Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles of Science BVetMed 3 > Immunomodulatory treatment > Flashcards

Immunomodulatory treatment Flashcards

You may prefer our related Brainscape-certified flashcards:
Biology 101 flashcards
1
Q

List tx options

A
  • corticosteroids (mainstay, various adjunctive tx may be helpful)
  • other immunosuppressive drugs (alkylating agents, antimetabolites, mitotic inhibitors - vinca alkaloids, calcineurine inhibitors, others)
  • novel agents offer more potent and targeted immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aim - tx

A
  • halting ongoing damage
  • satisfy nutrional and nursing requirements
  • non-specific immunosuppression is key
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are possible adjunctive therapies to corticosteroids?

A
  • diet
  • topical therapy and GIT barrier protection
  • splenectomy?
  • blood products and darbepoietin (synthetic erythropoeitin)
  • danazol? plasmapherisis?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is danazol?

A

drug which suppresses gonadotrophin production and has some weak androgenic effects

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

Indications - splenectomy

A
  • IMTP

- intractable haemolysis

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

Indications - topical therapy and GIT barrier protection

A
  • Topical: only if concurrent dz which increases tendency for ulcers to form - look out for GIT bleeding
  • GIT protection: usually for IMTP as ramifications bad if bleeding d/t ulcers occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is plasmapheresis?

A
  • filtering plasma using external filter

- for temporary/emergency control of intractable haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the important aspects of nursing care?

A
  • recumbency: urination, defecation, hygiene, gentle exercise
  • CS of clinical deterioration?
  • analgesia and general comfort
  • nutrition (naso-oesophageal, oesophageal, PEG tubes)
  • water access and ability to drink
  • IV catheter care, IVFT
  • procurement of diagnostic samples
  • client communication
  • TLC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Action - corticosteroids

A
  • associate with binding proteins (transcortin and albumin)
  • following dissociation from binding proteins, passively diffuse into cell
  • bind to a cytoplasmic receptor (>/3)
  • conformational change of receptor unmasks DNA binding domain; associates with GREs following nuclear translocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are GREs associated with?

A

= Growth Response Element

- associated with pro- and anti-inflammatory genes

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

What does fluorination of prednisone do?

A

increases GC and MC activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does addition of CH3 to prednisone to make it dexamethasone do?

A

abolishes MC activity so only left with GC activity

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

Is dexamethasone or prednisone most potent?

A

dexamethasone is 7-8 times more potent vs prednisone thus lower dose can last > 48 hours

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

Potential averse effects of corticosteroids

A
  • CNS
  • MSK
  • GIT
  • fluid, electrolyte balance
  • metabolic
  • endocrine
  • immune system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What stage of the cell cycle do vinca alkaloids target?

A

M phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which drugs target G1 of cell cycle?

A
  • calcineurin inhibitors

- leflunomide

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

Which drug targets cells b/w G1 and S phases?

A

rapamycin (but typically not used clinically)

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

Which drugs target the ‘S’ phase of the cell cycle?

A
  • corticosteroids
  • antimetabolites
  • Mycophenolate mofetil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Action - alkylating agents

A
  • alkylate DNA causing breaks in molecule and cross-linking of twin strands
  • inhibit protein synthesis in resting cells, prevent mitosis and kill dividing cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Examples - alkylating agents

A
  • cyclophosphamide, ifosfamide, chlorambucil
  • melphalan, mechlorethamine, nitrosoureas
  • procarbazine, dacarbazine
21
Q

Is cyclophosphamide or chlorambucil more frequently used as an alkylating agent in I-M dz?

A
  • CHLORAMBUCIL most commonly

- (cyclophosphaide not used for I-M dz but for shock chemo tx of lymphoma)

22
Q

Action - chlorambucil

A
  • rapidly metabolised to phenylacetic acid mustand
  • site of biotransformation poorly define
  • slowest acting, least toxic of all alkylating agents
  • myelosuppression (main side effect) generally not observed until administered for > 1mo
  • urinary and faecal excretion
  • administered without food
23
Q

Name 2 antimetabolites

A
  • AZATHIOPRINE

- (methotrexate)

24
Q

Action - azathioprine

A
  • greater decrease of cellular than humoral immunity
  • hepatic metabolism to active 6-mercaptopurine, then to 6-thioinosinic, 6-thioguanylic, thiouric acids
  • compete with endogenous adenine and guanine to form non-function nucleic acid strands
  • slow immunosuppressive effect? (at least 2 weeks, may be faster with steroids)
  • these side effects are relatively uncommon: haematological, GIT, hepatic +/- neuromuscular toxicity
  • CI in cats because narrow therapeutic window because cuases irreversible immunosuppression
25
Q

What are vinca alkaloids? Examples?

A
  • originally extracted from common periwinkle plant
  • vincristine and (vinblastine) are the most commobly used
  • difference is presence of a methyl (vinblastine) or formyl group (vincristine)
26
Q

Action - vinca alkaloids

A
  • bind to tubulin, block polymerisation, also break down pre-formed microtubules - increased release of PLTs from megakaryocytes
  • both vincristine and viblastine used in the tx of ITP (usually vincristine)
  • can be bolus IV or to pre-load PLTs
  • severe extra-vascular vesicants!
  • toxicity: haematological, GIT, neurologicall
27
Q

Potential averse effects of corticosteroids

A
  • CNS
  • MSK
  • GIT
  • fluid, electrolyte balance
  • metabolic
  • endocrine
  • immune system
28
Q

Name 2 calcineurin inhibitors

A
  • ciclosporin
  • tacrolimus
  • ACTION: target calcineurin which is a phosphatase enzyme
29
Q

Which drugs target G1 of cell cycle?

