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Immunology II > Immunosuppressants/Immunomodulators > Flashcards

Immunosuppressants/Immunomodulators Flashcards

1
Q

immunosuppressants

A
  • drugs that increase the risk of infection
  • broad targets/effects
  • old drugs
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2
Q

immunomodulators

A
  • drugs that do not increase the risk of infection
  • narrow targets/effects
  • new drugs
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3
Q

What are eicosanoids?

A

a diverse family of signaling molecules derived from fatty acids, synthesized by most cells and act as local vasodilators

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4
Q

three steps of the inflammatory response that immunosuppressants/immunomodulators can affect

A
  1. eicosanoid production inhibitors
  2. inflammatory cytokine production inhibitors
  3. leukocyte activation proliferation inhibitors
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5
Q

Three examples of eicosanoids

A
  1. prostaglandin E2
  2. thromboxane A2
  3. Leukotriene E4
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6
Q

prostaglandin E2 are produced by

A

most cells

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7
Q

thromboxane A2 are produced by

A

platelets

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8
Q

leukotriene E4 are produced by

A

leukocytes

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9
Q

cyclooxygenases (COX1 and COX2)

A

arachidonic acid –> prostanoids

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10
Q

NSAIDS

A

COX inhibitors

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11
Q

COX-1

A
  • constitutively expressed
  • Homeostatic effect; on renal homeostasis, GI mucosal protection, and platelet function
  • toxic effects
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12
Q

COX-2

A
  • induced and contributes to the inflammatory response

- therapeutic effect

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13
Q

COX inhibitors (NSAIDS) vary/do not vary in their selectivity for COX1 vs COX2

A

vary

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14
Q

COX 1 selective NSAIDS are less/more toxic than COX 2 selective NSAIDS

A

more

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15
Q

NSAID toxicities

A
  1. gastric damage (bleeding, ulcers)

2. inhibition of platelet activation and clotting

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16
Q

NSAIDs that inhibit PGES

A

inhibit mucous layer formation that protects stomach

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17
Q

NSAIDS that inhibit thromboxane A2

A

inhibits platelet activation and clotting

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18
Q

T/F Aspirin is not the only NSAID that reversibly inhibits COX1/2 through covalent modification

A

false

it is the only NSAID that irreversibly inhibits

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19
Q

the acetyl/salicylate portion of acetylsalicylate irreversibly inactivates COX1?

A

acetyl

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20
Q

the salicylate molecule from acetylcalicylate has what other effects

A

anti-inflammatory

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21
Q

Aspirin approved uses

A
  • ischemic condtions
  • pain
  • inflammation ex. RA- rheumatoid arthritis
    OA- osteoarthritis
  • fever ex. rheumatic fever
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22
Q

Off-label use for aspirin

A
  1. kawasaki disease
  2. pre-eclampsia
  3. prevention of colorectal cancer
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23
Q

kawasaki disease

A

immune disorder of unknown etiology

characteristics: conjunctivitis, swollen lymph nodes, swollen hands and feet, changes in oral mucosa, rash

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24
Q

to diagnosis kawasaki disease

A

4 out of 5 characteristics plus fever

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25
Q

standard of treatment for kawasaki disease

A

aspirin + IV immunoglobulin

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26
Q

pre-eclampsia

A

hypertension associated with pregnancy affecting 2-8 % of pregnancies worldwide

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27
Q

expression of PGE2 can/cannot lead to colon cancer

A

can

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28
Q

Aspirin toxicity examples

A
  1. reyes syndrome

2. aspirin sensitive asthma

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29
Q

Reye’s syndrome

A

affects children treated with aspirin for a viral infection

-20-40% mortality, long term neurological effects for many survivors

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30
Q

arachidonic acid —– (enzyme?) —> prostanoids

A

cyclooxygenases

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31
Q

arachidonic acid —– (enzyme?) —> leukotrienes

A

lipoxygenases

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32
Q

aspirin sensitive asthma proposed mechanism

A

aspirin blocks COX so there is a shift where arachidonic acid forms increased number of leukotrienes via lipoxygenases that lead to broncho-constriction

