Immunosuppression

Question 1

Indications of immunosupressions

Answer 1

1. Autoimmune diseases:
   - Lupus, pemphigus complex
   - IHA (immune haemolytic anemia)
   - KCS
2. Hypersensitivity diseases:
   - Atopic dermatitis
   - Asthma
   - IBD (Inflammatory bowel disease)

3.Transplantation

Question 2

What are the three main groups we split immunosupressions into?

Answer 2

Antimetabolites, alkylating agents, glucocorticoids and cytokine gene expression inhibition

Question 3

Name the drugs that are antimetabolites

Answer 3

Purine-analogues 
1.azathioprine
2.mycophenolate-mofetil,
Pyrimidine-analogues :(leflunomide)
Folic acid antagonists :
1.methotrexate

Question 4

Name the drugs that are alkylating drugs

Answer 4

Cyclophosphamide

Question 5

Name the drugs that are cytokine gene expression inhibitors:

Answer 5

Calcineurin-inhibitors

cyclosporine, tracrolimus, pimecrolimus

Question 6

Describe the purine-analogues drugs:

Answer 6

inhibition or DNA-damage
effect to cell division
1. Prodrug (mercaptopurine)
IV or oral 
Slow release longer effect
Application: Autoimmune diseases
2.Prodrug, decreases GMP
-Especially specific to T and B lymphocytes, much safer, but rarely used.

Question 7

Describe the folic acid antagonists

Answer 7

1.Dihydrofolate reductase inhibitors

Apoptosis of activated T cells

Question 8

Describe the alkylating agents

Answer 8

Nitrogen mustard, DNA-alkylating
B and T cells equally affected
GI, BM side effects, whiskers
\+ haemorrhagic cystitis  furosemide
Mostly per os  antineoplastic, autoimmune disorder

Question 9

Describe cyclosporing and its side-effects

Answer 9

• Very common, it is used per os and locally.
• Auto-immune-disease
• Atopic dermatitis
• IBD

Side effects:

• HO (kidney,liver)
• GI: vomiting,diarrhea
• Alopecia
• Gingival hyperplasia

Question 10

Describe Tacrolimus,pimecrolimus:

Answer 10

• More active than cyclosporin, but toxicity is increased.

- Topical application for atopic dermatitis (lupus)