B / 26 : Immunopharmacology I

Question 1

What are cytotoxic agents?

Answer 1

Agents that destroy / kill cells, mainly used for autoimmune diseases or for cancer therapy. The required dose is much lower for immunosuppression.

Question 2

What are the cytotoxic immunosuppressive agents? (5)

Answer 2

• Cyclophosphamide
• Methotrexate
• Leflunomide
• Azathioprine
• Mycophenolate-mofetil

(CLAMM-M)

Question 3

Cyclophosphamide
- MOA
- Effect
- Indication
- SE
- ROA

Answer 3

• Alkylating agent
• Attacks guanine : cross-bridges between DNA strands -> no protein formation
• For autoimmune diseases, hematological malignancies, organ transplantation
• BM suppression, teratogenic
• Oral, parenteral

(Remember BM suppression because it’s also a cancer agent)

Phosphorescent cyclops : cyclophosphamide - CH3 : alkylating agent

Question 4

Methotrexate
- MOA
- Effect
- Indication
- SE
- ROA

Answer 4

• Antimetabolite of folic acid
• Inhibits dihydrofolate reductase : inhibits growth
• For RA, IBD, psoriasis
• BM suppression, liver toxicity
• Oral, parenteral

Question 5

Leflunomide
- MOA
- Effect
- Indication
- SE
- ROA

Answer 5

• Antimetabolite of pyrimidine synthesis
• Block T cell proliferation and AB production of B cells
• For RA
• Hepatotoxicity
• Oral

Question 6

Azathioprine
- MOA
- Effect
- Indication
- SE
- ROA

Answer 6

• Antimetabolite of purines
• Inhibits purine synthesis
• For transplantations, RA, IBD
• BM suppression, hepatotoxicity
• Oral, parenteral

Question 7

Mycophenolate-mofetil
- MOA
- Effect
- Indication
- SE
- ROA

Answer 7

• Antimetabolite of purines
• Inhibits purine synthesis : both B and T cells are suppressed
• For solid organ transplantation (heart, liver, kidney) : 1st choice
• BM suppression
• Oral