immunosuppressive drugs

Question 1

How are glucocorticoids used in immunosuppressive cases?

Answer 1

decrease IgG and complement. Decreased lymphocyte and monocyte function. There is decreased ability of dendritic cells to present antigen and activate T cells.

Question 2

What is the immunosuppressive dose for glucocorticoids?

Answer 2

Dogs 2-4mg/kg/day Cats: 4-8mg/kg/day

Question 3

what is steroid tacyphylaxis?

Answer 3

Deminished response due to the drug dose used

Question 4

What is an indication for using cyclosporine in an immunosuppressive situation?

Answer 4

whole organ transplant

Question 5

what effect does cyclosporine have when used at an immunosuppressive dose?

Answer 5

T and B cell inhibition. reduced cytokine production.

Question 6

what is the immune suppressive dose for cyclosporine?

Answer 6

7-20mg/kg q12-24h

Question 7

What medication is a calcineurin inhibitor?

Answer 7

tacrolimus

Question 8

What enzyme is critical for the metabolism of Azathioprine in order to have maximal clinical benefit?

Answer 8

thiopurine-s-methyltransferase. If this enzyme is not present then there will be an acumulation of toxic metabolites.

Question 9

what is the mechanism of action for Oclicitinib

Answer 9

This is a JAK1 and JAK 3 inihbitor. It acts by inhibiting the production of inflammatory cytokines.

Question 10

What is the immunosuppressive does of azathioprine in dogs?

Answer 10

2mg/kg//day PO initially and then decreased to 0.5-1.0 mg/kg/day PQ q48hr

Question 11

what is the immunosuppressive dose of azathioprine in cats? Why is this smaller than the canine dose?

Answer 11

0.3mg/kg/day this is smaller due to the increased risk of neutropenia (@ dose of 1.1-2.2mg/kg/day)

Question 12

What is mycophenolate mofetil’s MOA?

Answer 12

this is a purine synthesis inhibitor. It is cleaved to the active metabolite: mycophenolic acid. This suppresses proliferation and decreases Ab synthesis by B-cells

Question 13

what condition is mycophenolate mofetil used for ?

Answer 13

commonly pemphigus foliaceus

Question 14

what is the dose of Mycophenolate mofetil for immunosuppression?

Answer 14

20-40mg/kg/day divided among 3 doses on an empty stomach

Question 15

What is the mode of action for Doxycycline?

Answer 15

This is a bacteriostatic antibiotic that inhibits 30S ribosomal unit. It suppresses leukocyte chemotaxis secondary to complement activation by antibody-antigen complexes and protease release from leukocytes. This is often combined with Niacinamide

Question 16

What is the immunosuppressive dose of doxycycline?

Answer 16

5mg/kg PO q12h

Question 17

What is Niacinamide?

Answer 17

Vitamin B3

Question 18

What is the MOA of Niacinamide?

Answer 18

immunomodulatory- blocks antigen IgE induced histamine release. This inhibits mast cell degranulation. this is synergistic with Doxycycline

Question 19

How does Chlorambucil work?

Answer 19

This inhibits DNA cross-linking, and induces apoptosis. This is an expensive medication and is not used as frequently anymore

Question 20

How are intravenous immunoglobulins used?

Answer 20

These may be used while your other immunosuppressive drugs kick in. This is basically a bandaid and buys you time.

This interferes with complement activation and cytokine network.

Question 21

what is a side effect we are most concerned about when administering intravenous immunoglobulins?

Answer 21

anaphylaxis with repeated injections

Question 22

What is the effect of Pentoxifylline?

Answer 22

Both rheologic and antiinflammatory (this increases the pliability of RBC and WBC and is used for vasculitis cases.

Phosphodiesterase 4 inhibitor