Immunotherapy

Question 1

Corticosteroids MOA

Answer 1

Inhibits T cell proliferations, cytokine response, decreases response to antibodies, decreases spleen size/content. Broad spectrum.

Question 2

Corticosteroid use

Answer 2

organ transplants, chronic immunosuppressant, prevent adverse reactions to drugs, topically.

Question 3

Corticosteroid toxicity

Answer 3

cushings syndrome, suppressed pituitary-hypothalamic axis, osteoporosis, ulcers, menstrual and reproductive issues.

Question 4

Cyclosporine MOA

Answer 4

Binds to cyclophilin to inhibit calcineurin/T-cell activation to decrease the formation of IL-2. Selective for T-lymphocytes.

Question 5

Cyclosporine characteristics

Answer 5

No bone marrow suppression, metabolized by CYP3A4 (drug interactions!)

Question 6

CYP3A4 Inducers

Answer 6

Phenobarbitol, phenytoin, Rifampin.

Question 7

CYP3A4 Inhibitors

Answer 7

Grape fruit juice, erythromycin, ketoconazole and verapamil.

Question 8

Cyclosporine uses

Answer 8

Prevents organ rejection (with corticosteroids or azathioprine), organ transplant maintenance, autoimmune diseases.

Question 9

Cyclosporine toxicity

Answer 9

nephrotoxic, gingival hyperplasia (need good oral hygeine, HTN, tremors, hirsutism, hyperlipidemia, hyperglycemia.

Question 10

Tacrolimus (FK506) MOA

Answer 10

Similar to cyclosporine but less toxic. Inhibits T cell activation and decreases IL2 and IL4. Narrow therapeutic range. Metabolized by CYP3A4.

Question 11

Tacrolimus (FK506) uses

Answer 11

Prevent rejection especially in liver and heart transplants.

Question 12

Tacrolimus (FK506) toxicity

Answer 12

nephrotoxic, HTN, hyperglycemia, HA, tremors, insomnia.

Question 13

Sirolimus MOA

Answer 13

Inhibits proliferation of T and B cells.

Question 14

Sirolimus uses

Answer 14

No renal toxicity so used in kidney transplants.

Question 15

Sirolimus toxicity

Answer 15

increased cholesterol and triglycerides.

Question 16

Pimecrolimus uses

Answer 16

Cream for atopic dermatitis that doesn’t cause skin atrophy.

Question 17

Mycophenolate-Mofetil MOA

Answer 17

Decreases DNA synthesis by inhibiting monophosphate dehydrogenase that only T and B cells need for purine synthesis.

Question 18

Mycophenolate-Mofetil Uses

Answer 18

Does NOT suppress bone marrow. Often combined with Tacrolimus to prevent transplant rejection.

Question 19

Mycophenolate-Mofetil toxicity

Answer 19

Rash, GI, very high risk of infections.

Question 20

Thalidomide MOA

Answer 20

blocks TNF alpha.

Question 21

Thalidomide uses

Answer 21

prevents graft versus host reaction

Question 22

Thalidomide toxicity

Answer 22

TERATOGENIC. Drowsiness and neutropenia.

Question 23

Azathioprine MOA

Answer 23

Prodrug that is converted into 6-mercaptopurine which inhibits purine synthesis.

Question 24

Azathioprine uses

Answer 24

Cancer (high doses), prevents rejection, glomerulonephritis in lupus, severe RA, dentists use in place of steroids.

Question 25

Azathioprine toxicity

Answer 25

Myelosuppression, hepatotoxicity, teratogenic, metabolized by xanthine oxidase (allopurinol).

Question 26

Cyclophosphamide MOA

Answer 26

Effects T and B cells. Blocks new antigens and can inhibit an established immune response (treat a rejection attack).

Question 27

Cyclophosphamide toxicity

Answer 27

hemorrhagic cystitis (treat with MESNA and hydration).

Question 28

Methotrexate MOA

Answer 28

Human dihydrofolate reductase inhibitor.

Question 29

Methotrexate uses

Answer 29

psoriasis, antineoplastic, severe RA and asthma.

Question 30

Methotrexate toxicity

Answer 30

hepatotoxicity and teratogenic.

Question 31

Daclizumab/Basiliximab MOA

Answer 31

Binds IL2 receptors on activated T cells to inhibit IL2 activation.

Question 32

Daclizumab/Basiliximab uses

Answer 32

great for kidney transplants. No side effects. No general immunosuppression.

Question 33

Bevacizumab/ranibizumab and Degaptanib/aflibercept MOA

Answer 33

Bind VEGF-A to inhibit angiogenesis. Used in macular degeneration.

Question 34

Interleukin 2 MOA

Answer 34

Immunomodulator that increases the proliferation and differentiation of helper T and cytotoxic T cells.

Question 35

Interleukin 2 Uses

Answer 35

renal cell carcinoma and malignant melanoma.

Question 36

Interleukin 2 toxicity

Answer 36

pulmonary edema, hypotension, hematological.

Question 37

Filgrastim (neupogen) MOA

Answer 37

granulocyte colony stimulation factor for severe neutropenia. Given as subcutaneous depot

Question 38

Filgrastim (neupogen) Toxicity

Answer 38

bone pain (making new marrow).

Question 39

Epoetin-alfa (procrit; epogen) MOV

Answer 39

EPO for severe anemia caused by zidovudine, interleukin, chemo or kindey disease. subcutaneaous depot.

Question 40

Epogen toxicity

Answer 40

HTN and thrombosis/stoke.

Question 41

Interferon alpha and beta

Answer 41

respond to viruses

Question 42

Interferon gamma

Answer 42

activates T lymphocytes and NK cells. Activates macrophages.

Question 43

interferon alfa-2b

Answer 43

Used with Hep C and uveitis

Question 44

Interferon beta-1B

Answer 44

multiple sclerosis.

Question 45

Glatiramer

Answer 45

Multiple sclerosis. acts as decoy. antibodies bind the drug instead of the nerves.

Question 46

Fingolimod

Answer 46

Multiple sclerosis. decreases lymphocytes to reduce the autoimmune response.

Question 47

Dimethyl fumarate

Answer 47

Multiple sclerosis. reduces inflammation.