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RUSVM Pharmacology > Immune And Chemotherapy > Flashcards

Immune And Chemotherapy Flashcards

1
Q

What should you use if your goal is to reduce secondary inflmmation?

A

Anti-inflammatory

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2
Q

What should you use if your goal is to significantly decrease the immune response

A

Immunosuppression

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3
Q

What should you do if your goal is to reduce cell replication and/or kill unwanted cells

A

Chemotherapy

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4
Q

What are your anti-inflammatory therapies?

A

NSIAD
Glucocorticoids
Cytokines inhibitors
Immunomodulators

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5
Q

What are your selective/preferential COX2 inhibitors?

A

Meloxicam
Deracoxib
Piroxicam

Firocoxib
Robenacoxib

Carprofen

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6
Q

What are the non selective cox inhibitors

A

Flunixin megulamine

Phenylbutazone

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7
Q

What would i used to somatic pain in my equine patients?

A

Phenylbutazone

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8
Q

What do I use to treat visceral pain in equines?

A

Visceral

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9
Q

T/F: flunixin meglumine is administered IM in horse

A

False

IM injection causes muscle necrosis
Don’t do that!

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10
Q

A dose of 0.5-1mg/kg/day of prednisone has _____________ effect, a dose of 2mg/kg/day has a _______________ effect

A

Anti-inflammatory; immunosuppressive

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11
Q

How does the potency of dexamethasone compare to prednisone?

A

Dexamethasone is 7-8x more potent than prednisone

Dosage should be adjusted accordingly

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12
Q

Glucocorticoids inhibit what part of the inflammatory pathway?

A

Inhibits phospholipase formation of acrachidonic acid

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13
Q

NSAIDS inhibit what part of the inflammatory pathway?

A

Cyclooxygenase

COX1 or COX2 or both

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14
Q

COX1 has what role in normal homeostasis ?

A

Mediates thromboxane A2 -> promoting platelet aggregation

Prostaglandin E1 -» GI mucosal maintenance and vasodilation of the kidney.

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15
Q

What is the role of COX2 in normal homeostasis

A

Indictable production of prostaglandins during inflammation ?

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16
Q

Which of the following NSAIDS would I choose if GI ulceration was a problem

A. Flunixin megutamine
B. Meloxicam
C. Phenylbutazone
D. Aspirin

A

B. Meloxiam
This is a selective COX2 inhibitor

All the others are have inhibitory activity on COX1 -> inhibit prostaglanin E => GI ulceration

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17
Q

How does a Janus Kinase inhibitor have immunomodulatory activity

A

Inhibits JAK1 and JAK3

-> no production of pro-inflammatory cytokines

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18
Q

How do anti-histamines have an immunomodulatory effect?

A

Antagonist at the histamine receptor -> block action of histamine

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19
Q

What is the first-line for general immunosuppression

A

High dose glucocoricoids

Prednisone or dexamethasone

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20
Q

What are common side effects seen with glucocorticoids therapy?

A

PU/PD/PP/Panting

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21
Q

How do glucocorticoids cause immunosuppression ?

A

Inhibit the production of local chemotactic factors

Inhibit secretion of destructive proteolytic enzymes

Redistribute monocytes and lymphocyte from peripheral to bone marrow

Reduced Tcell activation and cytotoxicity

Suppress cytokine activity and alter macrophage function

22
Q

What might you use in conjunction with glucocorticoids to have a dose-sparing effect?

A

Azathioprine

Start high-dose pred and azathioprine
Azathioprine should work after the first two weeks and prednisone can be tapered off

23
Q

What is the MOA of antimetabolites? What are the drugs in this category?

A

Impair nucleic acid synthesis (DNA) in rapidly dividing immune cells and can block signaling on Tcells

Azathioprine
Mycophenolate mofetil
Leflunomide

24
Q

T/F: azathioprine can be used int cats to have a dose-sparing effect for prednisone

A

False

Azathioprine is toxic to cats -> bone marrow and liver toxicity

25
Q

When would I use mycophenolate?

A

Mycophenolate is often reserved for immune disease that is resistant to other therapies

$$$$

26
Q

How are azathioprine, mycophenolate, and leflunomide administered?

A

Orally

Mycophenolate can also be given IV very slowly

27
Q

What are the Tcell inhibitors?

