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Immunology - DVM year 1 > Exam 4: Dr. Thomason Immunosuppressive Therapy > Flashcards

Exam 4: Dr. Thomason Immunosuppressive Therapy Flashcards

1
Q

What do long term immunosuppressive therapies cause?

A

Susceptibility to bacterial infections (common)

Overwhelming, unusual infections

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2
Q

What are the common infections that can occur with long term therapies?

A

Cystitis
Pyoderma
Pneumonia

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3
Q

What are the overwhelming, unusual infections that can occur with long term therapies?

A

Fungal (aspergiullus)
Protozoal (toxoplasma)
Parasitic (demodex)

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4
Q

What are mechanisms of immunosuppression?

A

Decrease antibody synthesis by plasma cells
Decrease antibody-cell binding affinity
Impair mononuclear phagocytic system cell destruction of antibody-coated cells

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5
Q

What are glucocorticoids?

A

Prednisone, prednisolone, dexamethasone

Mainstay of immunosuppressive therapy

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6
Q

What are the mechanisms of corticosteroids?

A

Once in the nucleus, it binds to specific DNA sequences

  • -Enhance/inhibit transcription of genes
  • -Induce or inhibit protein translation
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7
Q

What do glucocorticoids do?

A

Decrease antibody synthesis (days)
Decrease antibody cells binding affinity
Impair MPS (hours)

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8
Q

What do corticosteroids have effects on?

A

Complement and rapid down -regulation of Fc receptor expression on macrophages leads to the reduction of phagocytosis of opsonised cells

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9
Q

What are the additional immunosuppressive effects?q

A

Decrease egress of cells from the blood
Suppress macrophages and neutrophil bactericidal functions
Inhibit amplification pathways of the complement cascade
Decrease antigen presentation to Th cells
Anti-inflammatory properties

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10
Q

What are corticosteroids?

A

Very effective immunosuppressive agent and the mainstay treatment of most immune-mediated diseases

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11
Q

What are the acute side effects of glucocorticoid therapy?

A

Polyuria/polydipsia
Polyphagia
Panting
+/- GI ulcerations

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12
Q

What are the chronic side effects of glucocorticoid therapy?

A 
Alopecia
Thin skin
Pot belly
Hepatomegaly
Muscle weakness
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13
Q

How does standard glucocorticoid therapy work?

A

Wean down dose

Ultimate goal is to remove all medications

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14
Q

Describe local-acting steroids

A

Local effect and fewer systemic side effects

Poor systemic absorption metabolized by the liver right after absorption

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15
Q

What is combination immunosuppressive therapy?

A

Increase immunosuppresion

Dose-sparing effect with side effects

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16
Q

What is an example of immunosupressive agent?

A

Azathioprine

17
Q

What does azathioprine interfere with?

A

Purine synthesis

18
Q

What does azathioprine lead to?

A

Production of fraudulent nucleotides

19
Q

What does azathioprine do?

A

DNA and RNA syntheses are inhibited, and mitosis and cellular metabolism is disrupted
Reduction in lympocyten proliferation

20
Q

What are side effects of azathioprine?

A

Myelosuppression
Acute pancreatitis
Hepatopathy
Gastrointestinal

21
Q

How can you minimize side effects of prednisone and azathioprine?

A

Combination therapy of the 2

22
Q

What does cyclosporine do?

A

Decreases antibody synthesis

  • -Impairs IL-2 production
  • -Reduces lymphocyte activation
23
Q

What does suppressed IL-2 production due to cyclosporine reduce?

A

T cell, then B cell proliferation

24
Q

What does cyclophosphamide do?

A

Cross-links DNA
Preventing DNA separation
Toxic to resting and dividing cells, particularly proliferating lymphocytes
Suppresses CMI and humoral immunity

25
Q

What are cyclophosphamide side effects?

A

Myelosuppression
Gastrointestinal disease
Refractory cystitis or bladder neoplasia

26
Q

What does vincristine do?

A

Binds to tubulin and disrupts assembly of the mitotic spindle in mitosis

27
Q

What does vincristine do for IMTP?

A

Increases platelet counts

28
Q

What can management of immune-mediated blood disorders?

A

High dose intravenous immunoglobulins

29
Q

What does human intravenous immunoglobulin do?

A

Competitively inhibits the binding of canine IgG to monocytes by saturation of Fc receptors
Prevention of phagocytosis of antibody-coated erythrocytes and platelets

30
Q

Describe human intravenous immunoglobulins

A

Minimal toxicity but very expensive
May increased risk of blood clots
Availability is an issue

Immunology - DVM year 1 (35 decks)

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