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

Aani Immuno: Transplant & Immune therapies Flashcards

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

25
Q

Apremilast indication and mechanism?

A

Psoriasis & psoriatic arthritis

Inhibits PDE4

26
Q

Tofacitinib mechanism? Indication?

A

JAK inhibitor

Rheumatoid arthritis

27
Q

Cell surface antigen drugs used in transplant rejection prophylaxis?

A

Basiliximab
Daclizumab
MuromonabCD3
Anti-Thymocyte Globulin (ATG)

28
Q

What does Basiliximab do?

A

Inhibits CD25 via IL2 receptor

29
Q

Indications and S/Es of Basiliximab?

A

Used in rejection prophylaxis

Can cause injection or infusion reaction

30
Q

Daclizumab mechanism? Indication ?

A

Anti- CD25 via IL2 receptor

Good for organ transplantation

31
Q

Anit Thymocyte Globulin (ATG) indications? Mechanism?

A

Allograft rejection

Inhibits migration of T Cells

32
Q

What does Natalizumab do? Indications?

A

Anti-alpha-4 integrin via VCAM1 and MadCAM1 so inhibits T Cell migration. Used in Relapsing MS and Crohns

33
Q

S/E of Natalizumab?

A

Hepatotoxic

Hyperlipidaemia

34
Q

What does Abatacept do?

A

Anti- CTRL4 Ig so inhibits T Cell migration

35
Q

What is abatacept used for?

A

Rheumatoid arthirits

36
Q

Abatacept S/E?

A

Cough

37
Q

Tocilizumab indications?

A

Castleman syndrome & RA

38
Q

Tocilizumab mechanism?

A

Anti IL6 causing low T cells, low B cells, low macrophages and low neutrophils

39
Q

Alemtuzumab indications?

A

Graft rejection
CLL
MS

40
Q

Rituximab indications?

A

Lymphoma
RA
SLE

41
Q

Alemtuzumab mechanism?

A

Anti CD52

42
Q

S/E of alemtuzumab?

A

CMV infection

43
Q

Treatment of CLL?

A

Chlorambucil
Fudarabine
Alemtuzumab

44
Q

Rituximab mechanism?

A

Anti CD20. Depletes mature B Cells

45
Q

MuromonabCD3 mechanism? Indication?

A

Anti CD3 on t cells.
Allograph rejection
(mouse Ab)

46
Q

Efalizumab mechanism?

A

Anti CD2a

Reduces T Cell migration

47
Q

Mnemonic for TNF alpha inhibitors?

A 
I'm A Cool Girl. Alpha mums, like Ada and Goli, certainly inflict pain
Infliximab
Adalimumab
Certolizumab
Golimumab
48
Q

Infliximab mechanism?

A

TNF alpha inhibitor

49
Q

Indications for TNF alpha inhibitors?

A 
RA
Psoriasis
Psoriatic arthritis
IBS
Ankylosing Spondylitis
50
Q

Ustekinumab mechanism? Indications?

A

IL12 & IL23 inhibitor

Used in psoriasis & psoriatic arthritis

51
Q

Secukinumab mechanism? Indications?

A

IL17A inhibitor

Used in psoriasis & psoriatic arthritis

52
Q

Etanercept mechanism? Indications?

A

TNF alpha Br p75IgG

Used in psoriasis & psoriatic arthritis

53
Q

Denosumab mechanism? Indications?

A

Anti-Rank
Osteoporosis
MM
Bony Mets

54
Q

S/E of denosumab

A

Avascular necrosis of the jaw

55
Q

Which drug should be prescribed in osteoporosis?

A

Denosumab

56
Q

TNFa inhibitor used in ankylosing spondylitis. It may cause lupus-like syndromes and demyelination as a side effect.

A

Etarnacept

57
Q

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?

A

Mycophenolate Mofetil

58
Q

Which treatment is the most appropriate for x-linked agammaglobulinaemia?

A

Antibody replacement therapy

59
Q

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?

A

Bone Marrow Transplant

AANIYA PATH (35 decks)

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