B.31. immunopharmacology 3 (antibodies and fusion proteins) Flashcards
interferons given for diseases
IFN-𝝰
IFN-β
IFN-ᵧ
side effects for interferons
flu-like symptoms GI irritation hematotoxicity nephrotoxicity hepatotoxicity CNS presentation
what is IFN-𝝰 used for?
hepatitis B and C leukemia (CML, hairy-cell leukemia) malignant melanoma Kaposi's sarcoma (HHV-8) genital warts (HPV)
what is IFN-β used for?
multiple sclerosis (relapsing form)
what is IFN-ᵧ used for?
chronic granulomatous disease
which interferon has a greater immune-enhancing action?
IFN-ᵧ
mainly via synthesis of TNF
name the immunosuppressive antibodies
IVIG (intravenous immunoglobulin)
ATG (Anti-thymocyte globulin)
ALG (Anti- lymphocyte globulin)
Rh₀ (D) immunoglobulin
what is IVIG?
immunoglobulin preparation (IgG) from pools of thousands of healthy donors
how are immunosuppressive antibodies given?
IV
*Rh₀ (D) immunoglobulin also IM
indications for IVIG
immunoglobulin deficiencies hematological malignancies autoimmune disorders HIV infection stem cell transplantation hemolytic anemias
SE of IVIG
allergic reaction
nephrotoxicity (AKI)
mechanism oF IVIG
- neutralizes superantigens & autoantibodies
- block Fc receptors of macrophages
- inhibition of complement and immunocomplex- medicated tissue damage
- prevent RBC’S lysis in the spleen
mechanism of ATG and ALG
selective inhibition of cellular immunity
Ab’s bind T cells involved in antigen recognition–> destroy them by complement
what is ATG &ALG?
immunoglobulin preparation from horse, sheep or rabbits
indications for ATG or ALG
stem cell transplantation (prevent graft vs host disease)
solid organ transplantation
primary aplastic anemia (immune-mediated process)
side effects of ATG or ALG
hypersensitivity reaction (serum sickness, anaphylaxis) injection-site reaction
indications for Rh₀ (D) immunoglobulin
prevent Rh hemolytic disease of the newborn
what is Rh₀ (D) immunoglobulin?
Human IgG preparation
when is Rh₀ (D) immunoglobulin given?
24-72 hours after delivery of Rh₀ (D) + child
mechanism of Rh₀ (D) immunoglobulin
blocks the primary immune response to the foreign cells.
common SE if monoclonal antibodies
injection site reaction
how is injection site reaction presented?
erythema itching burning swelling pain
management of injection site reaction
topical hydrocortisone
Diphenhydramine (H₁ blocker)
NSAID’S
-omab suffix is for..
murine monoclonal Ab
no human components
-ximab suffix is for..
chimeric monoclonal Ab
65% humanized
-zumab suffix is for..
humanized Ab
>90% human
-umab suffix is for..
fully human 100% monoclonal Ab
what does Rituximab do?
anti-CD20
Reduce B cell count
how are the monoclonal antibodies given?
parenterally
list the monoclonal Ab
“I RUN BAD TV”
Infliximab
Rituximab
Ustekinumab
Natalizumab
Basiliximab
Adalimumab
Dupliumab
Tocilizumab
Vedolizumab
name the chimeric monoclonal Ab
“RIB”
Rituximab
Infliximab
Basiliximab
what are adalimumab, ustekinumab and dupliumab ?
Human monoclonal Ab
give the Humanized monoclonal Ab
Natalizumab
Tocilizumab
Vedolizumab
“Need TV”
indications for Rituximab
B cell lymphoma
autoimmune diseases (RA, vasculitis)
solid organ transplantation
SE o Rituximab
injection site reaction
infections
*first aid: ↑ risk of PML in patients with JC virus
mechanism of Infliximab and Adalimumab
Anti-TNF𝝰
↓ leukocyte activation
what is Adalimumab used for?
Rheumatoid arthritis
indications for Infliximab
autoimmune diseases (RA, ankylosing spondylitis, psoriasis) IBD
Side effects of infliximab and adalimumab
injection site reaction
infections
reactivation of latent TB
lymphoma
mechanism of Tocilizumab
Anti-IL-6 receptor
–> affect both B cell and T cell function
mechanism of Ustekinumab
Anti-IL-12 and IL-23
–> inhibit activation of TH1 and TH17 cells
indications for Tocilizumab
RA
juvenile idiopathic arthritis
SE of Tocilizumab
neutropenia
infections
injections site reaction
indications for ustekinumab
chron’s disease
Psoriasis
SE of ustekinumab
injection site reaction
infections
mechanism of Natalizumab
Anti-integrin 𝝰₄β₁–> inhibit T cell activity
when do we use Natalizumab?
multiple sclerosis
Chron’s disease
SE Natalizumab
injection site reaction
infection
reactivation of JC virus–> may develop PML disease
mechanism of Dupilumab
Anti-IL-4 receptor 𝝰
what is dupilumab for?
atopic dermatitis
SE of dupilumab
allergic reaction
conjunctivitis, keratitis
mechanism of vedolizumab
anti-integrin 𝝰₄β₇–> inhibit t cell function in the GI
what is vedolizumab used for?
crohn’s disease
what are the monoclonal Ab’s used for Crohn’s disease?
“NUV”
Natalizumab
Ustekinumab
Vedolizumab
is there a risk for JC virus when giving vedolizumab?
no
but risk of infection
mechanism of Basiliximab
Anti-IL2 receptor –>inhibit activation of lymphocytes
what is the indication for basiliximab?
solid-organ transplantation
side effects of basiliximab
GI irritation
injection site reaction
what are fusion proteins?
chimeric proteins, that consist of at least 2 domains (encoded by separate genes) that are joined, transcribed, and translated as a single unit–> producing a single polypeptide
name 2 fusion proteins
Abatacept
Etanercept
what is Abatacept and what does it do?
it’s a CTLA-4 fusion protein.
composed of Fc region of immunoglobulin IgG1 and CTLA-4
it binds to CD80/86 on APC and inhibits T cells
indications for giving abatacept
RA
juvenile idiopathic arthritis
Psoriasis
SE of abatacept
infections
producing neutralizing Ab’s
what is Etanercept and what does it do?
it’s an Anti-TNF𝝰 fusion protein
composed of Fc portion of the immunoglobulin IgG1 fused to the TNF receptor
indications of Etanercept
arthritis
ankylosing spondylitis
psoriasis
side effects of Etanercept
injection site reaction
hypersensitivity reaction
