Immunopharmacology

Question 1

Prednisone

Answer 1

Corticosteroid —> General immunosuppression
Rapid anti-inflammatory effect, but takes time for immune suppression to develop
Can be used for organ transplant, long term immunosuppression, general things

Question 2

Adverse effects of corticosteroids

Answer 2

Short term: Hyperglycemia
Long term:
Weight gain
Cushing like syndrome
Pituitary-hypothalamic axis suppression
Osteoporosis

Question 3

T-cell suppressants

Answer 3

Relatively selective for T-lymphocytes, leaving rest of immune response intact (no bone marrow suppression)
Used to prevent organ rejection

Examples:
Calcineurin Inhibitors (Cyclosporine, Tacrolimus)
Proliferation Signal Inhibitors

Question 4

Cyclosporine

Answer 4

Calcineurin Inhibitor —> selective inhibition of T lymphocytes (IL-2)

NO bone marrow suppression - good for BM transplants

Drug interactions are common, and therapeutic range is narrow
• No grapefruit juice
• No rifampin
• No erythromycin, ketoconazole

Question 5

Cyclosporine toxicities

Answer 5

RENAL
Gingival hyperplasia
hypertension
CNS issues
Hyperglycemia

Question 6

Tacrolimus

Answer 6

Also a calcineurin inhibitor but a lot less toxic than cyclosporine
No bone marrow suppression

Widely used drug of choice for preventing organ rejection

Toxicities - nephro, HTN, hyperglycemia

Question 7

Sirolimus

Answer 7

Inhibits T-cell proliferation by binding to mTOR

NO renal toxicity —> great for kidney transplant anti rejection therapy

Question 8

Mycophenolate-Mofetil

Answer 8

Prevents de novo purine synthesis in T/B lymphocytes

Used for preventing rejection, in combo with tacrolimus and corticosteroids

Question 9

Azathioprine

Answer 9

Converted in Vito to 6-mercaptopurine (anticancer drug) —> inhibits purine synthesis

Do NOT combine with allopurinol

Used to prevent rejection in transplant patients

BM suppression and TERATOGENIC

Question 10

Methotrexate

Answer 10

Inhibitors purine biosynthesis

Significant side fx:
BM suppression
Stomatitis
Can produce fetal death — dont use in pregnancy

Question 11

Cyclophosphamide

Answer 11

Direct T and B cell effect
Prevents DNA crosslinks
Blocks response to new antigens and can inhibit established immune response

Used for BM transplants

GIVE WITH MESNA to prevent hemorrhagic cystitis

Question 12

Basiliximab

Answer 12

Binds to IL-2 receptor (CD25) on activated T cells

Used at time of transplant for induction of immunosuppression

Reduces renal rejection by 50%

Question 13

Examples of biological used to treat psoriasis and rheumatoid arthritis

Answer 13

Abatacept (Orencia)
Adalimumab (Humira)
Eat receipt (Enbrel)

Question 14

Hematopoietic stimulating drugs

Answer 14

G-CSF (Neupogen)
Erythropoietin (Epogen)

Essential to be able to maintain therapy that cause causes polycytopenias

Question 15

Neupogen

Answer 15

Human recombinant granulocytes colony stimulating factor

Used to treat severe neutropenia

Question 16

Epogen

Answer 16

Used to treat severe anemia because drives the production of RBCs

Question 17

Corticosteroids cause widespread _______________.

Answer 17

Immunosuppression

Question 18

T-cell suppressants used for ______________

Answer 18

Organ transplants

Useful because they don’t cause bone marrow suppression

Question 19

Cytotoxic drugs will cause _____________ and other side effects

Answer 19

Bone marrow suppression