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Heme Onc Exam 2 > Immuno-modulating Drugs > Flashcards

Immuno-modulating Drugs Flashcards

1
Q

MOA of the glucocorticoids/corticosteroids

A

Bind intracellular hormone receptors preventing activation leading to inhibition of the synthesis of the eicosanoids
-which are used to make prostaglandins, thromboxanes, lipoxins, and leukotrienes; each contributes to inflammation

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2
Q

Main indications for corticosteroids.

A

Autoimmune disease or reactions
-ITP, AIHA, acute glomerulonephritis

Transplant
-renal, heart, liver, bone marrow

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3
Q

What are the toxic side effects of corticosteroids?

A

Osteoporosis
Hyperglycemia
Adrenal Insufficiency (negative feedback of hypothalamic-pituitary axis)
Peptic Ulcers

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4
Q

MOA of Cyclosporine

A

Binds and inhibits cyclophilin in the T cell cytoplasm preventing released of IL-2, IL-3, and INF-gamma

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5
Q

Indications for Cyclosporine

A

Solid organ transplant

Graft vs. Host Disease (with methotrexate)

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6
Q

Why does cyclosporine have many drug-drug interactions?

A

It is metabolism by CYP3A4, along with many other drugs, mainly Calcium channel blockers and antifungals

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7
Q

Name a major drug that increases the activity of CYP3A4 decreasing the 1/2 life of Cyclosporine.

A

Carbamazepine

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8
Q

Major toxic side effect of cyclosporine

A

Induces Tissue Growth Factor Beta (TGF-B) with chronic use. Leads to tumor invasion and metastasis
ex. lymphomas, Kaposi sarcoma

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9
Q

MOA of Tacrolimus

A

Binds Immunophilin FK binding protein (IFKBP)
-immunophilins are general immune proteins, cyclophilin is an immunophylin that cyclosporine specifically inhibits. Tacrolimus inhibits multiple immunophilins and is much more potent

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10
Q

Indications for Tacrolimus

A

Stem Cell transplant (more than solid organ)

Prophylaxis of Graft vs. Host disease (with methotrexate)

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11
Q

MOA of Sirolimus

A

Inhibits mTOR which inhibits T cell response to cytokines

Binds and inhibits action of Immunophilin FKBP-12
-no inhibition of calcineurin

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12
Q

What is calcineurin?

A

In order for a T cell to be activated cyclophilin (the thing that cyclosporine inhibits) must bind with calmodulin (calcium binding protein) to form calcineurin. The complex is a phosphatase enzyme that activates T cells.

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13
Q

Main indication of Sirolimus.

A

Stem Cell Transplant

Prophylaxis of Graft vs. Host disease (with methotrexate)

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14
Q

Major toxicity of Sirolimus

A

Myelosuppression

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15
Q

MOA of Mycophenolate Mofetil

A

Inosine Monophosphate Dehydrogenase Inhibitor

  • an enzyme for use in synthesis of GTP needed protein production
  • may be a possible target for cancer chemotherapy
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16
Q

Main indication for Mycophenolate Mofetil

A

Suppress the immune system in graft rejection

17
Q

Indication for Muromonab CD3

A

Autoimmune disorders and transplant management

18
Q

Indication for IVIG

A

Autoimmune disorders, HIV, bone marrow transplant

19
Q

Indication for RhD Immune Globuilin Micro-Dose

A

Rhogam

Hemolytic disease of Newborns

20
Q

What is the one requirement for Monoclonal Abs to function?

A

The target of the therapy must have receptors that bind to the MAbs

21
Q

MOA and indication for Alemtuzumab

A

Binds CD 52 on malignant WBCs

Treats B cell lymphoma/leukemia or T cell cancer

22
Q

Toxicity of Alemtuzumab

A

WBCpenias

-so patients are normally also on antibiotics to prevent infection

23
Q

MOA and indication for Bevacizumab

A

binds VEGF and prevents it from binding to its receptor

Used in colorectal cancer to prevent angiogenesis in tumors. Doesn’t work on already established tumors so it is often given in combination

24
Q

Toxicity of Bavacizumab

A

Hemorrhage and wound healing problems so not used within a month before or after surgery

25
Q

MOA and indication for Cetuximab

A

Binds the receptor for Epidermal growth factor

Used in colorectal cancer

26
Q

MOA and indication for Gemtuzumab

A

Binds CD33 on leukoblast cells in pts with AML

Treats acute myeloid leukemia (AML)

27
Q

Toxicity of Gemtuzumab

A

Myelosuppression

28
Q

MOA and indication for Rituximab

A

Binds CD20 on malignant B cells

Used to treat B cell non-Hodgkins Lymphoma

29
Q

MOA of Trastuzumab

A

Binds Human Epidermal Growth Factor 2 (HER-2/neu) receptor

Treats metastatic breast cacner

30
Q

Toxicity of Trastuzumab

A

Type 2 (irreversible) cardiotoxicity

31
Q

Treatment for any Type 1 HS reaction.

A

Prednisone

32
Q

Tx for Goodpasture Syndrome.

A

Anti-glomerular Basement Membrane Abs

  1. Prednisone
  2. Cyclophosphamide
  3. Plasmapheresis
33
Q

Tx for SLE

A

Anti-Nuclear Antibodies

  1. Prednisone
  2. Cyclophosphamide
  3. Azathioprine
34
Q

Tx for Sjogren Syndrome

A

Anti-exocrine gland Abs

1. Hydroxychloroquine

35
Q

Main treatment for Dermatomyositis.

A

Prednisone

36
Q

Tx for Psoriasis

A

Betamethasone (topical steroid)

Heme Onc Exam 2 (9 decks)

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