Immunosuppresion and Chemo

Question 1

Name four NSAIDs

Answer 1

Carprofen
Flunixin
Meglumine
Phenylbutazone

Acronym: Nate-SAID Phenomenal Carl & Megan Flunked

Question 2

COX-2 inhibitors, analgesics, less potent than glucocorticoids for anti-inflammatory

Answer 2

NSAIDs

Question 3

Potent anti-inflammatory, generally avoided unless needed & used at lowest effective dose

Answer 3

Glucocorticoids

Question 4

Four types of cytokine inhibitors used for immunomodulatory therapy

Answer 4

1) Leukotriene inhibitors (zafirlukast/zileuton)
2) Janus kinase inhibitors (oclacitinib)
3) Histamine inhibitors (diphenhydramine)
4) MMP inhibitors (doxycycline)

Question 5

General immunomodulators (2 types) and uses

Answer 5

1) Tetracycline/Niacinamine –> immune dermatopathies

2) Metronidazole –> chronic inflammatory bowel disease

Question 6

2 other strategies of immunomodulatory therapy

Answer 6

1) desensitization therapy

2) block specific cytokines

Question 7

Prednisone:
(low/high) dose anti-inflammatories
(low/high) dose immunosuppression

Answer 7

LOW dose anti-infl

HIGH dose immunosuppression

Question 8

Targets (2) for immunosuppressive drug action

Answer 8

Antimetabolites

T-Cell Inhibitors

Question 9

__________ impair DNA synthesis particularly in rapidly dividing immune cells (lymphocyte) and can block signaling on T-cells

Answer 9

Antimetabolites

Question 10

Azathioprine (Imuran) info

Antimetabolite

Answer 10

• Oral medication (takes weeks for immunosuppression)

- Often started with pred for difficult immune disease

Question 11

Azathioprine is contraindicated in __(species)__ due to

Answer 11

cats; toxicity in liver/bone marrow

Question 12

Mycopenolate mofetil (cell cept) info

Antimetabolite

Answer 12

• Less commonly used
• Very expensive ($$$$)
• Given orally (or slow IV infusion)

Question 13

Leflunomide (Arava) info

Antimetabolite

Answer 13

• Administered orally
• Relatively few side effects
• Less expensive ($$)

Question 14

Two T-Cell inhibitors

Answer 14

Cyclosporine

Tracolimus topical

Question 15

Cyclosporine MoA

Answer 15

• Blocks cyclophilin/calcineurin which reduces T-cell activation and response
• Inhibits production of various cytokines to alter function of other WBCs (eosinophils, mast cells, etc)

Question 16

Clinical uses for Cyclosporine

Answer 16

• Topically on eye to tx KCS in dogs
• Systemically PO to tx perianal fistulas or as adjunct w/ glucocorticoids for other immune Dz
• FDA approved for dogs/cats for allergic/autoimmune dermatitis (atopica)

Question 17

Tracolimus topical info:

Answer 17

Topical used in management of dermatologic dz, perianal fistulas
Slightly different target than cyclosporine but essentially the same MoA

Question 18

Chemotherapy Drugs info

Answer 18

• More aggressive cellular inhibition

- Cancer chemotherapy drugs have more narrow therapeutic index than other drugs, may require special handling

Question 19

T/F: GI signs are most common adverse effect in chemotherapy

Answer 19

True, tx with antiemetics

Question 20

Chemo Bone Marrow Suppression/Immunosuppression

Answer 20

• CBC typically monitored for drugs that cause myelosuppression
• Neutropenia > thrombocytopenia > anemia
• “Nadir”- Lowest neutrophil count (Generally predictable based on drug used)

Question 21

Toxicity with Chemotherapy

Answer 21

• hemorrhagic cystitis with cyclophosphamide
• Cardiotoxicity with adriamycin
• Nephrotoxicity with platinum agents

Question 22

T/F: Cancer cells can develop resistance to chemo drugs

Answer 22

TRUE

Question 23

_____: Massive killing of cancer cells leading to severe systemic dz (DIC, Shock, etc)

Answer 23

Acute Tumor Lysis Syndrome

Question 24

How can you reduce resistance developing in cancer cell population and minimize toxicity?

Answer 24

Multi-Drug Chemotherapy

Question 25

Metronomic Chemotherapy PO

Answer 25

• More common, differ the traditional

- Lower doses over longer periods of time