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Joshua's Drugs > Immunomodulatory Drugs > Flashcards

Immunomodulatory Drugs Flashcards

1
Q

Immune boosting methods

A

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

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2
Q

Interferon alpha uses

A

Hepatitis C
Hepatitis b
Kaposis hhv8

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3
Q

Name 4 anti T cell monoclonal antibodies

A

BMAT

Baciliximab
Muromonab
Abatacept
Tocilizumab

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4
Q

Name 3 anti proliferative agents

A

Cyclophosphamide
Mycophenylate
Azothioprine

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5
Q

Name 3 immune boosting monoclonal antibodies

A

Ipilimumab
Pembrolizumab
Nivolumab

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6
Q

What is the mode of action for ipilimumab

A

Antibody against CTLA4 blocking immune checkpoint.

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

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7
Q

What is the mode of action for pembrolizumab

A

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

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8
Q

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

A

PD1 antibodies
Pembrolizumab
Nivolumab

Causes IBD and inflammatory joint disease

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9
Q

1 use for interferon gamma

A

Chronic granulomatous disease

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10
Q

Human immunoglobulin use

A

Hyper IGM (x linked)

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11
Q

CorticoSteroid mode of action for immunosuppression 6 ways

A

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

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12
Q

Use and Side effects of cyclophosphamide

A

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

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13
Q

Azothioprine uses and mode of action

A

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

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14
Q

Mycophenolate mofetil mode of action

A

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

Used in transplantation
Autoimmune disease and vasculitis.

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15
Q

Side effects of Azothioprine

A

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

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16
Q

Side effects of mycophenylate mofetil

A

Progressive multifocal leukoencephalopathy. Due to JC virus reactivation.
CMV Reactivation
Bone marrow suppression. Infection

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17
Q

Uses for plasmapheresis

A

Severe Anti GBM
Severe acute myasthenia Gravis
Severe vascular rejection

(Mostly type 2 mediated hypersensitivity)

18
Q

Name 4 cell signalling inhibitors

A

Cyclosporin
Tacrolimus
Apremilast
Tofacitinib

19
Q

Tofacitinib use and mechanism

A

RA

JAK inhibitor

20
Q

Apremilast use and mechanism

A

Psoriasis and psoriatic arthritis

PDE4 inhibitor

21
Q

Cyclosporine side effects

A 
Hypertension
Gum hypertrophy and hirsuitism
Nephrotoxicity.
Neurotoxicity
Diabetogenic

Low doses can be used in pregnancy eg lupus
Psoriasis

22
Q

Cyclosporin and tacrolimus mode of action.

A

Calcineurin

IL2 production inhibited preventing activation and proliferation of T cells.

23
Q

Tacrolimus side effects

A

Diabetogenic
Hypertension
Nephrotoxic
Neurotoxic

24
Q

Rabbit anti thymocyte globulin

A

Human thymocyte placed into rabbit

Antibodies formed in serum against human T cells.

Can cause leukopenia and transfusion reactions and infection
Malignancy

25
Q

Baciliximab

A

Used to prevent graft rejection

Cd25 blocker. Blocking IL2 activation and proliferation of T cells.

26
Q

Abatercept

A

Ctla4 with IG. Blocks cd80 and cd86
Cannot activate cd28 or ctla4 and therefore doesn’t activate T cells

Works in RA

27
Q

Rituximab

A

Cd20 antibody. Binds to mature B cells but leaves plasma cells so have protective immunity still.

Used in lymphoma, rheumatoid, lupus. 2 doses per year

SE
Progressive multifocal leukoencephalopathy
Infusion reactions
Worsens CVD

28
Q

Natalizumab

A

Alpha 4 integrin

Bonds to VCAM1 and MadCAM1 to prevent rolling and transendothelial migration of leukocyte so.

Highly active relapsing remitting MS
Every4 weeks IV

PML
infusion reactions

29
Q

Efalizumab

A

Cd11a to inhibit T cell migration
Was used for psoriasis
Withdrawn due to PML

30
Q

Tocilizumab

A

IL6recepter monoclonal antibody
Can bind to soluble or anchored form in gp130

Reduces macrophage, T cell, B cell, neutrophil activation. V potent.

Rheumatoid arthritis
Castlemans (lymphoproliferative disorder)

Can cause severe depression resulting in infections

31
Q

Tocilizumab Indications

A

RA

32
Q

Name 5 anti TNF alpha drugs

A

CAGI E

certolizumab
Adalimumab
Golimumab
Infliximab

Ertanercept

33
Q

Uses of anti TNF alpha

A 
RA
Ank spond
Psorriasis
Psoriatic arthritis
IBD

IV or subcutaneous (except infliximab)

34
Q

Side effects of anti TNF alpha

A 
Injection site reactions
TB AND HEPATITIS
Lupus like skin
Demyelination
Skin malignancy
35
Q

What is etanercept not useful in

A

IBD

36
Q

What is ustekinumab

A

Binds to p40 subunit of il12/23

Inadvertently stops activation of th17 and therefore il17 expression.

Used in psoriasis and psoriatic arthritis

Subcut every 12 weeks

37
Q

What is secukinumab

A

Il17 family (alpha) mab

Used in psoriasis and psoriatic arthritis.
Also for use in ankylosis get spondylitis

38
Q

What is denosumab

A

RANK-L mab

Second line treatment in osteoporosis
After alendronate

Inhibits rank mediated osteoclast differentiation and function

39
Q

Chronic infection is a problem with biologics. Which infections are they t risk of

A

TB
HEP B (check core antibody)
hepc

40
Q

Risk of Immunosuppression

A

Lymphoma
Skin cancer
Autoimmunity

41
Q

side effects of methotrexate?

A

pulmonary fibrosis, pneumonitis and liver cirrhosis

42
Q

muromonab

A

CD3 blocker

for active rejection which is corticosteroid resistant

Joshua's Drugs (6 decks)

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