immunomodulation Flashcards

1
Q

what is immunomodulation

A

manipulating the immune system using immunomodulatory drugs to achieve a desired effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

name 2 ways that immune tolerance can be induced

A

immunomodulators used in allergy

adoptive immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is adoptive immunotherapy and when is it used

A
stem cell transplant 
BM transplant
immunodeficiencies eg SCID 
AI diseases
lymphoma and leukaemia
inherited metabolic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

name 3 types of allergy immunomodulation

A

anti-IL5 monoclonal treatment
anti -IgE monoclonal treatment
allergen specific - SC/SL/ aero allergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

give an example of an anti-IL5 monoclonal treatment

A

mepolizumab prevents eosinophil recruitment and activation
limited for asthma
no clinical efficacy for hyper-eosinophilic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

name an anti-IgE monoclonal therapy and describe its use

A
omalizumab
asthma
chronic urticarial
angioedema
may cause severe systemic anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how do aero-allergens help in allergy

A
promote Th2-Th1 switching
Treg cells and tolerance
use if anaphylaxis to insect venoms
allergic rhinoconjuncitivitis
-ve = localised and systemic allergic reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are biologic immunomodulators

A

substances nearly identical to the body’s own signalling proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

give an example of a monoclonal antibody

A

infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

give an example of a fusion protein

A

etanercept

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the mode of action of corticosteroids in immunosuppression

A
decrease neutrophil margination
decrease inflammatory cytokines
inhibit phospholipase A2
lymphopenia
decrease T cell proliferation
decrease IgA production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the side effects of corticosteroids

A

CHO metabolism –> diabetes, hyperlipidaemia
decreased protein synthesis –> poor wound healing
osteoporosis
glaucoma, cataracts
psychiatric problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the uses of corticosteroids

A

AI diseases e.g. CTD, vasculitis, RA
inflammatory disease eg crohns, sarcoid, GCA
malignancies e.g. lymphoma
allograft rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are biologic DMARDs

A

disease modifying anti-rheumatic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

name 5 types of biologic DMARDs

A
anti-cytokines
anti B cell
anti T cell activation
anti-adhesion molecules
complement inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

name 3 types of anti-cytokines

A

anti-IL6
anti-IL1
anti-TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

name a type of anti B cell biologic DMARD

A

rituximab = chimeric monoclonal antibody

targets CD20 be cell surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name 4 ways that lymphocytes may be targeted

A

IL-2 receptor MABS
M-TOR inhibitors
Calcineurin inhibitors
antimetabolites (inhibit purine nucleotide synthesis in T and B cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

name 2 types of antimetabolites

A

AZA and MMF

20
Q

how does AZA work

A

guanine antimetabolite

21
Q

how does MMF work

A

non competitive inhibitor for IMPDH so prevents guanosine triphosphate synthesis

22
Q

how do calcineurin inhibitors work

A

interfere with signals after TCR activation
prevent stimulate of cytokine production (c for c)
reversible inhibition of T cell activation, proliferation, clonal expansion

23
Q

name 2 clacineurin inhibitors

A

CyA and Tacrolimus FK506

24
Q

name an M-TORi and describe how it works

A

sacrolimus (rapamicin) is a macrolide antibiotic that binds to FKBP12 (and others) and inhibits mammalian target of rampamicin –> inhibits response to Il-2 so cell cycle arrect at G1-S phase

25
name 2 IL-2 receptor MABs
basilixumab | daclizumab
26
name 3 types of immunopotentiation
immunisation immune stimulants replacement therapies
27
describe a replacement therapy
pooled human immunoglobulin (IV or SC)for antibody deficient states
28
name some immune stimulants
G-CSF/ GM-CSF to stimulate BM to produce more neutrophils IL2 T cell activation a-interferon Hep C treatment B-interferon MS y-interferon certain intracellular infections + CGD + IL-12 deficiency
29
what is passive immunisation
giving specific high titre antibody for immediate but transient protection animal sera and pooled human immunoglobulin
30
what are the uses of passive immunisation
VZV (pregnancy0 Hep B prohpylaxis and treatment snake bites botulism diptheria
31
what is active immunisation and what are the negatives
stimulate immune response and memory with antigenic material | problems are delay, allergy to vaccine component, limited use in immunocompromised
32
what is the target of methotrexate
folate synethesis (form of anti-metabolite)
33
what is the target of cyclophosphamide
cross links DNA (anti metabolite)
34
what is cyclophosphamide used for
vasculitis SLE
35
what is AZA used for
AI disease (IBD vasculitis SLE) allograft rejections
36
what is MTX used for
RA PSA polymyositis vasculitis | GvHD
37
what are the side effects of anti-metabolites
hepatitis gastric upset susceptibility to infections BM suppression
38
what is a side effect of MTX
pneumonitis
39
what is a side effect of cyclophosphamide
cystitis
40
what are the side effects of calcineurin and MTORi
``` multiple drug interactions lymphomas hepato-toxicity hirsutism nephrotoxicity neurotoxicity hypertension opportunistic infections ```
41
what is the clinical uses of calcineruin and MTORi
transplantation and allograft rejection AI disease
42
what are biologic DMARDs mainly used for
inflammatory conditions
43
what is anti-TNF used for and what is a side effect
RA inflammatory conditions e.g crohns psoriasis ank. spond. | risk of TB
44
what is anti-IL6 used for
RA and AOSD | problem = control of serum lipids
45
what is anti-IL1 used for
AOSD and autoinflammatory conditions