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Clinical Pharmacology > Immunotherapeutics > Flashcards

Immunotherapeutics Flashcards

1
Q

what actions do corticosteroids have?

A

glucocorticoid and mineralocorticoid actions

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2
Q

how does the dose of dexamethasone compare to that of prednisone?

A

dex 7x pred

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3
Q

what is the anti-inflammatory dose of prednisone?

A

0.5-1 mg/kg

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4
Q

what is the physiologic dose of prednisone?

A

0.2 mg/kg

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5
Q

what is the mechanism of action of cyclosporin?

A

inhibits calcineurin which reduces cytokines needed for T cell function

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6
Q

what is bioavailability like of cyclosporin?

A

variable: need to do therapeutic drug monitoring for life-threatening states like transplantation

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7
Q

what is the mechanism of action of mycophenolate?

A

inhibits enzyme needed for purine synthesis

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8
Q

what is the mechanism of action of azathioprine?

A

antimetabolite purine antagonist

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9
Q

what are the adverse effects of chlorambucil?

A

myelosuppression
gastrointestinal upset

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10
Q

in whom is chlorambucil more commonly used in?

A

cats: blood disorders and IBD, small cell
dogs: PLE

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11
Q

what are the pros of using two drugs?

A

potentially more rapid/complete immunosuppression
may be able to taper steroid faster

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12
Q

what are the adverse effects of mycophenolate?

A

hemorrhagic diarrhea
anorexia

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13
Q

what drugs are often used as second drugs in dogs?

A

azathioprine
mycophenolate
cyclosporine

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14
Q

is there evidence to suggest that one drug is better for a second drug than others?

A

no

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15
Q

which drugs are used as second drugs in cats?

A

usually cyclosporine or chlorambucil

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16
Q

what second drug cannot be used in cats?

A

azathioprine

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17
Q

which second drug has the fastest speed of onset?

A

cyclosporine

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18
Q

how do the costs of cyclosporine, mycophenolate, and azathioprine compare?

A

cyclosporine»mycophenolate~azathioprine

19
Q

which second drug needs to be monitored with CBC and chem?

A

azathioprine
mycophenolate sometimes CBC

20
Q

how long are you treating with immunosuppressive tapering?

A

months

21
Q

do life-threatening diseases need longer treatment than non-life-threatening diseases?

A

not always

22
Q

how long does clinical remission of a systemic immune-mediated disease take?

A

usually 1-4 weeks

23
Q

if an animal is on two drugs, what do you taper first?

A

prednisone usually

24
Q

how do you taper?

A

~25% every 2-4 weeks

25
Q

how do you taper the second drug?

A

some taper following a similar schedule as for prednisone

26
Q

what should you check before commencing tapering and every time you reduce the dose?

A

parameter of interest: platelets, red blood cells

27
Q

what does the total treatment time depend on?

A

the disease

28
Q

what is the treatment time for many conditions?

A

4-8 months timeframe

29
Q

why should you not continue drugs at full doses forever without attempting a taper?

A

prednisone side effects can lead to euthanasia
excessive immunosuppression increases the risk for infections and malignancies

30
Q

which secondary agent is used in horses?

A

azathioprine mostly

31
Q

what is the immunosuppressive dose of pred?

A

2 mg/kg

32
Q

what are some side effects of glucocorticoids?

A

pu/pd
alopecia
thin skin

33
Q

what are the adverse effects of cyclosporin?

A

GI upset
gingival hyperplasia
weird infections

34
Q

what are the adverse effects of azathioprine?

A

hepatotoxicity
myelosuppression

35
Q

what are the adverse effects of mycophenolate?

A

hemorrhagic diarrhea
anorexia

36
Q

what makes using chlorambucil difficult?

A

expensive
need to compound
risks to household
must monitor CBC

37
Q

what are the cons of using two drugs?

A

increased cost
may need more monitoring
potential for side effects from second drug
may be more immunosuppressed than necessary
no proof superior response/outcome than just using pred

38
Q

what is usually prescribed for perianal fistulas?

A

calcineurin inhibitor

39
Q

how does GI tolerance compare for the three second drugs?

A

azathioprine>mycophenolate>cyclosporine

40
Q

how can you taper pred if a second drug is used in IMHA?

A

25-33% every 3 weeks or 25% every 2 weeks
can taper 25-50%

41
Q

what diseases are likely lifelong treatment?

A

atopic dermatitis
IBD

42
Q

how long should you treat IMHA?

A

glucocorticoid: 3-6 months
all immunosuppressive therapy: 4-8 months

43
Q

what should you do if there is a relapse?

A

confirm relapse
assess for trigger or missed diagnosis
add second drug if relapse was not during taper
if during taper: return to previous dose/effective dose
double time to initial taper and between subsequent tapers

44
Q

what secondary agents are used in equine?

A

azathioprine
cyclophosphamide
local cyclosporine

Clinical Pharmacology (19 decks)

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