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PPP-3 > Immunosuppressants for Immuno exam > Flashcards

Immunosuppressants for Immuno exam Flashcards

1
Q

What are the three major indications for immunosuppressants?

A
  1. Organ Transplant Rejection
  2. Chronic inflammatory diseases
  3. Autoimmune diseases
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2
Q

What are the major adverse effects of immunosuppressants?

A

Increased risk for infections and malignancies

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3
Q

What is the MOA of prednisone?

A
  • Antinflammatory effects at lower doses: decrease synthesis of inflammatory mediators and decrease expression of adhesion molecules for extravasation
  • Anti-inflammatory +immunosuppress effects at higher doses: increase expression of proteins that promote apoptosis
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4
Q

What are the major indications of prednisone?

A
  • Inflammatory disorders like osteoarthritis
  • Systemic inflammatory autoimmune diseases like RA, SLE, IBD
  • Organ transplant rejection
  • GVHD prophylaxis following bone marrow transplant
  • T cell mediated hypersensitivities like poison oak and chronic asthma
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5
Q

What are side effects of prednisone?

A

Cushings syndrome and caution for adrenal suppression

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6
Q

Cyclosporine (TCR signaling inhibitors) MOA

A

Inhibit T cell intracellular signal 1 that is initiated by CD3 after TCR and co-receptor bind to p-MHC (signal 1) –> inhibits calcineurin which decreases T cell activation

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7
Q

Cyclosporine indications

A
  • Systemic autoimmune disease like RA
  • Organ transplant rejection prophylaxis
  • GVHD prophylaxis following bone marrow transplant
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8
Q

Cyclosporine specific AEs

A
  • Nephrotoxicity
  • Hypertension
  • Neurotoxicity
  • Electrolyte abnormalities
  • Gingival hyperplasia
  • Hirsutism
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9
Q

Belatacept MOA

A

CTLA-4 binds to B7 and prevents T-cell activation via CD28 via signal 2

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10
Q

Belatacept indication

A

Organ transplant rejection prophylaxis

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11
Q

Belatacept AEs

A

Typical class effect (increased risk of infections and malignancies) and could cause PTLD or post-transplant lymphoproliferative disorder

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12
Q

Natalizumab MOA

A

Blocks VLA-4 and prevents extravasation of effector T cells into inflamed tissue (brain in MS, joints in RA, colon in IBD)

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13
Q

Natalizumab indication

A

Autoimmune diseases like MS

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14
Q

Natalizumab adverse effects

A

Typical class effect (increased risk of infections and malignancies) and increased risk of PML or progressive multifocal leukoencephalopathy

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15
Q

Rituximab (Anti-CD20 mab) MOA

A

Binds CD20 on B cells then initiates complement or ADCC to kill B cells which decreases circulating B cells & decreases absorption that mediates part of the inflammatory process of disease –> also kills tumor B-cells as well as normal B cells

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16
Q

Indications for rituximab

A
  • Relapsing/remitting MS
  • Antibody-mediated systemic autoimmune complex diseases like RA and SLE
  • Non-Hodgkins B cell lymphoma
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17
Q

Rituximab AEs

A
  • Hepatitis B reactivation
  • Increased risk of progressive multifocal encephalopathy (PME)
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18
Q

Infliximab (Anti-TNF mab) MOA

A

Prevents TNF from activating its R and decreases inflammatory effects and innate response

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19
Q

Infliximab Indications

A
  • Some systemic autoimmune diseases like RA and IBD
  • Psoriatic arthritis
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20
Q

Infliximab AE

A

Increased risk of TB as well as other infections

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21
Q

T/F: Adalimumab is a mouse antibody

A

False, it is a TNF humanized antibody because it has the suffix mumab

22
Q

Cetuximab (anti-EGFR mAb) MOA

A

IgG binding to cell EGFR causes initiation of ADCC to allow NK cells to kill tumor cells –> also blocks EGFR signaling which impairs tumor growth and survival

23
Q

Cetuximab indications

A

Used in tumors that overexpress EGFR as a cancer driver mutation

24
Q

Cetuximab side effects

A

Rash and diarrhea

25
Q

Anakinra MOA

A

Prevents IL-1 receptor activation and decreases it

26
Q

Anakinra indication

A

Hereditary fever syndromes like FMF

27
Q

Anakinra AEs

A

Class effects only (increase risk of infections and malignancies)

28
Q

Tocilizumab MOA

A

Binds to IL-6 receptor and decreases it which leads to lower inflammation

29
Q

Tocilizumab indications

A

RA

30
Q

Tocilizumab AEs

A

Class effects (increased risk of infections and malignancy)

31
Q

Trastuzumab MOA

A

mAB to HER-2 and blocks HER-2 signaling (leads to impaired tumor cell growth/survival) and has IgG mAB bind to HER-2 (initiates ADCC to allow NK cells to kill tumor cells)

32
Q

Trastuzumab indications

A

Tumors overexpressing HER-2

33
Q

Anti-CTLA-4 mAB MOA

A

Prevents inhibition of clonal expansion of T cells and allows a stronger T cell response against cancer and other tissues

34
Q

Anti-CTLA-4 indications

A

Melanoma

35
Q

Anti-PD1 mAB MOA

A

Prevents the inhibitory signal and allows CD8 T cells to kill the cancer cells

36
Q

Anti-PD1 indications

A

Many solid and hematologic cancers like melanoma, colon cancer, lung cancer, lymphoma

37
Q

Anti-CTLA and anti-PD1 adverse effect

A

Excessive T cell mediated inflammation in various organs

38
Q

Albuterol (B2 agonist) MOA

A

Stimulates B cell receptors on airway SM and causes bronchodilation but less effective with chronic inflammation

39
Q

Albuterol indications

A

Acute allergic asthma

40
Q

Albuterol AEs

A
  • Tremor
  • CNS effects like anxiety
  • Increased HR
41
Q

Epinephrine (mixed a/B agonist) MOA

A
  • Stimulates B2 receptors on airway smooth muscle which causes bronchodilation
  • Stimulates a1 receptors on vascular SM which increases SVR and blood pressure
  • stimulates a1 receptors on ECs which reclose tight junctions and decrease edema
42
Q

Epinephrine indications

A

Anaphylaxis

43
Q

Epinephrine AEs

A

Increased HR and cardiac arrhythmias

44
Q

Omalizumab (anti-IgE mAB) MOA

A

Binds Fc of soluble IgE and decreases binding to FCE receptors on mast cell (early response) and eosinophils (delayed response)

45
Q

Omalizumab indications

A
  1. Moderate to severe allergic asthma
  2. Chronic idiopathic urticaria
46
Q

Chlorpheniramine (1st gen) and fexofenadine (2nd gen) ( both are H1-R antagonists) MOA

A

Blocks H1-R and decreases histamine mediated symptoms caused by HM release from mast cells

47
Q

H1-R antagonist indications

A

Allergic rhinitis and urticaria (poison ivy or oak)

48
Q

Mepolizumab (anti-IL-5 mAB) MOA

A

Binds IL-5 and decreases activation of its receptor which leads to decreased activation/recruitment of eosinophils

49
Q

Mepolizumab indications

A

Severe asthma and chronic allergic dermatitis

50
Q

Montelukast (LT R antagonist) MOA

A

Blocks CysLT receptors and decreases LT symptoms

51
Q

Montelukast indications

A

Allergic rhinitis and chronic asthma

PPP-3 (21 decks)

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