immunosuppressants Flashcards
do glucocorticoids have any effect on humoral immunity?
no, but they decr cytokines, lymphocytes, and T cell activation
do glucocorticoids have any effect on humoral immunity?
no, but they decr cytokines, lymphocytes, and T cell activation
which immunosuppressant is used for GVHD?
glucocorticoids, calcineurin inhibitors
what is recommended to block 1st dose cytokine storm in transplant recipeients after muromonab-CD3 admin?
glucocorticoids can be given prophylactically
what is an issue with rapid discontinuation of glucocorticoisd?
adrenal crisis
what glucocorticoid is the reference standard?
prednisone
low dose
> 7.5 mg, but
medium dose
> 30 mg, but
high dose
greater than 250 mg prednisone eq per day for 1 day or a few days
pulse therapy
> 250 mg prednisone eq per day for 1 day or a few days
pulse therapy
for what diseases does cyclosporine work after tx failure
- RA (after methorexate)
2. psoriasis (after failed tx)
what is recommended to block 1st dose cytokine storm in transplant recipeients after muromonab-CD3 admin?
glucocorticoids can be given prophylactically
grapefruit juice incr which drug concentrations?
cyclosporine + tacrolimus
AE: nephrotoxicity, HTN, DM, neurotoxicity?
cyclosporine + tacrolimus
less than 7.5 mg prednisone eq per day?
low dose
what anti-proliferative immunosuppr is a tx option for crohns disease?
aziothioprine or anti-TNFalpha reagents
what sort of tests need to be monitored with aziothioprine admin?
CBC & liver tests
AE: bone marrow suppression, incr susceptibility to viral infxns, incr risk of lymphoma
azathioprine
MOA: prodrug metabolized into NPA–>inhibs inosine monophosphate dehydrogenase req’d for de novo synthesis of guanine NT?
mycophenolate mofetil
does mycophenolate mofetil act in the stomach?
NO, not soluble in low pH
for what diseases does cyclosporine work after tx failure
- RA (after methorexate)
2. psoriasis (after failed tx)
major AE assc’d with cyclosporine?
nephrotoxicity
grapefruit juice incr which drug concentrations?
cyclosporine + tacrolimus
AE: nephrotoxicity, HTN, DM, neurotoxicity?
cyclosporine + tacrolimus
MOA: purine antimetabolite used to inhibit lymphocyte proliferation–>metabolized into 6 MP and integrated into DNA–>blocking lymphocyte proliferation
aziothioprine
which immunosuppr would you use for intense immunosuppression in the 1st days-weeks post transplant?
antithymocyte globulin
what dort of tests need to be monitored with aziothioprine admin?
CBC & liver tests
AE: bone marrow suppression, incr susceptibility to viral infxns, incr risk of lymphoma
azathioprine
wat can be used to reverse glucocorticoid resistant organ transplant rejection episodes?
muromonab-CD3
does mycophenolate mofetil act in the stomach?
NO, not soluble in low pH
AE: hematologic, GI, incr infxns with CMV, teratogenic
mycophenolate mofetil
contains the ligand-binding portion of a human TNF-α receptor fused to the Fc portion of human IgG1
Etanercept
what is the immunosuppressant that can ONLY be administereed orally?
sirolimus
MOA: blocks mTOR–>cannot remove inhibitory protein that normally initiates cell cycle proliferation–>cell cycle proliferation blocked
sirolimus
what is sirolimus used for?
prophylaxis of organ transplant rejection.
used in combo with glucocorticoids + calcineurin inhib
which immunosuppr would you use for intense immunosuppression in the 1st days-weeks post transplant?
antithymocyte globulin
MOA: bind CD and HLA 1/2–>complement mediated cytotox and inhib of lymphocyte fxn
antithymocyte globulin
MOA: mouse Ab directed at CD3
muromonab-CD3
wat can be used to reverse glucocorticoid resistant organ transplant rejection episodes?
muromonab-CD3
chimeric monoclonal antibody containing a human constant region and a murine variable region
Inflixamab
recombinant human IgG1 monoclonal
Adalimumab
contains the ligand-binding portion of a human TNF-α receptor fused to the Fc portion of human IgG1
Etanercept
how to inflixamab, Adalimumab, etanercept act?
prevent TNF-alpha from binding receptor
