immunosuppressant Flashcards
what are the Glucocorticoid effects
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)
what are the therapeutic uses of GLucocorticoid
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”
what is the increased risk for taking immunosuppressants
increase risk of infection, increases cancer risk of lymphoma and other malignancies
which drug causes Adrenal crisis up rapid discontinuation
Glucocorticoid
cyclosporine MOA
inhibit IL-2–> suppress T cell mediated immunity
cyclosporine adverse effects
Nephrotoxicity–renal dysfunction, neurotoxicity, Hirsutism
grapefruit juices increases which drugs blood concentration
cyclosporine, tacrolimus
what is cyclosporines therapeutic use? and what do we have to be cautious about when using it?
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)
which drug is mainly used for prophylaxis of allograft rejection in organ transplant
Tacrolimus
which drug inhibits lymphocyte proliferation by blocking purine synthesis
Azathioprine
Azathioprine tx
Prevent organ transplant rejection, severe cases of rheumatoid arthritis
Mycophenolate Mofetil MOA
MMF (prodrug) hydrolyzes to MPA (active)–> blocks lymphocyte proliferation
what is usually the combo therapy for prophylactic transplant rejection
MMF +glucocorticoid+ calcineurin inhibitor, to allow lower doses of calcineurin inhibitor, in order to lower tox
what do you have to be cautious for when taking Azathioprine
CBC and liver function test should be monitored
what is the off label drug that could be used to treat lupus
MMF
which drug is the mTOR inhibitor? what does that effect?
Sirolimus; inhibit lymphocyte cell prolliferation
which drug cause susceptibility to VZV and HSV
Azathioprine
which drug should be avoided forpregnancy
mycophenolate Mofetil
if calcineurin inhibitors cannot be tolerated for renal transplant, what is the new combo prophylactic therapy
sirlimus+MMF+ glucocorticoid
which drug protects kidney from nephrotoxic effects
sirolimus
which drugs inhibit lymphocyte proliferation
Azathioprine, Mycophenolate Mofetil. sirolimus
which group of drugs cause hematologic effects cause decrease in WBC, RBC, platelets
Anti-proliferative, antimetabolic agents: Azathioprine, MMF, Sirolimus
which drug kills or inactivates T lymphocytes
antithymocyte globulin, Muromonab CD3
Antithymocyte globulin
- Induction immunosuppression right after transplant
- prophylactic immunosuppression
- tx acute rejecton of organ tranplant–combo w/ other immunosuppressant
which drug can only be used once?
Muromonab-CD3
what reduces the “cytokine storm” produced by which agents?
Biological antibodies: Antithymocyte Globulin and Muromonab-CD3 induce “cytokine storm” which can be reduced combo w/ Glucocorticoid
which drug is used to reverse glucocorticoid resistant organ transplant rejection
Muromonab-CD3
what are the anti-TNF alpha agents? and what are their functions
Infliximab, Adlimumab, Etanercept: bind to TNF-alpha to prevent from binding to cytokine–>inhibit inflammation
Anti-TNF alpha agent therapeutic use
VERY effective with inflammatory disease: rheumatoid arthritis, crohns. DOes NOT cure cond’t, just treating symptoms