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33
Q

acute aspirin toxicities

A

respiratory depression, CNS depression, sweating, dehydration, electrolyte imbalance, vasodilation, hypotenstion, coma, death
* tend to only occur in children

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34
Q

chronic aspirin toxicities

A

nausea/vomiting, headache, tinnitus, hyperglycemia, delirium

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35
Q

pediatrics OD

A

> 150 mg /kg

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36
Q

kaopectate, peptobismol, alka seltzer, bengay, and goodys

A

contain aspirin

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37
Q

most frequently used NSAID

A

ibuprofen

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38
Q

Ibuprofen vx. naproxen

A

ibuprofen has a longer half life (12-17 hours compared to 2-4 hours) therefore two dose/day compared to the four doses per day required by ibuprofen

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39
Q

ibuprofen and naproxen have high/low Vd

A

low because they bind proteins in the plasma

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40
Q

ibuprofen is nonselective/selective for COX1 and COX2

A

nonselective

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41
Q

celecoxib and rofecoxib are nonselective/selective for COX1 and COX2

A

selective for cox-2

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42
Q

aspirin is nonselective/selective for COX1 and COX2

A

nonselective

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43
Q

naproxen is nonselective/selective for COX1 and COX2

A

nonselective

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44
Q

COX 2 inhibitor advantage is _____ and disadvantage is _____

A

fewer GI toxicities

increased CV toxicities

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45
Q

celebrex class name

A

celecoxib

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46
Q

rofecoxib trade name

A

vioxx

47
Q

rofecoxib also inhibits the synthesis of ____ which is anti-clotting

A

PG12 prostacyclin

48
Q

prostacyclins

A

PG12

49
Q

prostaglandins

A

PGD2, PGE2, PGF2a

50
Q

thromboxanes

A

TXA2 and TXB2

51
Q

leukotriene inhibitors

A

inhibit the synthesis and activation of leukotrienes

52
Q

leukotriene inhibitor indications

A

asthma

53
Q

zileuton

A

inhibits synthesis of leukotrienes by inhibiting lipoxygenase

54
Q

montelukast

A

inhibits function of leukotrienes by being a LT antagonists

55
Q

corticosteroids (CSs) can inhibit all/some of the eicosanoids

A

all

56
Q

all corticosteroids are derived from

A

cortisol- stress hormone

57
Q

Mechanism of action for corticosteroids

A

alter transcription of genes in target cells

58
Q

steroid hormones are hydrophobic/hydrophilic

A

hydrophobic- therefore pass through the plasma membrane to reach their target receptors in the cytoplasm which are then relocated into the nucleus

59
Q

CSs inhibit/induce the expression of pro-inflammatory proteins

A

inhibit

60
Q

CSs inhibit/induce the expression of anti-inflammatory proteins

A

induce

61
Q

other name for lipocortin

A

annexin 1

62
Q

lipocortin/annexin 1 is an anti-inflammatory/pro-inflammatory

A

anti-inflammatory

63
Q

TNF alpha is an anti-inflammatory/pro-inflammatory

A

pro-inflammatory

64
Q

CSs inhibit/induce the expression of lipocortin/annexin 1 and inhibit/induce the expression of TNF alpha

A

induce; inhibit

65
Q

lipocortin inhibit

A

phospholipase A2
the enzyme that catalyzes
cell membrane phospholipids —> arachidonic acid

66
Q

corticosteroid toxicities

A
  1. immunosuppression

2. Hypercortisolism

67
Q

hypercortisolism

A

cushing syndrome

  • weight gain
  • moon face
  • buffalo hump
  • skin- thinning and fragility
  • vascular- new or worsened blood pressure
  • bones- increased risk of fractures
68
Q

moon face and buffalo hump

A

related to redistribution of fat due to high corticosteroid levels

69
Q

osteocalcin is decreased/increased during hypercortisolism leading to ______

A

decreased; weakens bones

70
Q

keratin is decreased/increased during hypercortisolism leading to ______

A

decreased; weakens skin

71
Q

calcineurin inhibitors

A

inhibit T-cell activation by blocking t cell receptor signaling through calcineurin

