Immunomodulatory Drugs

Question 1

Immune boosting methods

Answer 1

Vaccination
Replacement of missing components e.g transplantation of bone marrow
Immunoglobulin (subcutaneous or IV)
T cell infusion used in Ebv or CMV particularly
Cytokines infusion eg interferon alpha

Question 2

Interferon alpha uses

Answer 2

Hepatitis C
Hepatitis b
Kaposis hhv8

Question 3

Name 4 anti T cell monoclonal antibodies

Answer 3

BMAT

Baciliximab
Muromonab
Abatacept
Tocilizumab

Question 4

Name 3 anti proliferative agents

Answer 4

Cyclophosphamide
Mycophenylate
Azothioprine

Question 5

Name 3 immune boosting monoclonal antibodies

Answer 5

Ipilimumab
Pembrolizumab
Nivolumab

Question 6

What is the mode of action for ipilimumab

Answer 6

Antibody against CTLA4 blocking immune checkpoint.

Allows CD80 and CD86 to bind to CD28 and activate T cells.

Question 7

What is the mode of action for pembrolizumab

Answer 7

PD1 blockade.
Would otherwise be stimulated by Treg cells dampening down the immune response.
This allows activation of T cells more readily.

Question 8

Name a monoclonal antibody used for advanced melanoma. What are its side effects?

Answer 8

PD1 antibodies
Pembrolizumab
Nivolumab

Causes IBD and inflammatory joint disease

Question 9

1 use for interferon gamma

Answer 9

Chronic granulomatous disease

Question 10

Human immunoglobulin use

Answer 10

Hyper IGM (x linked)

Question 11

CorticoSteroid mode of action for immunosuppression 6 ways

Answer 11

Inhibit phospholipase a2 to reduce arachidonic acid and therefore prostaglandin production via cyclooxygenases

Also blocks transendothelial migration of phagocytes by reducing expression of adhesion molecules.
Causes a slightly raised neutrophil count

Inhibit release of proteolytic enzymes in phagocytes.

Lymphocytes remain in lymphoid tissue causing a lymphopenia

Blocks cytokines expression
Decreased antibody production

Promotes apoptosis

Question 12

Use and Side effects of cyclophosphamide

Answer 12

Anca associated vasculitis
Renal lupus

Bone marrow suppression
Hair loss and sterility
Haemorrhagic cystitis (acrolein)

Malignancy
Bladder blood (basal cell carcinomas) or non melanoma skin ca

PCP infection

Question 13

Azothioprine uses and mode of action

Answer 13

IBD
Lupus

Anti proliferative
Converted to 6 mercaptopurine which inhibits DNA synthesis by blocking purine synthesis.

Acts primarily on T cells by inhibiting activation and replication

Question 14

Mycophenolate mofetil mode of action

Answer 14

Blocks de novo synthesis of nucleotides and prevents T cell replication (more than B cell)

Used in transplantation
Autoimmune disease and vasculitis.

Question 15

Side effects of Azothioprine

Answer 15

1 in 300 people are susceptible to bone marrow suppression due to Azothioprine build up with a lack of metabolism. This is due to genetic polymorphisms in thiopurine methyltransferase

Must check tpmt activity

Infection

Question 16

Side effects of mycophenylate mofetil

Answer 16

Progressive multifocal leukoencephalopathy. Due to JC virus reactivation.

Bone marrow suppression. Infection

Question 17

Uses for plasmapheresis

Answer 17

Severe Anti GBM
Severe acute myasthenia Gravis
Severe vascular rejection

(Mostly type 2 mediated hypersensitivity)

Question 18

Name 4 cell signalling inhibitors

Answer 18

Cyclosporin
Tacrolimus
Apremilast
Tofacitinib

Question 19

Tofacitinib use and mechanism

Answer 19

RA

Question 20

Apremilast use and mechanism

Answer 20

Psoriasis and psoriatic arthritis

PDE4 inhibitor