immunosupression - session 3/4

Question 1

What is the target of Cyclosporine? (B cells or T cells)

Answer 1

T cells

Question 2

What are adverse effects of Vincristine?

Answer 2

peripheral neuropathy
severe ileus
thrombocytosis (useful in ITP)
lymphoma & TVT
Vessicant

Question 3

What chemo drugs are vessicants?

Answer 3

Doxyrubicin & Vincristine

Question 4

What drug causes ileus?

Answer 4

Vincristine

Question 5

What is the mechanism of action of cyclophosphamide?

Answer 5

DNA alkylating agent

Question 6

What is the MOA of azothioprine?

Answer 6

purine (nucleic acid) synthesis inhibitors

Question 7

What is the MOA of the Chlorambucil?

Answer 7

DNA alkylating agent

Question 8

What is the role of DNA alkylating agents?

Answer 8

Chemo: Inhibit DNA replication

Question 9

What part of the cell cycle does vincristine affect?

Answer 9

Microtubule inhibitor - affects mitosis

Question 10

What is the MOA of mycophenolate?

Answer 10

Purine (nucleic acid) synthesis inhibitor

Question 11

What is the MOA of Leflunamide?

Answer 11

pyrimidine (nucleic acid) synthesis inhibitor

Question 12

What drug class is Cisplatin?

Answer 12

Platinum Analog

Question 13

Why is Cisplatin contraindicated in cats?

Answer 13

fatal pulmonary edema (SPLAT CATS)

Question 14

What is Mitoxantrone used for?

Answer 14

AGASACA

Question 15

Some drugs that may not be excreted from cells normally due to a mutation in the MDR protein. This can lead to an increased side effect profile in these patients. Should these patients be given a higher or lower dose than normal?

Answer 15

Reduced dose

Question 16

Chemo drugs target rapidly dividing cells. Name 3 common side effects of chemo.

Answer 16

Alopecia
GI toxicity
Hematopoetic toxicity

Question 17

Name 4 adverse effects associated with Cyclosporine

Answer 17

vomiting/diarrhea
gingival hyperplasia
inc susceptibility to other infections

Question 18

Adverse effect of Doxorubicin in humans and dogs affect what system?

Answer 18

Cardiotoxic

Question 19

A metabolite of Cyclophosphamide can accumulate in which organ and cause what symptom?

Answer 19

Bladder

Sterile hemorrhage cystitis

Question 20

What is an AE of CCNU (Lomustine)?

Answer 20

hepatotoxicity

Question 21

What is the mechanism of action of CCNU (Lomustine)?

Answer 21

DNA Alkylating Agent

Question 22

Which species have reduced ability to bioactivate prednisone, and thus should be prescribed prednisolone?

Answer 22

Cats and horses

Question 23

What toxicity is caused by Vincristine?

Answer 23

Neurotoxicity

Question 24

Which chemotherapy agent can be used to increase circulating platelet count?

Answer 24

Vincristine

Question 25

What are first line immunosupressive agents?

Answer 25

Glucocorticoids

Question 26

Why is it critical to taper long term immunosupressive doses to the lowest effective dose?

Answer 26

To minimize adverse effects. Short-term adverse effects must be tolerated initially to achieve disease remission.

Question 27

What is the use of mycophenolate?

Answer 27

Immunosupressive

Question 28

Is Azothioprine an immunosupressive or chemo agent?

Answer 28

Immunosupressive

Question 29

What are the most appropriate second-line immunosuppressive medications to consider in cats?

Answer 29

Chlorambucil or cyclosporine

Question 30

What are acceptable second-line immunosuppressive medications in dogs?

Answer 30

azathioprine, cyclosporine, and mycophenolate

Question 31

Dexamethasone is more/less potent when compared to Prednisone?

Answer 31

More (8x)

Question 32

Dexamethasone has a longer/shorter half life then prednisone?

Answer 32

Longer, not good for chronic use

Question 33

Which of the following immunosuppressive drugs causes gastrointestinal toxicity in up to 67% of patients?

Answer 33

Mycophenolate

Question 34

Which immunosuppressive drugs is used to treat atopic dermatitis in cats and dogs and perianal fistulas in dogs in addition to treating a variety of other immune-mediated diseases?

Answer 34

cyclosporine

Question 35

True or false: Topical otic preparations deliver high concentrations of antimicrobials to the ear canal

Answer 35

Topical otic medications deliver high concentrations of antimicrobials and glucocorticoids to the ear canal, so culture and susceptibility, which provides information about achievable serum levels of antimicrobials, is not typically needed for treatment of acute otitis

Question 36

Is C&S typically needed for treatment of acute otitis?

Answer 36

No

Question 37

best technique for direction of the otoscope

Answer 37

ventral, rostral, medial

Question 38

What drug will work the fastest to control the immune mediated thrombocytopenia and should be started immediately?

Answer 38

glucocorticoids as the first line of therapy for immune mediated disorders

• rapid onset of action
• broad immune-suppressive effects
• low risk of immediate toxicity
• low cost

Question 39

In addition to immunosuppressive therapy, what other medication is commonly recommended to start while pending serology for infectious causes of ITP?

Answer 39

concurrent treatment with doxycycline is often initiated with immunosuppressive drugs.” If the ITP is potentially secondary and caused by a tick-borne infection, doxycycline is needed to treat the underlying infection