immunosuppressant

Question 1

what are the Glucocorticoid effects

Answer 1

Rapid decrease in peripheral blood lymphocytes

Downregulate pro-inflammatory cytokines

Inhibit IL-2 production by T Cells

Reduce neutrophil and lysosomes

little effeect on humoral immunity (Bcells/anitbody production)

Question 2

what are the therapeutic uses of GLucocorticoid

Answer 2

PREVENTand TREAT transplant rejection in combo with other immunosuppressive agents.

Tx GVHD in bone marrow transplant

tx: a whole variety of autoimmune disorders: rheumatoid arthritis, lupus–all dealing with inflammatory or autoimmune disease

blocks “cytokine storm”

Question 3

what is the increased risk for taking immunosuppressants

Answer 3

increase risk of infection, increases cancer risk of lymphoma and other malignancies

Question 4

which drug causes Adrenal crisis up rapid discontinuation

Answer 4

Glucocorticoid

Question 5

cyclosporine MOA

Answer 5

inhibit IL-2–> suppress T cell mediated immunity

Question 6

cyclosporine adverse effects

Answer 6

Nephrotoxicity–renal dysfunction, neurotoxicity, Hirsutism

Question 7

grapefruit juices increases which drugs blood concentration

Answer 7

cyclosporine, tacrolimus

Question 8

what is cyclosporines therapeutic use? and what do we have to be cautious about when using it?

Answer 8

Prophylaxis for rejection of organ transplant–do NOT give BEFORE renal transplant due to nephrotoxicity

• rheumatoid arthritis that has not responded to methotrexate
• Tx GVHD
• Psoriasis (if other tx failed)

Question 9

which drug is mainly used for prophylaxis of allograft rejection in organ transplant

Answer 9

Tacrolimus

Question 10

which drug inhibits lymphocyte proliferation by blocking purine synthesis

Answer 10

Azathioprine

Question 11

Azathioprine tx

Answer 11

Prevent organ transplant rejection, severe cases of rheumatoid arthritis

Question 12

Mycophenolate Mofetil MOA

Answer 12

MMF (prodrug) hydrolyzes to MPA (active)–> blocks lymphocyte proliferation

Question 13

what is usually the combo therapy for prophylactic transplant rejection

Answer 13

MMF +glucocorticoid+ calcineurin inhibitor, to allow lower doses of calcineurin inhibitor, in order to lower tox

Question 14

what do you have to be cautious for when taking Azathioprine

Answer 14

CBC and liver function test should be monitored

Question 15

what is the off label drug that could be used to treat lupus

Answer 15

MMF

Question 16

which drug is the mTOR inhibitor? what does that effect?

Answer 16

Sirolimus; inhibit lymphocyte cell prolliferation

Question 17

which drug cause susceptibility to VZV and HSV

Answer 17

Azathioprine

Question 18

which drug should be avoided forpregnancy

Answer 18

mycophenolate Mofetil

Question 19

if calcineurin inhibitors cannot be tolerated for renal transplant, what is the new combo prophylactic therapy

Answer 19

sirlimus+MMF+ glucocorticoid

Question 20

which drug protects kidney from nephrotoxic effects

Answer 20

sirolimus

Question 21

which drugs inhibit lymphocyte proliferation

Answer 21

Azathioprine, Mycophenolate Mofetil. sirolimus

Question 22

which group of drugs cause hematologic effects cause decrease in WBC, RBC, platelets

Answer 22

Anti-proliferative, antimetabolic agents: Azathioprine, MMF, Sirolimus

Question 23

which drug kills or inactivates T lymphocytes

Answer 23

antithymocyte globulin, Muromonab CD3

Question 24

Antithymocyte globulin

Answer 24

• Induction immunosuppression right after transplant
• prophylactic immunosuppression
• tx acute rejecton of organ tranplant–combo w/ other immunosuppressant

Question 25

which drug can only be used once?

Answer 25

Muromonab-CD3

Question 26

what reduces the “cytokine storm” produced by which agents?

Answer 26

Biological antibodies: Antithymocyte Globulin and Muromonab-CD3 induce “cytokine storm” which can be reduced combo w/ Glucocorticoid

Question 27

which drug is used to reverse glucocorticoid resistant organ transplant rejection

Answer 27

Muromonab-CD3

Question 28

what are the anti-TNF alpha agents? and what are their functions

Answer 28

Infliximab, Adlimumab, Etanercept: bind to TNF-alpha to prevent from binding to cytokine–>inhibit inflammation

Question 29

Anti-TNF alpha agent therapeutic use

Answer 29

VERY effective with inflammatory disease: rheumatoid arthritis, crohns. DOes NOT cure cond’t, just treating symptoms