Week 3 Immonosuppresants

Question 1

What are immunosuppressants?

Answer 1

A class of drugs that decrease the activity of the immune system in conditions such as autoimmune diseases, organ transplantation, and malignancies.

Question 2

What is the general effect of immunosuppressants?

Answer 2

Dampening of the immune response.

Question 3

What are biologic agents?

Answer 3

Medications derived from living organisms that target particular components of the immune system.

Question 4

List the primary targets of biologic agents.

Answer 4

• Tumor necrosis factor (TNF)
• Interleukins (ILs)
• B- or T-cell activity

Question 5

What do calcineurin inhibitors do?

Answer 5

They halt the activity of calcineurin, a phosphatase involved in T-cell activation.

Question 6

What is the role of corticosteroids?

Answer 6

They interfere with the cell cycle of inflammatory cells and modify the activity of other immune components.

Question 7

What do mTOR inhibitors do?

Answer 7

They are proliferation signal inhibitors that reduce immune-cell proliferation.

Question 8

What types of conditions are treated with immunosuppressants?

Answer 8

• Autoimmune conditions
• Organ transplant rejection
• Malignant diseases

Question 9

What is the mechanism of action of B-cell inhibitors?

Answer 9

They reduce inflammation and decrease immune response by decreasing antibody production, antigen presentation, T-cell activation, and proinflammatory cytokine production.

Question 10

Name a few B-cell inhibitors.

Answer 10

• Belimumab
• Ocrelizumab
• Rituximab

Question 11

What is the mechanism of action for IL-1 inhibitors?

Answer 11

They block the IL-1 receptor or inhibit IL-1beta.

Question 12

List some IL-6 inhibitors.

Answer 12

• Sarilumab
• Tocilizumab

Question 13

What are tumor necrosis factor inhibitors?

Answer 13

Agents that bind to tumor necrosis factor (TNF) and block its interaction with TNF receptors.

Question 14

What are the adverse effects of TNF inhibitors?

Answer 14

• Infections
• Malignancy
• Heart failure
• Demyelinating disease

Question 15

What is the mechanism of action of T-cell inhibitors?

Answer 15

They inhibit T-cell activation by blocking the interaction between CD28 on T cells and CD80/CD86 on antigen-presenting cells.

Question 16

Give examples of calcineurin inhibitors.

Answer 16

• Cyclosporine
• Pimecrolimus
• Tacrolimus

Question 17

What are the indications for corticosteroids?

Answer 17

• Allergic/respiratory conditions
• Dermatologic conditions
• Endocrinologic conditions
• Gastroenterologic conditions
• Hematologic conditions
• Ophthalmologic conditions
• Rheumatologic conditions

Question 18

What are some common adverse effects of corticosteroids?

Answer 18

• Cardiovascular issues
• Skin atrophy
• Hyperglycemia
• Adrenal suppression
• Osteoporosis

Question 19

Fill in the blank: Calcineurin inhibitors target _______.

Answer 19

[calcineurin]

Question 20

True or False: Corticosteroids can be used for the treatment of uveitis.

Answer 20

True

Question 21

What is the effect of IL-17 inhibitors?

Answer 21

They target IL-17 to reduce inflammation in conditions like plaque psoriasis and psoriatic arthritis.

Question 22

List some adverse effects of mTOR inhibitors.

Answer 22

• Infections
• Nephrotoxicity
• Hyperlipidemia

Question 23

What is the role of biologic agents in treating autoimmune diseases?

Answer 23

They specifically suppress components or pathways of the immune system.

Question 24

What is the significance of the nomenclature for biologic agents?

Answer 24

Names indicate their structure and origin, such as ‘-mab’ for monoclonal antibodies.

Question 25

What is hyperglycemia?

Answer 25

Elevated blood glucose levels ## Footnote Often associated with diabetes mellitus.

Question 26

Define diabetes mellitus.

Answer 26

A group of diseases that affect how the body uses blood sugar (glucose).

Question 27

What is adrenal suppression?

Answer 27

Decreased production of adrenal hormones.

Question 28

List some Cushingoid features.

Answer 28

* Moon facies * Buffalo hump * Central obesity * Skin changes

Question 29

What is the consequence of growth suppression in children?

Answer 29

Impaired growth and development.

Question 30

What gastrointestinal condition is associated with corticosteroids?

