTLA-4
d. PD-1

Answer 1

a. CD20
Clears CD20+ cells by Antibody Dependent Cellular Cytotoxicity (ADCC)

Question 2

Infliximab is used in RA as an antagonist to which cytokine?
a. CD20
b. TNF-a
c. CTLA-4
d. PD-1

Answer 2

b. TNF-a

Question 3

which of the following antibodies upregulate the immune system?
a. Aldesleukin
b. anakinra
c. basiliximab
d. etanercept

Answer 3

a. Aldesleukin (immunostimulant)
- release multiple cytokines
- cytotoxic potential against tumours

anakinra - IL-1 neutralisation
basiliximab - inhibit IL-2 action
etanercept - TNF-a neutralisation

Question 4

Prednisolone (corticosteroid) inhibits:
a. IL-2 production and hence T cell proliferation
b. pyrimidine synthesis
c phospholipase A2 and hence IL-1 production
d. purine synthesis

Answer 4

c phospholipase A2 and hence IL-1 production

a. cyclosporine, tacrolimus (Calcineurin inhibitors )
b. leflunomide
d. Mycophenolate

Question 5

what drug inhibits IL-2 signal transduction (m-TOR inhibitors)?

Answer 5

sirolimus

Question 6

cyclosporine inhibits ___ production and hence T cell proliferation

Answer 6

IL-2

Question 7

tacrolimus inhibits ___ production and hence T cell proliferation

Answer 7

IL-2

Question 8

what drug inhibits pyrimidine synthesis?

Answer 8

leflunomide

Question 9

what drug inhibits purine synthesis?

Answer 9

Mycophenolate

Question 10

what is the MOA of Basiliximab?

Answer 10

inhibit IL-2 action

Question 11

what is the MOA of Etanercept?

Answer 11

TNF-a neutralisation

Recombinant version of TNF-α receptor → prevent binding of TNF-α to TNF receptors on inflammatory cells → suppression of downstream cytokines

Question 12

what is the MOA of Anakinra?

Answer 12

IL-1 neutralisation

Prevents binding of IL-1 to IL-1 receptors on inflammatory cells → suppression of downstream cytokines

Question 13

what immunosuppressant is indicated in SLE (lupus)?

Answer 13

leflunomide (inhibit pyrimidine synthesis)

Question 14

which of the following drugs is a teratogen?
a. interferons
b. thalomide (thalidomide)
c. etanercept
d. 6-merceptopurine

Answer 14

b. thalomide (thalidomide)

Question 15

Rituximab treat hodgkin or non-hodgkin lymphoma?

Answer 15

non-Hodgkin’s lymphoma

Question 16

does cyclosporine have complete oral absorption?

Answer 16

No

Question 17

which of the following immunosuppressants is not indicated for RA?
a. cyclosporine
b. basiliximab
c. mycophenolate
d. rituximab

Answer 17

b. basiliximab

Question 18

which of the following is false regarding m-TOR inhibitor sirolimus?
a. low oral absorption
b. can cause delayed wound healing
c. can cause hypolipidaemia
d. used for coronary stents

Answer 18

c. can cause hypolipidaemia

causes HYPERlipidaemia

Question 19

Link the CORRECT anti-metabolite with its target:

a. methotrexate – DNA synthesis
b. leflunomide – folic acid synthesis /use
c. mycophenolate – inosine monophosphate dehydrogenase (IMPDH)
d. cyclophosphamide – pyrimidine synthesis

Answer 19

c. mycophenolate – inosine monophosphate dehydrogenase (IMPDH) –> inhibit purine synthesis –> inhibit T cell proliferation

Question 20

what is Fludabarine?

Answer 20

purine analogue

Question 21

side effects of Fludarabine?

Answer 21

haemolytic anaemia
bone marrow suppression (myelosuppression/myelotoxicity)

Question 22

what is Fludarabine indicated in?

Answer 22

chronic lymphocytic leukaemia

Question 23

In addition to fludarabine, the other drug used to treat chronic lymphoid leukaemia is

a. Cyclophosphamide
b. Prednisolone
c. Paracetamol
d. Ketamine

Answer 23

a. Cyclophosphamide

Question 24

I am an alkylating agent - I create crosslinks in DNA that impairs subsequent DNA synthesis and apoptosis of rapidly proliferating tissues. Also, I require activation in the liver.

a. fludarabine
b. rituximab
c. warfarin
d. cyclophosphamide

Answer 24

d. cyclophosphamide

Question 25

side effects of Cyclophosphamide

Answer 25

alopecia myelosuppression infertility

Question 26

Cyclosporine is used for a. acute prophylactic for transplant rejection b. rheumatoid arthritis c. psoriasis d. all of the above

Answer 26

d. all of the above

Question 27

I am an immunostimulant that works by enhancing the cytokine production of T cells. I can also cause peripheral neuropathy. Who am I? a. interferons b. aldesleukin c. thalidomide d. anakinra

Answer 27

c. thalidomide

Question 28

I am an immunostimulant used to treat hairy cell leukaemia and karposi's sarcoma a. thalidomide b. interferons c. basiliximab d. aldesleukin

Answer 28

b. interferons

Question 29

Interferons work by: a. enhancing T cell production of cytokines b. binding to cell surface receptors that initiate intracellular events, enhanced macrophage phagocytic activity, and increased T cell proliferation c. having cytotoxic potential against tumours d. binding to IL-1 and resulting in downstream cytokine suppression

Answer 29

b. binding to cell surface receptors that initiate intracellular events, enhanced macrophage phagocytic activity, and increased T cell proliferation

Question 30

Aldesleukin (IL-2) is used to treat a. melanoma, multiple sclerosis b. chronic hepatitis B and C c. hairy cell leukaemia d. rheumatoid arthritis

Answer 30

a. melanoma, multiple sclerosis

Question 31

what is ipilimumab?

Answer 31

a-CTLA-4 (block negative signalling from CTLA-4 --> promote immunity)

Question 32

what is Nivolumab?

Answer 32

a-PD-1

Question 33

Corticosteroids do NOT: a. inhibit IL-1 expression b. inhibit TNF-alpha c. inhibit IL-2 expression d. inhibit phospholipase A2

Answer 33

c. inhibit IL-2 expression

Question 34

Which of these is not a calcineurin inhibitor? a. sirolimus b. tacrolimus c. cyclosporin

Answer 34

a. sirolimus (m-TOR inhibitor)

Question 35

Calcineurin inhibitors: a. inhibit all cell proliferation b. inhibit IL-2 expression and proliferation of T-cells c. inhibits IL-2 signal transduction

Answer 35

b. inhibit IL-2 expression and proliferation of T-cells

Question 36

For the following immunopharmacological agents choose the CORRECT statement: a. sirolimus is a potent inhibitor of target-of rapamycin (mTOR) inhibiting IL-2 signal transduction b. mycophenolate is a Il-2 antagonist preventing T-Cell activation c. tacrolimus inhibits inosine monophosphate dehydrogenase involved in the de novo synthesis of purines d. cyclosporine is a calcineurin activator that enhances T-cell responses

Answer 36

a. sirolimus is a potent inhibitor of target-of rapamycin (mTOR) inhibiting IL-2 signal transduction b. myocphenolate: Inhibit purine synthesis → inhibit T cell proliferation c. tacrolimus: inhibit IL-2 expression d. cyclosporine: inhibit IL-2 (calcineurin inhibitor)