72
Q

calcineurin toxicities

A

malignancies; Non-Hodgkin’s lymphoma is the most common

73
Q

corticosteroids can also decrease/increase the transcription of numerous cytokine genes

A

decrease

74
Q

tofacitinib

A

jak/stat inhibitors

75
Q

jak/stat inhibitors

A

inhibit signaling through the IL-2 receptor therefore inhibit cytokine production t-cell activation and proliferation

76
Q

cytokine antibodies

A

inhibit cytokine function by directly binding to the cytokine so that it cannot bind receptor

77
Q

cytokine antibodies that inhibit TNF

A
  1. adalimumab
  2. infliximab
  3. etanercept
78
Q

cytokine antibody that inhibit IL-5

A

mepolizumab

79
Q

cytokine antibody that inhibits IL-6

A

tocilizumab

80
Q

antibody drugs are large proteins therefore must be administered ____ or ______

A

IV or IM

81
Q

anti-IL-5 mepolizumab

A

indicated for eosinophilic asthma

82
Q

inhibitors of leukocytes proliferation and activation

A

DNA synthesis inhibitors

  1. methotrexate
  2. azathioprine
  3. mycophenolate
83
Q

methotrexate

A

inhibits DHFR and therefore the production of tetrahydrofolic acid (folate); inhibits purine production

84
Q

azathioprine

A

inhibits purine synthesis and aberrant nucleotide that incorporates into DNA as tdGTP

85
Q

toxicities of azathioprine

A

mutagenicity
acute myeloid leukemia and lung adenocarcinoma
(occcurs if daughter t-cell has survived with tdGTP)

86
Q

mycophenolate

A

inhibits inosine monophosphate dehydrogenase; therefore inhibiting GTP production

87
Q 
DNA synthesis inhibitors 
1. methotrexate 
2. azathioprine 
3. mycophenolate 
toxicities
A

d/x pregnancy category; embryo-toxic and fetal toxicity

methotrexate = category X

88
Q

sirolimus

A

mTOR inhibitor- which in inhibits IL-2 production and therefore activation and proliferation of T-cells

89
Q

anakinra

A

IL-1 receptor in various cells

cytokine receptor antibody; inhibitor of leukocyte proliferation /activation by binding to cytokine receptor

90
Q

basilixumab

A

IL-2 receptors on T cells

cytokine receptor antibody; inhibitor of leukocyte proliferation /activation by binding to cytokine receptor

91
Q

benralizumab

A

IL-5 receptors on eosinophils

cytokine receptor antibody; inhibitor of leukocyte proliferation /activation by binding to cytokine receptor

92
Q

omalizumab

A

IgE on B cells

cytokine receptor antibody; inhibitor of leukocyte proliferation /activation by binding to cytokine receptor

93
Q

rituximab

A

CD20 on b-cells

cytokine receptor antibody; inhibitor of leukocyte proliferation /activation by binding to cytokine receptor

94
Q

cytokine antibodies and cytokine receptor antibodies have mechanisms of action outside/inside the cell

A

outside

95
Q

leukotrienes either block the synthesis of LOX or the activity of leukotrienes. they are indicated primarily for ______ due to the localized LT receptors in the bronchiole of smooth muscle

A

asthma

96
Q

calcineurin examples

A

cyclosporin

tacrolimus

97
Q

prastanoids

A

prostaglandins
prostacyclins
thromboxanes

98
Q

Tofacitinib inhibits the inflammatory response by doing which of the following?

A) Inhibiting COX2, but not COX1
B) Increasing the expression of annexin 1 in target cells
C) Blocking an intermediate in the IL-2 intracellular signaling pathway
D) Inhibiting mTOR
E) Binding to the IL-2 receptor on T-cells
A

C) Blocking an intermediate in the IL-2 intracellular signaling pathway

99
Q

2) In treating eosinophilic asthma, which of the following would probably have effects that most closely match those of benralizumab?

