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Path Y > Immunology - Immune-modulating therapies 1 & 2 > Flashcards

Immunology - Immune-modulating therapies 1 & 2 Flashcards

1
Q

By what mechanism can B cells provide immunological memory?

A

High affinity IgG remains circulating in blood

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2
Q

What is the best predictor of immunity to influenza following a vaccine?

A

IgG against haemaglutinnin (moreso than CD8 T cells) detected using a Haemagluttinin (HA) assay

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3
Q

Why is adjuvant used in some vaccines?

A

increase the immune response without altering its specificity:

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4
Q

What does PEP for HIV contain?

A

Specific immunoglobulin for HIV

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5
Q

What monoclonal antibody can be used in melanoma treatment? Its specific for what antibody?

A

Ipilimumab (anti-CTL-A4)
This blocks an immune checkpoint by binding to CTLA4, forces CD80 and CD86 to go through stimulatory CD28 pathway –> enhanced T cell response

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6
Q

In what disease can IFN gamma be given therapeutically?

A

Chronic granulomatous disease

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7
Q

In what disease can IL2 be given therapeutically?

A

Renal cell carcinoma
IL-2 expands NK and T cell responses via the IL-2 surface receptor

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8
Q

In what 2 diseases can IFN alpha be given therapeutically?

A

CML
Multiple myeloma

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9
Q

How do steroids inhibit the immune response?

A

Inhibit phospholipase A2 which is a key enzyme in prostaglandin formation, reducing inflammation

Also decrease phagocyte trafficking (hence there is a transient increase in neutrophil count)

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10
Q

Recall 3 examples of anti-proliferative agents

A

Cyclophosphamide
Azothioprine
Mycophenalate

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11
Q

What is the mechanism of action of cyclophosphamide?

A

alkylating agent
Alkylation of guanine –> inhibition of DNA synthesis
affects B cells > T

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12
Q

What is the mechanism of action of azothioprine?

A

purine analogue

coverts purine to 6 mercaptopurine (6-MP

inhibits de novo purine synthesis and acts as an antiproliferative
affects T cells > B

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13
Q

What must always be checked before prescribing azothioprine?

A

TPMT activity
Thiopurine methyltransferase

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14
Q

How can plasmapheresis be used to treat autoimmune diseases? What should you give in conjunction

A

emoves problematic antibody
Need to give alongside an antiproliferative agent such as cyclophosphamide to prevent rebound antibody production

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15
Q

How do calcineurin inhibitors work?

A

blocks IL2 production

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16
Q

Give 2 examples of a calcineurin inhibitor? What cells do they inhibit

A

inhibit t lymphocytes

Cyclosporine
tacrolimus

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17
Q

Give 2 diseases in which JAK2 (janus kinase) inhibitors can be useful?

A

Rheumatoid and psoriatic arthritis

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18
Q

By what mechanism do PDE4 (phosphodiesterase) inhibitors work, and in what disease are they useful?

A

increased cAMP
activates PKA (protein kinase A)
leads to decrease in cytokine production

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19
Q

Recall 2 immune-modulating therapies that are useful in the prophylaxis of allograft rejection

A

Anti-thymocyte globulin (rabbit)
Anti-CD25 (Basiliximab)

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20
Q

Wha type of antibody is rituximab?

A

Anti-CD20

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21
Q

What monoclonal antibody can be used in IBD treatment?

A

Vedolizumab
Anti - alpha4beta7 integrin

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22
Q

What is infliximab?

A

Anti-TNF alpha

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23
Q

What monoclonal therapy can be used in osteoporosis?

A

anti-RANK/RANK-ligand = Denosumab

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24
Q

What is the mechanism of action of tofacitinib

A

JAK inhibition

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25
Q

What is the mechanism of action of apremilast?

A

Anti-PDE4

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26
Q

What is the mechanism of action of basilixumab?

A

Anti-CD25 (alpha chain of interleukin 2)

27
Q

What is the mechanism of action of Abatacept?

A

CTLA4 Ig
opposite of ipilimumab
it turns off T cells reducing autoimmunity hence why used in RA

28
Q

What is the mechanism of action of rituximab?

A

Anti-CD20

29
Q

What is the mechanism of action of natalizumab?

