drugs

Question 1

muromonab

Answer 1

Indication: transplant rejection
MOA
- anti-CD3
- Binds surface protein present on all T cells that normally binds antigen leading to hyper stimulation
- Hyperstimulation leads to T cell death and new organ is accepted
First approved therapeutic Ab

Question 2

fingolimod

Answer 2

Indication: MS
MOA
- Sphingosine analog, S1PR1 agonist
- Triggers Gai to inhibit RacI GTPase function in cell motility
- Results in sequestering lymphocytes in lymph nodes
- Can’t go to CNS and contribute to disease

Question 3

corticosteroids

Answer 3

Indication: inflammation
MOA
- Agonist of glucocorticoid receptor
- Decrease transcription of pro-inflammatory molecules
- TNFa
- Increase transcription of anti-inflammatory molecules
- IL-10, IL-1

Question 4

NSAIDs

Answer 4

Indication: inflammation
MOA
- Decrease prostaglandins
- Inhibit COX 1 and 2 enzymes
Salicylic acid- natural product from willow bark

Question 5

anti-IL5s (mepolizumab, reslizumab, benralizumab)

Answer 5

Indication: eosinophilic asthma
MOA
- Block IL5 binding to IL5R
- Prevents activation and degranulation of eosinophils

Question 6

infliximab (Remicade)

Answer 6

Infliximab (Remicade)
Indication: Crohn’s disease
MOA
- anti-TNF, binds to extracellular TNF and neutralizes it
- If TNF can’t bind receptor, can’t cause inflammation

Question 7

anakinra (Kineret)

Answer 7

Indication: RA
MOA
- IL-1 receptor antagonist
- Competitively inhibits binding to receptor
- Reduces inflammation

Question 8

nivolumab

Answer 8

Indication: cancer
MOA
- Prevents PD-1R from interacting with ligand
- Blocking inhibitory signal increases T cell activation
Immune checkpoint therapy

Question 9

lifitegrast (Xiidra)

Answer 9

Indication: dry eye
MOA
- Prevents LFA-1 ICAM interaction
- Decreases T cell activation by blocking immune synapse formation
- Decrease local eye inflammation

Question 10

aldesleukin

Answer 10

Indication: metastatic renal carcinoma
MOA
- Stimulates T cell response
- Recombinant form of IL-2, stimulating T cell proliferation

Question 11

basiliximab (Simulect)

Answer 11

Indication: transplant rejection
MOA
- Antibody to IL-2 receptor of T cells
- Binding drug to receptor means that antigen can’t bind and there’s no activation of T cells

Question 12

dupilumab (Dupixant)

Answer 12

Indication: atopic dermatitis
MOA
- IL-4 antibody
- Decreases Th2 cells

Question 13

ixekizumab (Taltz)

Answer 13

Indication: plaque psoriasis
MOA
- Binds IL-17, preventing inflammation
- Prevents progression of disease

Question 14

conjugate vaccines

Answer 14

T cell dependent response gives a stronger B cell response
- May have stronger efficacy against pathogen
Some pathogens express polysaccharides
- Can use to directly activate B cells
- T cell independent- weaker, short lived
Conjugating polysaccharide to stronger antigen will get cells to produce a stronger antibody response to a weaker antigen
- Makes T cell independent into dependent
Ex. Tetanus toxoid protein can be conjugated to a weaker epitope
- Will be presented by B cells to activate tetanus toxoid specific Th cells
- Then leads to stronger response

Question 15

Hib vaccine

Answer 15

Haemophilus influenzae type B vaccine is a conjugate of tetanus toxoid and polyribosyl ribitol phosphate
For prevention of meningitis
Initial vaccines with PRP gave weak antibody response that diminished rapidly
Reformulation in 1990 as conjugate vaccine boosted efficacy
- Changed from T-independent to T-dependent response

Question 16

etanercept (Enbrel)

Answer 16

Indication: RA
MOA
- Combined anti-TNF IgG with TNF receptor
- Extended stability due to fusion

Question 17

rituximab

Answer 17

Indication: autoimmune diseases and cancer
MOA
- Monoclonal Ab targeting CD20 on B cells
- Healthy or malignant
ADCC is mediated by Fc portion which triggers NK cells to kill B cells
- Coats B cell by targeting CD20
- Attacks B cell by NK cells with ADCC mechanism

Question 18

daratumumab

Answer 18

Indication: multiple myeloma
MOA
- CD38 Ab, which is expressed in myeloma cells
- Triggers complement pathway in addition to ADCC and ADCP
- Recruits C1 complement protein
- MAC made
- Ab also capable of ADCC, ADCP, apoptosis

Question 19

7 kinds of vaccines

Answer 19

attenuated/ killed bacteria
live attenuated viruses
subunit vaccines
conjugate vaccines
synthetic vaccines
viral and DNA vectors

Question 20

methotrexate

Answer 20

Indication: autoimmune disorders
MOA
- Inhibitor of folate metabolism
- Decreases proliferation of immune cells
- Immunosuppression

Question 21

cyclosporine

Answer 21

Indication: organ transplant rejection
MOA
- Inhibits calcineurin, which is critical to transcription of IL-2 and T cell response
- Blocking T cell response causes immunosuppression

Question 22

natalizumab

Answer 22

Indication: MS
MOA
- Monoclonal antibody targeting CD49d
- CD49 is an integrin which is required for T cell migration into affected organs
- Prevents infiltration of immune cells into brain

Question 23

mycophenolic acid

Answer 23

Indication: kidney transplant
MOA
- Inhibitor of inosine-5’-monophosphate dehydrogenase
- Prevents de novo GMP synthesis, which is required for lymphocyte proliferation
- Good localization to kidney

Question 24

cancer vaccines

Answer 24

2 vaccines (HBV, HPV) prevent liver cancer and cervical cancer, but these work through inhibiting the virus that causes these cancers
Unlike vaccines for infectious diseases, cancer vaccines are therapeutic not prophylactic
Not yet used in humans, but Torigen markets this product for dogs
- Founder is a UConn grad
- Tumor is taken out of dog, isolated into tumor cells, combined with adjuvant, and then can be injected into dog for anything residual remaining

Question 25

epinephrine

Answer 25

Indication: allergy
MOA
- Vasoconstrictor and bronchodilator
Catecholamine

Question 26

diphenhydramine

Answer 26

Indication: allergy
MOA
- Binds to histamine receptors to prevent action