	A) Omalizumab
	B) Mepolizumab
	C) Tocilizumab
	D) Infliximab
	E) Tocilizumab
A

B) Mepolizumab

100
Q

3) Which of the following NSAIDs is LEAST likely to cause gastric damage with long-term use?

	A) Celecoxib
	B) Ibuprofen
	C) Naproxen
	D) Ketorolac
	E) Indomethacin
A

A) Celecoxib

101
Q

4) Which of the following targets a molecule found on the surface of an immune cell?

	A) Etanercept
	B) Cyclosporin
	C) Dexamethasone
	D) Montelukast
	E) Rituximab
A

E) Rituximab

102
Q

5) Where are you most likely to find the molecular target of montelukast?

	A) Mast cells 
	B) Bronchiole smooth muscle cells
	C) T-helper cells
	D) B-cells
	E) Eosinophils
A

B) Bronchiole smooth muscle cells

103
Q

Which of the following drugs carries a warning of increased risk of non-Hodgkin’s lymphoma?

	A) Azathioprine
	B) Tacrolimus
	C) Tofacitinib
	D) Methotrexate
	E) Adalimubmab
A

B) Tacrolimus

104
Q

7) In which cell type would you expect to find the primary molecular target of cyclosporin?

	A) Mast cell
	B) Antigen-presenting cell
	C) B-cell
	D) T-cell
	E) Eosinophil
A

D) T-cell

105
Q

8) The enzyme dihydrofolate reductase (DHFR) is the molecular target of which anti-inflammatory drug?

	A) Methotrexate
	B) Sirolimus
	C) Dexamethasone
	D) Zileuton
	E) Azathioprine
A

A) Methotrexate

106
Q

9) Which drug has the widest range of clinical anti-inflammatory applications?

	A) Celecoxib
	B) Hydrocortisone
	C) Adalimumab
	D) Sirolimus
	E) Ibuprofen
A

B) Hydrocortisone

107
Q

10) Which drug is most likely to be used to prevent rejection following a kidney transplant?

	A) Mepolizumab
	B) Indomethacin
	C) Methotrexate
	D) Cyclosporin
	E) Tocilizumab
A

D) Cyclosporin

108
Q

11) Which drug induces the expression of the protein, lipocortin/annexin 1, as part of its mechanism of action?

A) Celecoxib
	B) Hydrocortisone
	C) Adalimumab
	D) Sirolimus
	E) Ibuprofen
A

B) Hydrocortisone

109
Q

stages of reyes syndrome

A 
toxicity of aspirin in children after viral infection 
stage I- fever and liver dysfunction 
stage II- lethargic 
stage III- light coma 
stage IV- deep coma 
stage V- seizures
110
Q

kawaskis disease 5 symptoms and criteria

A

4 of 5 symptoms + fever (5 days of fever)
1. enlarged lymph nodes
2. rash
3. oral mucosa- cracked lips , red, cracked tongue
4. conjunctivae- red
5. swelling of hands and feet
extreme irritability

111
Q

kawaskis disease leads to what risk if not treated

A

vasculitis and coronary artery

112
Q

treatment for kawaskis

A

treatment with IVIg and aspirin

113
Q

The patient was admitted overnight due to signs and symptoms consistent with an aspirin overdose. How would this child have presented?

A
  • acute poisoning
    respiratory depression, respiratory acidosis, CNS depression, sweating, dehydration, electrolyte imbalance, vasodilation, coma, death
  • chronic poisoning
    nausea, vomiting, headache, tinnitus, hyperglycemia
  • hidden salicylates
114
Q

The parents of the next febrile child on rounds only want to use herbal medications to treat inflammation. How do you respond to this request?

A

just tell me and make sure they do not have drug interactions

Immunology II (11 decks)

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