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DIT Immunology > Imm 8 - Immunosuppressants > Flashcards

Imm 8 - Immunosuppressants Flashcards

1
Q

What are the four types of Transplant rejection?

A

Hyperacute. Acute. Chronic. Graft-vs-host disease (GVHD).

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2
Q

What is Hyperacute rejection?

A

Can be seen in the OR. Minutes to hours. This is an antibody-mediated type II hypersensitivity reaction; where the recipient has preformed Ab against donor antigens.

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3
Q

What is Acute rejection?

A

Weeks (within 3 months). Cell mediated. Cytotoxic T lymphocytes recognize foreign MHC I.

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4
Q

What is Chronic rejection?

A

Occurs several months to years. Mediated both by T cells and Ab. Cytotoxic T-cells treat transplant cell as self-cells presenting non-self antigen. There is vascular damage and fibrosis. This is irreversible.

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5
Q

What is Graft-versus-Host disease?

A

When the new bone marrow transplanted (essentially giving a new immune system) attacks the donor; grafted T-cells proliferate and attack host.

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6
Q

What are the symptoms of GVHD?

A

Maculopapular rash (neck, shoulders, ears, palms). Hemolysis/jaundice. Hepatosplenomegaly. Abdominal pain. Diarrhea. Nausea/vomiting.

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7
Q

What is the MOA and unique SE of Cyclosporine?

A

Binds to cylophilins in cytosol T cells. This complex inhibits calcineurin, which activates the transcription of IL2. This inhibition prevents the production of IL2, disrupting T cell activation and differentiation. SE: Nephrotoxicity and HTN (this drug causes vasoconstriction of afferent and efferent arterioles).

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8
Q

In what diseases is Cyclosporin used?

A

Prevent transplant rejection. Psoriasis. Severe RA.

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9
Q

What is the MOA and unique SE of Tracrolimus and Pimecrolimus?

A

Binds to enzyme called FK binding proteins, which inhibits calcineurin. This in turn inhibits production of IL-2. SE: Nephrotoxicity, HTN. Neurotoxicity (headaches and paresthesias) when used systemically.

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10
Q

In what disease is Tracrolimus and Pimecrolimus used?

A

Both can be used topically for eczema. Tracroliums used systemically for transplant rejection.

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11
Q

Whats is the MOA of Sirolimus?

A

Binds FKBP-12 intracellular protein causing inhibition of mTOR (mammalian target of rapamycin) which causes inhibition of T-cell proliferation.

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12
Q

Whats is the MOA and unique SE of Azathioprine?

A

Precursor of 6-MP, it interferes w/ nucleic acid synthesis. SE: bone marrow suppression. Metabolized by xanthine oxidase (therefore toxic effects are increased by allopurinol).

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13
Q

Whats is the MOA and unique SE of Mycophenolate?

A

Inhibits IMP-dehydrogenase, preventing the synthesis of guanine. This prevents the rapid proliferation of B cells and T cells.

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14
Q

In what diseases can Mycophenolate used?

A

Transplant patients and Lupus nephritis.

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15
Q

Whats is the MOA of Muromonab (OKT3)? When is it used primarily?

A

Works by binding to CD3 (which is found in all T cells) This interferes w/ T cell signal transduction. Used in transplant.

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16
Q

Whats is the MOA and unique SE of Daclizumab?

A

Binds to CD25, which is the IL-2 receptor on activated T cells. This blocks IL-2 signaling, not IL-2 production.

17
Q

Whats is the MOA and unique SE of Thalidomide?

A

Affects TNF-alpha. SE: Phocomelia (prior use as a sedative during pregnancy).

18
Q

What are the modern uses of thalidomide?

A

Immunosuppressopm (SLE, organ transplant), anti-angiogenic.

19
Q

Which immunosuppressant matches the following statement: Precursor of 6-mercaptopurine.

A

Azathiorpone.

20
Q

Which immunosuppressant matches the following statement: antibody that binds to CD3 on T cells.

A

Muromonab.

21
Q

Which immunosuppressant matches the following statement: antibody that binds IL-2 receptor on activated T cells.

A

Daclizumab.

22
Q

Which immunosuppressant matches the following statement: Inhibits IMP dehydrogenase.

A

Mycophenolate mofetil.

23
Q

Which immunosuppressant matches the following statement: inhibits calcineurin resulting in the loss of IL-2 production and blocks T cell differentiation and activation.

A

Cyclosporine.

24
Q

Which immunosuppressant matches the following statement: Binds FK-binding protein leading to loss of IL-2 production.

A

Tacrolimus (FK506). Pimecrolimus.

25
Q

Which immunosuppressant matches the following statement: Binds FKBP-12 leading to inhibition of mTOR and T cell proliferation.

A

Sirolimus.

26
Q

Which immunosuppressant matches the following statement: used for lupus nephritis.

A

Azathioprine. Mycophenolate (off-label). Cyclosporine (off-label).

27
Q

Which immunosuppressant matches the following statement: Metabolized by xanthine oxidase, therefore allopurinol increases its toxicity.

A

Azathioprine.

28
Q

What malignancy is associated w/ mycophenolate mofetil?

A

Lymphoma.

29
Q

Why is mycophenolate mofetil not used in pregnancy?

A

Congenital malformation of face and ear and first trimester miscarriage.

DIT Immunology (10 decks)

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