A

Cyclosporine

Tacrolimus (topical)

28
Q

What is the MOA of cyclosporine?

A

Polypeptide that blocks cyclophilin/calcineurin which reduces T-cell activation and response, inhibits production of various cytokines to alter function of other WBC’s

29
Q

Cyclosporine is used topically in the eye to treat?

A

Keratocnjuctivitis sicca (KCS)

In dog

30
Q

What is cyclosporine used to treat systemically?

A

Perianal fistulas or as an adjunct with glucocorticoids for other immune disease (IMHA)

Allergic/autoimmune dermatitis

31
Q

What are major side effects of cyclosporine?

A

GI upset
Gingival proliferation
Nephrotoxicity
Hepatotoxicity

32
Q

Tacrolimus is used topically to treat????

A

Dermatological disease

Perianal fistula

33
Q

Aggressive cellular inhibiton of what therapy?

A

Chemotherapy

34
Q

T/F: cancer chemotherapy have a relatively narrow therapeutic index and require special handling

A

T

35
Q

What relatively low toxicity chemotherapeutics are used to manage immune-mediated diseases?

A

Cyclophosphamide (immune mediated hemolytic anemia)

Chorambucil (IBD)

Cytosine arabinoside (granulomatous meningioencephalitis)

36
Q

How should chemotherapy drugs be administered?

A

Vesicant drugs- catheter placement first try

Long infusion

Body surface area dosing

37
Q

Why do we used body surface dosing for chemotherapy drugs and levothyroxine?

A

Reflects the metabolic ‘size’ of the patient

38
Q

What is levothyroxine and what do we use it to treat?

A

AKA thyro-tabs
T4

Treat hypothyroid in dog - direct replacement of hormone

39
Q

What drugs are contraindicated with levothyroxine use?

A 
Phenobarbital 
Zonisamide 
Sulfonamides 
Glucocorticoids 
Phenylbutazone 
Quindine
40
Q

What precautions should the owner take when handling chemotherapy?

A

Wear gloves
No crushing or splitting pills
Make sure pet consumed the pill

Elimination -> wear gloves to collect excretion, seal in plastic bag for disposal in trash several days after drug administration

41
Q

What are the two most common adverse effects of chemotherapy ?

A

GI signs
-> nausea (use anti-emetic) before/during treatment

Bone marrow suppression/immunosuppression

  • > monitor CBC
  • > neutropenia>thrombocytopenia>anemia
42
Q

What do you call the lowest neutrophil count

A

Nadir

Generally predictable based on the drug used

  • > drop below a certain expected point -> delay chemo
  • > severe start prophylactic antibiotics
43
Q

Are we concerned about alopecia in our chemotherapy patients?

A

No. Most animals will not lose excessive hair or go bald

Some breeds with continuously growth hair coats may show more hair loss
Cats whiskers may fall out
Shaved areas can be slow to regrow

44
Q

What drugs would be useful to treat the nausea associated withe chemotherapy and what is their MOA?

A

Maropitant (dog and cat)->NK1 antagonist ->block subP at CRTZ

Metoclopramide (more useful in dog, cat)->D2 receptor and 5-HT antagonist @vomiting center

Ondasetron (dog and cat)-> 5-HT receptor antagonist @vomiting center

45
Q

Why is metoclopramide more useful in dogs than cats?

A

Dogs have a higher number of D2 receptors than cats

Can still be used in cats because of its action on 5-HT receptor

46
Q

What species is more susceptible to nephrotoxicity caused by chemotherapeutic platinum agents?

A

Cats

47
Q

What is acute tumor lysis syndrome?

A

Massive killing of cancer cells leading to severe systemic diseases (shock, DIC)

48
Q

Convention chemotherapy dosing uses ___________ to achieve the greatest efficacy

A

Maximum tolerated dose

49
Q

Why would one use a multi-drug chemotherapy protocol?

A

Reduce resistance development in the cancer cell population and minimize toxicity to the patient

50
Q

What is metronomic chemotherapy ?

A

Lower doses are given over longer periods of time

Caution: risk of owner exposure

51
Q

What phases of the cell cycle can chemotherapeutic drugs act?

A

M-phase: mitosis
S-phase: DNA synthesis
G2 phase: protein and RNS synthesis

RUSVM Pharmacology (18 decks)

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