A

Anti-alpha4 integrin

30
Q

What is the mechanism of action of tocilizumab?

A

Anti-IL6-Receptor

31
Q

What is the mechanism of action of muromonab

A

Mouse monoclonal against CD3

32
Q

What is the mechanism of action of alemtuzumab?

A

Anti-CD52

33
Q

What is the mechanism of action of adalizumab?

A

Anti-TNF alpha

34
Q

What is the mechanism of action of certolizumab?

A

Anti-TNF alpha

35
Q

What is the mechanism of action of golimumab?

A

anti-TNF alpha

36
Q

What is the mechanism of action of etanercept?

A

TNFa antagonist

37
Q

What is the mechanism of action of ustekinumab?

A

Anti-IL12/23

38
Q

What is the mechanism of action of sekukinumab? Treats what 2 conditions

A

Anti-IL17a
psoriasis/psoritatic arthritis
ankylosing spondy

39
Q

What condition can be treated with apremilast?

A

Psoriasis

40
Q

What conditions can be treated with natalizumab?

A

MS
Crohn’s

41
Q

What conditions can be treated with abatacept?

A

Rheumatoid arthritis

42
Q

give 2 live attenuated vaccines

A

BCG
MMR

43
Q

give 4 inactivated vaccines

A

influenza
pertussis

polio

hep A

44
Q

what’s the mechanism of mycophenelate

A

anti metabolite
blocks guanosine nucleotide synthesis, prevents DNA replication
prevent T cell proliferation > B cell

45
Q

give an example of a JAK2 inhibitor

A

ruxolotinib

46
Q

give an example of a PDE4 inhibitor

A

apremilast

47
Q

give 3 classes of drug that inhibit cell signalling

A

calcineurin inhibitors
JAK inhibitors
PDE4 inhibitors

48
Q

give 4 anti TNFa drugs

A

infliximab
adalimumab
certolizumab
golinmumab

49
Q

anti IL-12 and IL-23 can be used for what 2 conditions

A

psoriasis/psortiatic arthritis
crohns

50
Q

guselkumab is used to treat what?

A

psoriasis

51
Q

guselkumab is anti IL…

A

IL 23

52
Q

What infection should be ruled out before commencing inflximab for cronhs

A

TB via mantoux test

if mantou +ve then an interferon gamma release assay (IGRA)

if ve = latent TB mist treat before immune modulating therapy

53
Q

whats a recombinant vaccine? give 2 examples

A

accine contains proteins found on the surface of the viruses in addition to an adjuvant. Examples include Hep B and HPV.

54
Q

what a conjugate vaccine? what are they used against? give 3 examples

A

For encapsulated bacteria.

Consist of bacterial polysaccharides conjugated to an immunogenic toxin (diphtheria toxin).

Used for Haemophilus influenzae, meningococcus and pneumococcus.

55
Q

What antigen is injected intradermally as part of the mantoux screening test for tuberculosis?

A

Tuberculin Purified Protein Derivative

56
Q

how is the mantoux test interpreted

A

The size of the induration (not erythema) is measured after 48-72 hours.

>5mm is positive in HIV or immunosuppressed patients or people at very high risk of TB (such as living with someone with active TB)

>10mm is positive in IVDU, medium risk populations such as healthcare workers or children <4 years old

>15mm is positive in low risk populations.

57
Q

give a complication of the use of natalizumab, mycophenelate & rituiximab

A

Progressive Multifocal Leukoencephalopathy caused by the

john cuNNINGHAM vIRUS

58
Q

What mouse monoclonal antibody targets CD3 on the surface of T cells?

A

Muromonab

59
Q

what antibody targets cd 25? whats its use

A

basiliximab

allograft rejection

60
Q

what is tocfatinib and its use

A

JAK inhibitor used in rheum arthritis

61
Q

what monoclonal antobody targerts CD52. whats the effect

A

alemtuzumab

depletion of all lymphocyte subsets

62
Q

state 4 anti TNFa drugs

A

Infliximab/Adalimumab/Certolizumab/Golimumab

directly bind to TNFa

63
Q

give the se’s of prednisolone, cyclophosphamide and tacrolimus

A

pred - osteoporosis

cyclo - infertility

tacro - nephrotixicity

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