Immunopharmacology Flashcards
What are the four possible mechanisms by which immunosuppressants work?
- General immunosuppression
- Suppress T cells
- Inhibit proliferation of B AND T cells
- Apoptosis of T cells
What is the one drug that works by general immunosuppression as an immunosuppressant?
Prednisone (Corticosteroids)
What are the three primary toxicities associated with Prednisone (Corticosteroids)?
- Hyperglycemia (“steroid diabetes”)
- Cushing’s-like syndrome
- Weight gain
What is the primary goal of T cell Suppressors as immunosuppressants?
Prevent organ transplant rejection
What is an important characteristic of all T cell Suppressors as immunosuppressants?
NO bone marrow suppression
What specific type of inhibitor are Cyclosporine and Tacrolimus?
Calcineurin inhibitors (think MOA)
What are the three primary toxicities associated with Cyclosporine?
- NEPHROTOXICITY
- Drug interactions
- Gingival hyperplasia
What are the four primary toxicities associated with Tacrolimus?
- Nephrotoxicity
- HTN
- Hyperglycemia
- Tremors/HA/insomnia
What is the DOC to prevent organ transplant rejection?
Tacrolimus
What is the MOA of Sirolimus?
What is it used to treat (aka what lecture is it from)?
Bind to mTOR → T cell cycle stops and no B cell proliferation
Immunosuppression
What is the advantage of using Sirolimus over Cyclosporine or Tacrolimus?
NO nephrotoxicity
- Good for kidney transplant
What is the one drug that works by inhibition of B cell AND T cell proliferation as an immunosuppressant?
Mycophenolate-Mofetil
What is the MOA of Mycophenolate-Mofetil?
What is it used to treat (aka what lecture is it from)?
Inhibit purine synthesis → No DNA → No B/T proliferation
Immunosuppression
When is the use of Mycophenolate-Mofetil contraindicated?
What is it used to treat (aka what lecture is it from)?
Pregnancy
Immunosuppression
What three drugs work by apoptosis of T cells as an immunosuppressant?
- Azathriopine
- Methotrexate
- Cyclophosphamide
What is the MOA of Azathriopine?
Inhibits purine synthesis → No DNA → Apoptosis
What is the MOA of Methotrexate?
Inhibits DHF → No DNA → Apoptosis
What is the MOA of Cyclophosphamide?
Alkylating agent inactivates DNA
What is the primary toxicity associated with Azathriopine?
Bone marrow suppression
What should ALWAYS be ruled out with Azathriopine?
Use of Allopurinol
- If used, combination can be potentially fatal
What are the two primary toxicities associated with Methotrexate as an immunosuppressant?
What is its other use?
- Bone marrow suppression
- Stomatitis
Also a cancer drug
What is the primary toxicity associated with Cyclophosphamide? How can this be prevented (2)?
Hemorrhage cystitis
- Prevent with MESNA and hydration
What is the primary goal of monoclonal antibodies as immunosuppressant biologics?
Used to induce pre-organ transplant suppression
What is the MOA of Basiliximab (Simulect)?
Binds IL-2 receptors on T cells
What is the primary purpose of Basiliximab (Simulect) as a immunosuppressant biologic specifically?
Reduce renal rejection
What is the MOA of both Adalimumab (Humira) and Etanercept (Enbrel)?
Target TNF-alpha
What is the MOA of Abatacept (Orencia)?
Competes with CD28 for CD80/86 → inhibits T cell activation
What is the purpose of adding Neupogen or Epogen to a medication regimen?
Allows patients to continue with chemotherapy or immunotherapy
- Neupogen: treats neutropenia
- Epogen: treats anemia
