IMMUNOLOGY- Immunosuppressants Flashcards by Armando Monroy

What are the immunosuppressants?

Agents that block lymphocyte activation and proliferation

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Which is the clinical use for immunosuppressants?

Reduce acute transplant rejection by suppressing cellular immunity

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Which is the recommendation to have greater efficacy with decreased toxicity for immunosuppressants use?

Frequently combined to achive them

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Which is the risk of Chornic suppression with immunosuppressants?

Increased risk of infection and malignancy

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These drugs are immunosuppressants

Cyclosporine
Tacrolimus
Sirolimus (Rapamycin)
Basiliximab
Azathioprine
Glucocorticoids

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This is the mechanism of action of Cyclosporine

Calcineurin inhibitor; binds cyclophilin

Blocks T cell activation by preventing IL-2 transcription

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Which are the clinical use for Cyclosporine?

Transplant rejection, prophylaxis, psoriasis, rheumatoid arthritis

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Which are the possible toxic effects of Cyclosporine?

Nephrotoxicity
Hypertension 
Hyoerlipidemia
Hyperglycemia
Tremor
Hirsutism
Gingival hyperplasia

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Which are the higher risk of Calcineurin inhibitors?

Highly nephrotoxic

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Who are consider Calcineurin inhibitors?

Cyclosporine

Tacrolimus

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How does Tacrolimus works?

Binds FK506 binding protein (FKBP)

Blocks T cell activation by preventing IL-2 transcription

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This is the use for Tacrolimus

Transplant rejection prophylaxis

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Which could be the secondary effects of Tacrolimus?

Similar to cyclosporine, ↑ risk of diabetes and neurotoxicity; no gingival hyperplasia or hirsutism

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Which drugs bind to FKBP?

All -limus drugs

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Who is inhibited with Sirolimus?

mTOR inhibitor

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How else is Sirolimus known?

Rapamycin

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This is the mechanism of Sirolimus

Binds FKBP

Blocks T cell activation and B cell diferentiation by preventing IL-2 signal transduction

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When is recommended Sirolimus?

Kidney transplant rejection prophylaxis

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When is consider that Rapamycin caused toxicity?

Anemia
Thrombocytopenia
Leukopenia
Insulin resistance
HyperlipidemiaIs

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Is sirolimus nephrotoxic?

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With which medicine is Sirolimus synergistic?

Ciclosporine

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This is an alternative of using Sirolimus

Drug eluting stent

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How does Basiliximab works?

Monoclonal antibody; blocks IL- 2R

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When is recommended to use Basiliximab?

Kidney transplant rejection prophylaxis

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These are secondary effects of Basiliximab

Edema, hypertension, tremor

This immunosuppressant is antimetabolite precursor of 6 mercaptopurine

Azathioprine

How does Azathioprine works?

Inhibits lymphocyte proliferation by blocking nucleotide synthesis

These are the clinical use for Azathioprine

Transplant rejection prophylaxis Rheumatoid arthritis Chron disease Glomerulonephritis

Which are the possible toxic efects of Azathioprine?

Leukopenia Anemia Thrombocytopenia

Who degrades 6 MP?

Xanthine oxidase

Who increases 6 MP toxicity?

Allopurinol

What is inhibited by Glucocorticoids?

Inhibit NF- kB

What is suppressed by Glucocorticoids?

Both B and T cell function by ↓ transcription of many cytokines

These are recommendations of using Glucocorticoids

Transplant rejection phrophylaxis (immune suppression) Many autoimmune disorders Inflamation

These are the classic toxic effects of Gucocoticoids

``` Hyperglycemia Osteoporosis Central obesity Muscle Breakdown Psycosis Acne Hypertension Catarcts Peptic Ulcers ```

Which enzyme is inhibited by Azthioprine?

PPRP Amidotransferase

If PPRP Amidotransferase is inhibited by 6- MP, which are the results?

Inhibition of Purine nucleotides and last DNA replication

Which are Recombinant cytokines?

``` Epoetin alfa Thrombopoietin Oprelvekin Filgratim Sargramostim Aldesleukin IFN alfa IFN beta IFN gamma ```

What is Epoetin alfa?

Erythropietin

When is recommended the clinical use of Erythropoietin?

Anemias (especially renal failure)

Which is the clinical use for Thrombopoietin?

Thrombocytopenia

Which is the commercial name for Interleukin 1?

Oprelvekin

This is the recommendation for Interleukin 1 as medication

Thrombocytopenia

What is filgrastim?

Granulocyte colony stimulating factor

Which medicines are indicated for Recovery of bone marrow?

Filgrastim and Sargramostim

What is Sargramostim?

Granulocute macrophage colony stimulating factor

Commercial name for Interleukin 2

Aldesleukin

When is Interleukin 2 recommended?

Renal cell carcinoma, metastatic melanoma

Which is the clinical ise for INF alfa?

Chronic hepatitis B and C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma

This is the indication of IFN beta

Multiple Sclerosis

When is recommended the clinical use of IFN gamma?

Chronic granulomatous disease

Name therapeutic antibodies cancer therapies

``` Alemtuzumab Bevacizumab Cetuximab Rituximab Trastuzumab ```

Which is the target of Aletuzumab?

CD52

Which is the use of Aletuzumab?

CLL

This Therapeutic antibody cancer therapy´s target is VEGF

Bevacizumab

For these cases Bevacizumab is indicated

Colorectal cancer | Renal cell carcinoma

This is the target of Cetuximab

EGFR

This Therapeutic antibody cancer therapy is recommended for Stage IV colorectal cancer, head and neck cancer

Cetuximab

Who is targeted by Rituximab?

CD20

These diseases can be treated with Rituximab

B cell non Hodgkin lymphoma Rheumatoid arthritis Idiopathic thrombocytopenic purpura (ITP)

Which medication is indicated with Rituximab in order to treat Rhematoid arthritis?

MTX

Which Therapeutic antibody cancer therapy´s target is HER2/neu?

Trastuzumab

Which is the clinical use for Trastuzumab?

Breast cancer | Gastric cancer

Therapeutic antibodies for Autoimmune disease

Ifiximab, adalimumab | Natalizumab

This medications target is TNF-alfa

Ifiximab, adalimumab

In this cases Ifiximab, adalimumab are indicated

Inflammatory bowel disease (IBD) Rheumatoid arthritis Ankylosing spondylitis Psoriasis

This is Natalizumab target

α4 Integrin

This autoimmune diseases are treated with Nafalizumab

Multiple sclerosis | Chron Disease

Which is the importance of α4 Integrin?

Leukocyte adhesion

If John Cunningham virus (JCV) is present and you give Nafalizumab which is the risk?

Progressive multifocal leukoencephalopathy (PML)

Anti-platelet agent that acts in Glycoprotein IIb/ IIIa

Abxicimab

What does Abxicimab prevents?

Prevention of ischemic complications in patients undergoing percutaneous coronary intervention

This is the target of Denosumab

RANKL

In this cases Denosumab is indicated

Osteoporosis

How does Denosumab acts in Osteoporosis?

Inhibits osteoclast maturation

This medication is mimic by Denosumab

Osteoprotegin

Which therapeutic antibodies act in Digoxin?

Digoxin immune Fab

Antidote for digoxin toxicity

Digoxin immune Fab

Which is the target of Omalizumab?

IgE

This therapeutic antibodies work for Asthma?

Omalizumab

Prevents IgE binding to FcERI

Omalizumab

Which is the target of Palivixumab?

RSV F protein

RSV prophylaxis for high risk infants

Palivizumab