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Pathology > I - Suppressing The Immune Response > Flashcards

I - Suppressing The Immune Response Flashcards

1
Q

do steroids have glucocorticoid or mineralocorticoid activity or both?

A

only glucocorticoid

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2
Q

how are steroids anti inflammatory

A

phospholipase a2 breaks down phospholipids to form arachidonic acid –> prostaglandins –> inflam
therefore, block phospholipase a2 –> anti inflammatory

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3
Q

what do steroids do to neutrophil count and what is the effect

A

increase neutrophils
reduced cell trafficking to site

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4
Q

4 effects steroids have on the adaptive immune system

A

lymphocytes sequestered therefore low WCC
block cytokine gene expression
block AB production
increase apoptosis of BTT cells

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5
Q

side effects of steroids

A

metabolic - DM, obesity, moon face, change in lipids, osteoporosis, hirsuitism, adrenal suppression
other - cataracts, glaucoma, peptic ulcer, pancreatitis, avascular necrosis
IMMUNE SUPPRESSION and infection

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6
Q

give 3 examples of anti proliferative agents

A

cyclophosphamide
azathioprine
mycophenolate

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7
Q

how do anti proliferative agents cause immune suppression

A

inhibit DNA synthesis of rapid turnover cells ie immune cells

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8
Q

SE of anti proliferative agents

A

BM suppression
infection
malignancy
teratogenicity

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9
Q

SE of cyclophosphamide

A

toxic to proliferating cells - hair loss, BM support, sterility
haemorrhagic cystitis
malignancy - bladder, blood, non melanoma skin
infection - PCP

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10
Q

SE of azothioprine

A

BM suppression - variable severity
hepatotoxicity
infection

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11
Q

which anti proliferative agent gives more infections as a SE

A

cyclophosphamide

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12
Q

mycophenolate SE

A

BM suppression
infection

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13
Q

which infections are most common with mycophenolate

A

HSV reactivation
JC virus causing progressive multifocal leucoencephalopathy

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14
Q

aim of plasma exchange

A

removal of pathogenic ABs

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15
Q

what happens in plasma exchange

A

pts own blood put through cell separator
removes Ig from plasma, then re infused
rebound AB production (however only temporary)

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16
Q

indications for plasma exchange

A

AB mediated disease ++severity
eg Goodpastures, MG, ABO incompatibility

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17
Q

which classes of drugs are used to inhibit cell signalling

A

calcineurin inhibitors
mTOR inhibitors
JAC inhibitors (Jakinibs)
PDE4i

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18
Q

how do calcineurin inhibitors suppress the immune system

A

T cell proliferation inhibitors

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19
Q

indications for calcineurin inhibitors

A

transplant
SLE
psoriatic arthritis

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20
Q

examples of calcineurin inhibitors

A

ciclosporin
tacrolimus

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21
Q

indication for mTOR inhibitors

A

transplant

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22
Q

examples of mTOR inhibitors

A

rapamycin
sirolimus

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23
Q

indications for jakinibs

A

RA
psoriatic arthritis
axial spondylrthritidies

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24
Q

how do jakinibs work

A

inhibits JAK-STAT signalling
inhibits production of inflammatory molecules and influences gene transcription

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25
Q

example of PDE4i

A

apremlias

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26
Q

indications for PDE4i

A

psoriatic arthritis
psoriasis
(not used commonly)

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27
Q

3 agents that bind to T cell surface antigens

A

rabbit anti thymocyte globulins
basiliximab / doclizumab
abatacept

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28
Q

what is rabbit anti thymocyte globulins used for

A

allograft rejection

29
Q

how does rabbit anti thymocyte globulins work

A

reduced lymphocytes, modifies T cell activation

30
Q

SE of rabbit anti thymocyte globulins

A

infusion reactions
leucopenia
infection
malignancy

31
Q

how is rabbit anti thymocyte globulins given

A

daily IV infusion

32
Q

what are basiliximab / doclizumab

A

CD25 AB

33
Q

what are basiliximab / doclizumab used for

A

prophylaxis of allograft reaction

34
Q

how do basiliximab / doclizumab work

A

blocks IL2 induced signalling and stops T cell proliferation

35
Q

how are basiliximab / doclizumab given

A

IV pre and post transplant surgery

36
Q

SE of basiliximab / doclizumab

A

infusion reaction
infection
malignancy risk long term

37
Q

what is abatacept

A

CTLA4-Ig fusion protein

38
Q

what is abatacept for

A

RA

39
Q

how is abatacept given

A

IV 4x weekly or SC weekly

40
Q

how does abatacept work

A

reduced co-stimulation of T cells via CD28

41
Q

SE of abatacept

A

infusion reaction
infection - TB, HBV, HCV
malignancy

42
Q

2 agents that bind to B cell surface antigens

A

rituximab
vedolizumab

43
Q

what is rituximab

A

AB to CD20

44
Q

what is rituximab used for

A

lymphoma
RA
SLE

45
Q

how is rituximab given

A

2 x IV every 6-12 months

46
Q

how does rituximab work

A

depletes mature B cells - leaves plasma cells

47
Q

SE of rituximab

A

infusion reaction
infection - PML
exacerbates CVD

48
Q

what is vedolizumab

A

alpha 4 beta 7 integrin AB

49
Q

how does vedolizumab work

A

inhibits leucocyte migration
stops exavasation into tissues

50
Q

what is vedolizumab used for

A

IBD

51
Q

how is vedolizumab given

A

IV every 8 weeks

52
Q

SE of vedolizumab

A

infusion reaction
hepatotoxicity
infection
malignancy

53
Q

what are TNF alpha blockers used for

A

RA
psoriatic arthritis
IBD
FMF
ank spon

54
Q

examples of TNF alpha blocker ABs

A

infliximab
adalimumab
certolizumab
golimumab

55
Q

SE of TNF alpha blocker ABs

A

infusion reactions
infection - TB, HBV, HCV
Lupus like conditions
demyelination
cancer

56
Q

example of TNF alpha antagonist

A

etanercept

57
Q

what is etanercept used for

A

RA
ank spon
psoriatic arthritis

58
Q

what are anti IL1 agents used for

A

FMF
gout
adult onset stills

59
Q

what are anti IL6 agents used for

A

RA
GCA
large vessel vasculitis

60
Q

what can anti IL23 agents be used for

A

ax spon
psoriatic arthritis
IBD

61
Q

describe the inflammasome

A

pyrin / urate feed into the ASC –> procaspase 1 –> IL1 / NFKB / apoptosis

62
Q

what are anti IL4/5/13 agents used for

A

asthma / eczema

63
Q

what are anti rank and anti rank ligand agents used for

A

osteoporosis

64
Q

4 main side effects of biological agents

A

infusion reactions
injection site reactions
infection
malignancy

65
Q

how is infection risk for imm support managed

A

vaccination - not live attenuated
stop imm sup agents if ill
appropriate ABx
hand hygiene
avoid unwell contacts

66
Q

4 potential viruses that can cause chronic infection in someone on imm supp

A

TB
hep B/C
HIV
JC virus

67
Q

what can JC virus cause in someone imm sup

A

progressive multifocal leucoencephalopathy

68
Q

what is progressive multifocal leucoencephalopathy

A

destroys oligodendrocytes - can be fatal

69
Q

what cancers are imm sup people at risk of

A

lymphoma from EBV
non melanoma skin cancer - HPV
melanoma - unsure of risk
NOT solid tumours

Pathology (87 decks)

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