Immuno

Question 1

Cyclosporine

mech, clin use, toxicity

Answer 1

• binds cyclophilins -> blocks differentiation and act’n of T cells by inhib’ing calcineurin -> no prod of IL-2 and its R
• suppresses organ rejection post-transplant; select autoimm d/o’s
• nephrotoxic, gingival hyperplasia, hirsutism, hyperlipid/glc/HTN, tremor

Question 2

Tacrolimus (FK-506)

mech, clin use, toxicity

Answer 2

• like cyclosporine, binds FK-binding pr -> inhib’s calcineurin and secretion of IL-2
• immsupp’n, use in organ transplants
• like cyclosporine: nephrotoxicity, hyperlipid/glc/HTN, tremor (but NO gingival hyperplasia nor hirsutism, unlike cyclosporine)

Question 3

Sirolimus (rapamycin)

mech, clin use, toxicity

Answer 3

• inhibits mTOR, inhibits T cell prolif from IL-2
• immsupp’n post-kidney transplant w/ cyclosporine/ccs, also use w/ drug-eluting stents
• hyperlipidemia, decr’d plts/leuk’s

Question 4

Azathioprine

mech, clin use, toxicity

Answer 4

• antimetabolite precursor of 6-MCP, interferes w/ metab’n and syn of nucleic acids; toxic to prolif’ing lymphocytes
• kidney transplant, autoimm d/o’s (GN, hemolytic anemia)
• BM suppression, metab’d by XO (-> more toxic effects w/ allopurinol)

Question 5

Muromonab-CD3 (OKT3)

mech, clin use, toxicity

Answer 5

• mAb to CD3 on T cells -> blocks interaction w/ CD3 pr, so no Tcell signal transduction
• immsupp’n post-kidney transplant; prevent acute transplant rejection
• cytokine release synd, HSR

Question 6

Clinical uses of recombinant cytokines:

1) Aldesleukin (IL-2)
2) Epoetin alfa (EPO)
3) Filgrastim (G-CTF)
4) Sargramostim (GM-CSF)
5) a-IFN
6) b-IFN
7) g-IFN
8) Oprelvekin (IL-11)
9) Thrombopoietin

Answer 6

1) RCC, melanoma
2) anemias (esp in renal failure)
3) recovery of BM
4) recovery of BM
5) HepB/C, Kaposi’s, leukemias, melanoma
6) MS
7) CGD (chronic granulomatous dz)
8) thrombocytopenia (stim’s megakaryocyte prolif)
9) thrombocytopenia

Question 7

Infliximab
target?
used for?

Answer 7

mAb to TNF-a

CD, RA, AS, psoriatic arthritis

Question 8

Abciximab
target?
used for?

Answer 8

GPIIb/IIIa (fibrin R on plts)

prevent cardiac ischemia in unstable angina and in pt’s trted w/ PCI

Question 9

Rituximab
target?
used for?

Answer 9

mAb to CD20

B-cell NHL

Question 10

Omalizumab
target?
used for?

Answer 10

mAb to IgE

severe asthma

Question 11

Adalimumab
target?
used for?

Answer 11

mAb to TNF-a

CD, RA, AS, psoriatic arthritis

Question 12

Trastuzumab
target?
used for?

Answer 12

mAb to HER2

HER2-overexp’ing br ca