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0. Clinical Pharmacology > Immunomodulatory Drugs > Flashcards

Immunomodulatory Drugs Flashcards

1
Q

What are the 3 main types of immunomodulatory drugs?

A

Glucocorticoids
Anti-TNF agents
Immunosuppressant drugs

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2
Q

List the 3 ways of administering steroids.

Give 3 examples of each.

A

ORAL:
Prednisolone
Hydrocortisone
Dexamethasone

TOPICAL:
Hydrocortisone
Betamethasone
Clobetasone

IV:
Methylprednisolone
Hydrocortisone
Triamcinolone

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3
Q

Describe the mechanism of action of glucocorticoids. (3)

A
  1. Bind to glucocorticoid receptors
  2. This causes upregulation of anti-inflammatory mediators and downregulation of pro-inflammatory mediators
  3. This causes immunosuppression
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4
Q

List 4 indications for glucocorticoids.

A

Replacement therapy in adrenal insufficiency
Post-transplant immunosuppression
Exacerbations of inflammatory conditions (e.g. eczema, RA, IBD, MS)
Acute asthma

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5
Q

Describe the side effects of glucocorticoids. (11)

A 
Sleep disturbance
Mood disturbance
Hyperglycaemia
Immunodeficiency
Easy bruising
Moon face
Increased abdominal fat
Glaucoma
Striae
Hypertension
Gastric irritation
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6
Q

Describe the important pharmacokinetics/dynamics of glucocorticoids. (2)

What would you tell the patients when prescribing steroids?

A

PHARMA:
Drugs have different levels of glucocorticoid/mineralocorticoid activity

PATIENT INFO:
Avoid alcohol/caffeine
Take with food
Don't stop abruptly
Always tell doctors
Carry steroid card
Sick day rules
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7
Q

Which glucocorticoids also have some/potent mineralocorticoid activity? (2)

Which glucocorticoids have no/minimal mineralocorticoid activity? (3)

A

SOME/POTENT:
Hydrocortisone
Fludrocortisone

NO/MINIMAL:
Prednisolone
Betamethasone
Dexamethasone

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8
Q

Give 3 examples of anti-TNF drugs.

What sort of drug is each of these?

A

Etanercept (receptor fusion protein)
Infliximab (monoclonal antibody)
Adalimumab (monoclonal antibody)

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9
Q

Describe the mechanism of action of anti-TNF agents. (2)

A
  1. Block interaction of TNF alpha and TNF beta with TNF cell receptors
  2. TNF alpha/beta usually stimulate cytokines, esp. IL1, IL8 and IL16
    a. Therefore inhibition reduces inflammation
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10
Q

List 4 indications for anti-TNF agents.

A

RA
Psoriatic arthritis
Ankylosing spondylitis
Juvenile arthritis

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11
Q

List 3 side effects of anti-TNF agents.

A

Injection site reactions
Flu-like symptoms
Immunodeficiency (esp. risk of legionella, listeria and reactivation of TB)

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12
Q

Describe the important pharmacokinetics/dynamics of anti-TNF agents. (1)

What would you tell the patient when prescribing them? (2)

A

PHARMA:
Administration: subcut injection

PATIENT INFO:
Maintain good hygiene
Report symptoms of infection early

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13
Q

Give 3 examples of immunosuppressant drugs.

A

Methotrexate
Azathioprine
Mercaptopurine

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14
Q

Describe the mechanism of action of immunosuppressant drugs. Specifically:

a) Methotrexate (2)
b) Azathioprine (1)

A

GENERAL:
1. Disrupt DNA synthesis

METHOTREXATE:

  1. Inhibits dihydrofolate reductase, which metabolises folic acid
  2. This disrupts DNA production

AZATHIOPRINE:

  1. Blocks purine synthesis (mainly in lymphocytes)
    a. Therefore disrupts DNA synthesis
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15
Q

List 4 indications for immunosuppressant drugs.

A

Post-transplant immunosuppression
IBD
Renal vasculitis
Paediatric leukaemia

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16
Q

List 8 side effects of immunosuppressant drugs.

A 
Bone marrow suppression (leukopenia)
Risk of infection
Nephrotoxicity
Hepatotoxicity
Seizures
GI upset
Mucosal ulceration
Alopecia
17
Q

Describe the important pharmacokinetics/dynamics of immunosuppressant drugs. (4)

A

Do NOT cross the BBB
Hepatic metabolism
Oral absorption is dose dependent
Patients with low levels of thiopurine methyltransferase are more prone to bone marrow suppression

18
Q

What would you tell the patient when prescribing immunosuppressant drugs? (2)

A

Limit caffeine intake

Take without regard to meals

0. Clinical Pharmacology (14 decks)

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