Answer 30

Peptic ulcer.

Question 31

What are common genitourinary effects of corticosteroids?

Answer 31

Menstrual irregularities.

Question 32

List musculoskeletal effects of corticosteroids.

Answer 32

* Aseptic necrosis of the humeral head/femoral head * Susceptibility to fractures * Myopathy * Osteoporosis

Question 33

Identify neurologic and psychiatric effects of corticosteroids.

Answer 33

* Headache * Idiopathic intracranial hypertension * Paresthesia * Seizures * Vertigo * Psychosis * Agitation * Insomnia

Question 34

What ophthalmic conditions can arise from corticosteroid use?

Answer 34

* Glaucoma * Cataracts

Question 35

What is a common consequence of corticosteroid therapy?

Answer 35

Impaired wound healing.

Question 36

What are the contraindications for corticosteroids?

Answer 36

* Hypersensitivity to the drug or its components * Recent administration of live or live attenuated vaccines * Uncontrolled active infections * Uncontrolled diabetes * Uncontrolled psychotic states * Uncontrolled hypertension * Peptic ulcer

Question 37

True or False: Corticosteroids enhance the adverse effects of live vaccines.

Answer 37

True.

Question 38

What effect do corticosteroids have when used with NSAIDs?

Answer 38

Increased risk of GI ulcers and bleeding.

Question 39

How do corticosteroids affect warfarin?

Answer 39

They increase anticoagulant effects.

Question 40

What are mTOR inhibitors?

Answer 40

Medications that reduce the activity of mTOR serine/threonine kinase.

Question 41

What is the role of the mTOR signaling pathway?

Answer 41

Involved in cell growth, metabolism, and immune cell proliferation.

Question 42

List the drugs classified as mTOR inhibitors.

Answer 42

* Everolimus * Temsirolimus * Sirolimus

Question 43

What are the two complexes formed by mTOR?

Answer 43

* mTORC1 * mTORC2

Question 44

What is the pharmacokinetics of everolimus?

Answer 44

* Oral * Rapid absorption * 74% protein-binding * Half-life: approximately 30 hours * Hepatic metabolism * Excretion: mostly in feces

Question 45

What are the indications for everolimus?

Answer 45

* Renal cell carcinoma * Prevention of transplant rejection * Tuberous sclerosis complex-associated partial-onset seizures * Neuroendocrine tumors * Breast cancer

Question 46

What adverse effects are associated with mTOR inhibitors?

Answer 46

* Serious infections * Pulmonary toxicity * Angioedema * Increased lipid levels * Secondary malignancy

Question 47

What is azathioprine?

Answer 47

A prodrug of mercaptopurine used for immunosuppressive therapy.

Question 48

What is the mechanism of action of azathioprine?

Answer 48

Inhibits purine synthesis, reducing cell proliferation.

Question 49

List indications for azathioprine.

Answer 49

* Prevention of transplant rejection * Rheumatoid arthritis * Off-label: Crohn's disease, psoriasis

Question 50

What are common adverse effects of azathioprine?

Answer 50

* Alopecia * Myelosuppression * GI toxicity * Hepatotoxicity * Increased infections

Question 51

What is the mechanism of action of cyclophosphamide?

Answer 51

Alkylating agent that binds alkyl groups to DNA.

Question 52

What are the indications for hydroxychloroquine?

Answer 52

* Systemic lupus erythematosus (SLE) * Rheumatoid arthritis (RA)

Question 53

What is the mechanism of action of methotrexate?

Answer 53

Inhibits dihydrofolate reductase, decreasing DNA synthesis.

Question 54

What are the indications for mycophenolate?

Answer 54

To prevent organ transplant rejection.

Question 55

What is thalidomide used for?

Answer 55

* Multiple myeloma * Erythema nodosum leprosum

Question 56

List common drug interactions for leflunomide.

Answer 56

* Activated charcoal and cholestyramine * Immunosuppressive drugs * Vaccines

Question 57

What is the general mechanism of cytotoxic agents?

Answer 57

Interfere with nucleic acid and protein synthesis.

Question 58

What class of drugs does methotrexate belong to?

Answer 58

Antimetabolite agents.

Question 59

List common indications for immunosuppressive agents.

Answer 59

* Rheumatoid arthritis * Inflammatory bowel disease * Transplant rejection