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Theo's Path > Immune therapies > Flashcards

Immune therapies Flashcards

1
Q

Contains preformed IgG against full range of organisms

Used for immune deficiencies and passive vaccination

A

A. Human Normal Immunoglobulin

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2
Q

Containes Ig specific to Rabies, VZV, HBV etc.

A

A. Specific immunoglobulin post-exposure prophylaxis

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3
Q

Used to boost immune response to HBV, HCV, Kaposi’s, Hairy cell leukaemia, CML and MM

A

A. INF-a

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4
Q

Used to boost immune response in relapsing-remitting MS

A

A. INF-B

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5
Q

Used to boost immune response in Chronic Granulomatous Disease

A

A. INF-y

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6
Q

Anti-CTLA4 antibody
Blocks immune checkpoint allowing T cell activation
Used in advanced melanoma

A

A. Ipilimumab

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7
Q

Anti-PD1
Blocks immune checkpoint allowing T cell activation
Used in advanced melanoma

A

A. Pembrolizumab/Nivolumab

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8
Q

This type of drug inhibits phospholipase A2, reducing prostaglandin synthesis
- Used in autoimmune and inflammatory disease as well as prevention and treatment of transplant rejection

A

A. Corticosteroids e.g. prednisolone

SE - Cushing’s syndrome, osteoporosis, peptic ulceration

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9
Q

This group of drugs are cytotoxic agents. Acting by inhibiting DNA synthesis, they target cells with rapid turnover. Can you name 4 examples and give their specific function?

A

A. Antiproliferative agents

  1. Cyclophosphamide - alkylating agent
  2. Mycophenolate mofetil - prevents guanine synthesis
  3. Azathioprine - metabolised to 6-MP which blocks de novo purine synthesis
  4. Methotrexate - inhibits DHFR
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10
Q

Give three side effects of anti-proliferative agents

A

A. Bone marrow suppression, teratogeny, infection

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11
Q

What must you be aware of when prescribing azathioprine?

A

A. TMPT polymorphism prevents metabolism in some people

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12
Q

When is plasmapheresis indicated?

A

A. Severe antibody mediated disease e.g. Goodpasture’s, myasthenia gravis, vascular rejection and antibody mediated rejection

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13
Q

What is the mechanism of tacrolimus and cyclosporin?

A

A. Calcineurin inhibitor –> prevents transcription of IL-2 –> reduces T cell proliferation
(Group: inhibitors of cell signalling)

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14
Q

Which inhibitor of cell signalling is less nephrotoxic?

A

A. Sirolimus

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15
Q

Can you name 5 inhibitors of cell signalling and give their specific mechanisms?

Hint: CASTT

A 
A. 
Cyclosporin - calcineurin inhibitor 
Apremilast - PED4 inhibitor 
Sirolimus - blocks clonal proliferation of T cells
Tofacitinib - JAK inhibitor 
Tacrolimus - calcineurin inhibitor
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16
Q

What are the side effects of tacrolimus and cyclosporin?

A

A. Both nephro- and neurotoxic, HTN
Tacro: diabetogenic
Cyclo: gum hypertrophy, dysmorphism

17
Q

Anti-CD25 (IL2 receptor alpha chain) used in allograft rejection?

A

A. Basiliximab

18
Q

Anti-CTLA4 Ig used in rheumatoid arthritis?

A

A. Abatacept

19
Q

Anti-CD20 used in lymphoma, RA and SLE?

A

A. Rituximab

20
Q

Anti-alpha4 integrin used in MS and Crohn’s?

A

A. Natalizumab

21
Q

Anti-IL6R used in Castleman’s disease and RA?

A

A. Tocilizumab

22
Q

What is the mechanism of Muromonab-CD3 (OKT3) and when is it used?

A

A. Blocks CD3 on T cells (mouse monoclonal antibody)

Used in active allograft transplant rejection

23
Q

Can you name 6 agents directed at cell surface antigens?

Hint: barnTM

A 
A. 
Basiliximab - anti-CD25
Abatacept - anti-CTLA4 Ig
Rituximab - anti-CD20 
Natalizumab - anti-alpha4 integrin 
Tocilizumab - anti-IL6R
Muromonab-CD3 - blocks CD3
24
Q

Which biologics are indicated in rheumatoid arthritis? Name 4.

A 
A. infliximab 
adalimumab
certolizumab 
golimumab (all anti-TNFa) 
tofacitinib (JAKi), 
abatacept (CTLA4), 
tocilizumab (IL-6R), 
rituximab (CD20), 
etanercept (TNFa/BR p75-IgG fusion protein)
25
Q

Which agent directed at cell surface antigens can result in CMV infection?

A

A. Alemtuzumab (used in CLL)

26
Q

Which two agents target CD25 and are used in transplant rejection?

A

A. Basiliximab and Daclizumab

27
Q

What is the mechanism and class of efalizumab?

A

A. Anti-CDIIa (cell surface antigen)

28
Q

Which agent causes lymphocyte depletion and modulation of T cell activation and migration?

A

A. Anti-thymocyte globulin (ATG)

29
Q

Give four examples of anti-TNFa antibodies used in rheumatoid arthritis, psoriasis, ankylosing spondilitis and IBD.

A

A. Infliximab
Adalimumab
Certolizumab
Golimumab

30
Q

What is the mechanims of infliximab and adalimumab?

A

A. anti-TNFa

31
Q

Which cytokine-directed agent is used in osteoporosis when bisphosphonates are contraindicated?

A

A. Denosumab - anti-RANKL

Also used in MM and bony mets

32
Q

Anti-IL-12 and IL-23, used in psoriasis and psoriatic arthritis?

A

A. Ustekinumab

33
Q

Mechanism of secukinumab?

A

A. Anti-IL-17

Used in psoriasis, psoriatic arthritis and ankylosing spondilitis

34
Q

Which agents make patients more susceptible to infection with TB?

A

A. Agents directed against cytokines e.g. infliximab, etanercept, ustikinumab etc.

35
Q

Mechanism of golimumab?

A

A. Anti-TNFa

36
Q

Which agent alkylates guanine base of DNA?

A

A. Cyclophosphamide

37
Q

Give two examples of pre-transplant induction agents?

A

A. Alemtuzumab (anti-CD52)
Basiliximab (anti-CD25)
or OKT3/Murmonab-CD3

38
Q

Which agents could you use post-transplant to reduce rejection?

A 
A. Calcineurin inhibitor e.g. tacrolimus/cyclosporin 
MMF/AZA (cytotoxic) 
Steroids 
OKT3/Muromonab-CD3
ATG
39
Q

A 45 year old man with myasthenia gravis presents to A&E with difficulty in breathing. Assisted ventilation is administered. Which of the following is the best initial management of his condition?

  1. Ciclosporin
  2. Tacrolimus
  3. Rapamycin
  4. Corticosteroids
  5. Plasmapheresis
A

A. 5 Plasmapheresis

Severe myasthenia gravis (myasthenic crisis) is typified by paralysis of the respiratory muscles requiring ventilator assistance. The best management is plasmapheresis because it rapidly removes anti-AchR abs from circulation.
Long term treatment involves Ach-esterase inhibitors and immunosuppressive agents e.g. corticosteroids.

Theo's Path (9 decks)

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