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AANIYA PATH > Aani Immuno: Transplant & Immune therapies > Flashcards

Aani Immuno: Transplant & Immune therapies Flashcards

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1
Q

Which cell features are recognised in transplant/grafts?

A

HLA (A/B/DR)
Minor HLA
ABO Blood Antigens

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2
Q

What are the types of recognition in transplants?

A

Direct - the donor’s APCs present the antigens

Indirect - the recipients APCs present the antigens

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3
Q

Which kind of antigen presentation is involved in Chronic rejection?

A

Indirect

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4
Q

Which kind of antigen presentation is involved in Acute rejection?

A

Direct

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5
Q

What can you give before transplantation to reduce rejection?

A

Suppress T cell responses.

Anti-CD52 Alemtuzumab or Anti-CD25 Basiliximab

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6
Q

How can you prevent rejection from start to finish?

A
  1. Determine donor and recipient HLA (Using PCR).
  2. Check recipient’s preformed Abs against donor HLA and ABO
  3. CROSS-MATCH
  4. Check for new Abs after transplantation
  5. Give immunosuppressive therapy e.g. AntiCD25/D52
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7
Q

How to treat episodes of acute rejection?

A
  1. Cellular - give steroids

2. Ab-mediated - plasma exchange or IVIG or Anti C5

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8
Q

Apart from rejection, name some post-transplant complications

A
  1. Infection
  2. Atherosclerosis
  3. Malignancy
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9
Q

Mnemonic for remembering the anti-proliferative immune therapies?

A 
Aaniya Can't Make More
Azathioprine
Cyclophosphamide
Methotrexate
Mycophenolate Sodium/Mofetil
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10
Q

What is methotrexate used for?

A

RA
Psoriasis
Crohn’s

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11
Q

Side effect of methotrexate?

A

Reduces folate –> Megaloblastic anaemia

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12
Q

What is Mycophenolate Sodium/Mofetil used for?

A

Transplantation and vasculitis

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13
Q

Side effect of mycophenolate mofetil?

A

Herpes virus reactivation

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14
Q

What is azathioprine used for?

A

Transplantation, autoimmune/inflamm diseases

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15
Q

Contraindications to azathioprine?

A

Allopurinol use

TPMT Polymorphism

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16
Q

Cyclophosphamide indication?

A

Anti cancer agent
Vasculitis
Connective Tissue disease

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17
Q

S/E of cyclophosphamide

A

Infertility & hair loss

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18
Q

Mnemonic for T-Cell Signalling Inhibitors

A 
ST CAT
Sirolimus
Tacrolimus
Cyclosporin
Apremilast
Tofacitinib
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19
Q

Sirolimus indications? And mechanism?

A

Rejection prophylaxis

Blocks T Cell proliferation

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20
Q

Tacrolimus indications? And mechanism?

A

Rejection prophylaxis

Inhibits calcineurin which reduces IL2 so it reduces T cell function

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21
Q

Cyclosporin indications? And mechanism?

A

Rejection prophylaxis

Inhibits calcineurin which reduces IL2 so it reduces T cell function

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22
Q

Which is the least nephrotixic of the T cell signalling inhibitor drugs?

A

Sirolimus

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23
Q

S/E of Tacrolimus?

A

Nephrotoxicity

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24
Q

S/E of Cyclosporin?

A

Nephrotoxicity

Gym Hypertrophy

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25
Apremilast indication and mechanism?
Psoriasis & psoriatic arthritis | Inhibits PDE4
26
Tofacitinib mechanism? Indication?
JAK inhibitor | Rheumatoid arthritis
27
Cell surface antigen drugs used in transplant rejection prophylaxis?
Basiliximab Daclizumab MuromonabCD3 Anti-Thymocyte Globulin (ATG)
28
What does Basiliximab do?
Inhibits CD25 via IL2 receptor
29
Indications and S/Es of Basiliximab?
Used in rejection prophylaxis | Can cause injection or infusion reaction
30
Daclizumab mechanism? Indication ?
Anti- CD25 via IL2 receptor | Good for organ transplantation
31
Anit Thymocyte Globulin (ATG) indications? Mechanism?
Allograft rejection | Inhibits migration of T Cells
32
What does Natalizumab do? Indications?
Anti-alpha-4 integrin via VCAM1 and MadCAM1 so inhibits T Cell migration. Used in Relapsing MS and Crohns
33
S/E of Natalizumab?
Hepatotoxic | Hyperlipidaemia
34
What does Abatacept do?
Anti- CTRL4 Ig so inhibits T Cell migration
35
What is abatacept used for?
Rheumatoid arthirits
36
Abatacept S/E?
Cough
37
Tocilizumab indications?
Castleman syndrome & RA
38
Tocilizumab mechanism?
Anti IL6 causing low T cells, low B cells, low macrophages and low neutrophils
39
Alemtuzumab indications?
Graft rejection CLL MS
40
Rituximab indications?
Lymphoma RA SLE
41
Alemtuzumab mechanism?
Anti CD52
42
S/E of alemtuzumab?
CMV infection
43
Treatment of CLL?
Chlorambucil Fudarabine Alemtuzumab
44
Rituximab mechanism?
Anti CD20. Depletes mature B Cells
45
MuromonabCD3 mechanism? Indication?
Anti CD3 on t cells. Allograph rejection (mouse Ab)
46
Efalizumab mechanism?
Anti CD2a | Reduces T Cell migration
47
Mnemonic for TNF alpha inhibitors?
``` I'm A Cool Girl. Alpha mums, like Ada and Goli, certainly inflict pain Infliximab Adalimumab Certolizumab Golimumab ```
48
Infliximab mechanism?
TNF alpha inhibitor
49
Indications for TNF alpha inhibitors?
``` RA Psoriasis Psoriatic arthritis IBS Ankylosing Spondylitis ```
50
Ustekinumab mechanism? Indications?
IL12 & IL23 inhibitor | Used in psoriasis & psoriatic arthritis
51
Secukinumab mechanism? Indications?
IL17A inhibitor | Used in psoriasis & psoriatic arthritis
52
Etanercept mechanism? Indications?
TNF alpha Br p75IgG | Used in psoriasis & psoriatic arthritis
53
Denosumab mechanism? Indications?
Anti-Rank Osteoporosis MM Bony Mets
54
S/E of denosumab
Avascular necrosis of the jaw
55
Which drug should be prescribed in osteoporosis?
Denosumab
56
TNFa inhibitor used in ankylosing spondylitis. It may cause lupus-like syndromes and demyelination as a side effect.
Etarnacept
57
A 63 year old man received a renal transplant 5 years ago. He has now started to develop herpes infections and on recent investigations bone marrow suppression is seen. Which drug is responsible?
Mycophenolate Mofetil
58
Which treatment is the most appropriate for x-linked agammaglobulinaemia?
Antibody replacement therapy
59
A 2 month old child presents with recurrent infections, failure to thrive, persistent diarrhoea and reticular dysgenesis (low neutrophil, lymphocytes, macrophage, platelets). What is the treatment of choice?
Bone Marrow Transplant
60
Anti-TNF alpha antibody used to treat inflammatory bowel disease?
Infliximab/Adalimumab/Certolizumab/Golimumab

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