A
  • calcineurin inhibitors

- leflunomide

30
Q

Action and use - ciclosporin

A
  • IV and oral forms
  • large volume of distribution
  • primary hepatic metabolism
  • therapeutic drug monitoring
  • acute and chronic
  • ketoxonazole may be used to reduce costs
  • GIT, renal, hepatic toxicity, also hirsutism, gingival hyperplasia, papillomatosis, +/- diabetogenic (thus CI if DM).
31
Q

Which drugs target the ‘S’ phase of the cell cycle?

A
  • corticosteroids
  • antimetabolites
  • Mycophenolate mofetil
32
Q

Action - alkylating agents

A
  • alkylate DNA causing breaks in molecule and cross-linking of twin strands
  • inhibit protein synthesis in resting cells, prevent mitosis and kill dividing cells
33
Q

Examples - alkylating agents

A
  • cyclophosphamide, ifosfamide, chlorambucil
  • melphalan, mechlorethamine, nitrosoureas
  • procarbazine, dacarbazine
34
Q

Is cyclophosphamide or chlorambucil more frequently used as an alkylating agent in I-M dz?

A
  • CHLORAMBUCIL most commonly

- (cyclophosphaide not used for I-M dz but for shock chemo tx of lymphoma)

35
Q

Action - chlorambucil

A
  • rapidly metabolised to phenylacetic acid mustand
  • site of biotransformation poorly define
  • slowest acting, least toxic of all alkylating agents
  • myelosuppression (main side effect) generally not observed until administered for > 1mo
  • urinary and faecal excretion
  • administered without food
36
Q

Name 2 antimetabolites

A
  • AZATHIOPRINE

- (methotrexate)

37
Q

Action - azathioprine

A
  • greater decrease of cellular than humoral immunity
  • hepatic metabolism to active 6-mercaptopurine, then to 6-thioinosinic, 6-thioguanylic, thiouric acids
  • compete with endogenous adenine and guanine to form non-function nucleic acid strands
  • slow immunosuppressive effect? (at least 2 weeks, may be faster with steroids)
  • these side effects are relatively uncommon: haematological, GIT, hepatic +/- neuromuscular toxicity
  • CI in cats because narrow therapeutic window because cuases irreversible immunosuppression
38
Q

What are vinca alkaloids? Examples?

A
  • originally extracted from common periwinkle plant
  • vincristine and (vinblastine) are the most commobly used
  • difference is presence of a methyl (vinblastine) or formyl group (vincristine)
39
Q

What is vinorelbine?

A
  • semi-synthetic derivative of vinblastine

- can cause neutropaenia

40
Q

Name 2 calcineurin inhibitors

A
  • ciclosporin

- tacrolimus

41
Q

What is ciclosporin isolated from?

A

2 different fungal organisms

42
Q

Action and use - ciclosporin

A
  • IV and oral forms
  • large volume of distribution
  • primary hepatic metabolism
  • therapeutic drug monitoring
  • acute and chronic
  • ketoxonazole may be used to reduce costs
  • GIT, renal, hepatic toxicity, also hirsutism, gingival hyperplasia, papillomatosis, +/- diabetogenic (thus CI if DM).
43
Q

What is human IVIG?

A
  • polyspecific IgG derived from healthy donor plasma
  • primary use in human medicine is in tx of immunodeficiency
  • blockade of Fc R on mononuclear phagocytic cells accounts for rapid response
  • inhibits phagocytosis of Ab-coated RBCs
  • possible role in acute rx IMHA, immune-mediated non-regen anaemia, pure red cell aplasia, ITP, EM, TEN and SARDS
  • SIDE EFFECTS: thromboembolism, hypersensitivity possible
  • high cost, limited availability
44
Q

What is Mycophenolate mofetil?

A
  • increasingly common immunosuppressive drug

- antagonises the enzyme needed for BC and TC growth

45
Q

List guidelines for immunosuppressive tx

A
  • start with prednisone or prednisolone
  • cats tolerate better
  • max dose in dogs >30kg is 60-80mg/dog
  • caution if used in parallel with doxycyline for ricekettsial or protozoal infection.
  • caution if IMHA or aggressive I-M dz, consider adjunctive tx from outset: azathioprine in dogs or chlorambucil in cats
  • caution as rx of acquired MG represents special case
  • always consider co-morbidities
46
Q

What is response to immunosuppressive therapy is porr?

A
  • add adjunctive immuno-suppressants if not already being administered
  • caution if combination rx used from outset and still no response, consider additional measures (vincristine, hIVIG)
  • beware of occult infsn, neoplasia, iatrogenic cause
  • always consider supportive measures (FWB, PLT-rick plasma)
47
Q

How often should the CBC and UA be monitored?

A
  • q7-14 days
  • also examine urine sediment
    (+/- monitor synovial fluid with sterile technique)
48
Q

How should corticosteroid dose be tapered?

A
  • over 3-4mo following initial remission
  • 20-25% decrease in dose every 4-6 wks so long as clinical remission maintained
  • don’t alter adjunctive rx at same time unless essential (e.g. fulminant infxn)
  • if signs recur, return to previous dose: attempt reinduction of remission, taper more slowly next time
  • corticosteroid rx may be stopped completely if clinical remission persists
  • cautious tapering of additional agents over following 2-3 months
  • caution if several immunosuppressant used, taper one at a time and slowly
  • all rx may be stopped if long-term remission
  • TLC essential
49
Q

T/F: phenobarbital has a known I-M reaction sometimes

A

True

Principles of Science BVetMed 3 (110 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions