Lecture 1 and 2: Immunopharmacology Flashcards
What are three possible long-term effects that are associated with corticosteroids (prednisone, methylprednisolone, dexamethasone)?
1) Iatrogenic Cushing’s Syndrome
2) Osteoporosis Infections
3) Ulcers
How do corticosteroids affect the concentration of neutrophils (PMN’s)?
How do corticosteroids affect the concentration of lymphocytes (T and B cells), monocytes, eosinophils, and basophils?
Corticosteroids
- Increase concentration of PMN’s
- Decrease concentration of lymphocytes (T and B cells), monocytes, eosinophils, and basophils in peripheral blood
How do corticosteroids affect the functions of leukocytes and tissue macrophages?
1) Reduce response to antigens and mitogens
2) Reduce production of IL-1, IL-2, and TNF-a
Corticosteroids inhibit which two enzymes?
PLA2 (inhibition results in lower prostaglandin and leukotriene synthesis)
and
COX-2 (inhibition results in lower prostaglandin formation)
How do corticosteroids affect vasoconstriction, complement effects, and antibody production?
Vasoconstriction: Increase, thereby reducing capillary permeability
Complement: Inhibit
Ab production: Reduce
True or False: The adverse effects associated with glucocorticoid therapy include: adrenal suppression, dyslipidemia, glucose intolerance, and increased bacterial and mycotic infections
True
Which four conditions can be treated with corticosteroids?
1) Allergic disorders
2) Hematological disorders
3) Hepatic and renal disorders
4) Collagen disorders
Which of the following corticosteroids are long-acting and can be administered orally, IV, or IM?
A. Prednisone
B. Dexamethasone
C. Methylprednisolone
B. Dexamethasone
Which four drugs are cytotoxic and anti-proliferative agents (T and B cells)?
1) Cyclophosphamide
2) Azathioprine
3) Methotrexate
4) Mycophenolate Mofetil
True or False: Methotrexate is nitrogen gas while Mycophenolate Mofetil is a purine analog
False - Cyclophosphamide is nitrogen gas while Azathioprine is a purine analog
Which four drugs are Signal 3 Inhibitors?
Cyclophosphamide
Mycophenolate Mofetil
Methotrexate
Azathioprine
Which of the following cytotoxic and anti-proliferative agents preferentially inhibits T cells over B cells?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
D. Azathioprine
Which of the following cytotoxic and anti-proliferative agents is used to treat cancers (malignant diseases) as well as RA and RA-like conditions?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
A. Cyclophosphamide
____ is a cell cycle-nonspecific alkylating agent that inhibits nucleotide synthesis while ____ is a cell cycle specific (s phase!) anti-metabolite that inhibits nucleotide synthesis
Cyclophosphamide ; Azathioprine
Which of the following requires metabolic activation by cytochrome P450, where it is activated to alkylating metabolites?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
A. Cyclophosphamide
True or False: Azathioprine inhibits adenosine deaminase, thereby inhibiting the production of adenosine MP
True
Which of the following can be used to treat RA, Renal Homotransplantation, or Chron’s Disease (low dose)?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
D. Azathioprine
True or False: Methotrexate can cause fetal harm, has a risk of carcinogenesis, and can temporarily decreased spermatogenesis (!!!)
False - Azathioprine
____ competitively inhibits dihydrofolic acid reductase, thereby interfering with DNA synthesis, repair, and cellular replication
Methotrexate
Delayed ___ ____ is one of the major factors responsible for toxicity of methotrexate
Delayed drug clearance
How can you decrease the potential for toxicity associated with methotrexate?
Leucovorin calcium
Alopecia is an AE associated with ____ use
Cyclophosphamide
True or False: Leukopenia and Thrombocytopenia are AE associated with Cyclophosphamide and Azathioprine
True
Which of the following is associated with hepato/nephrotoxicity, leukopenia, and COPD?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
B. Methotrexate
Black box warning: periodic monitoring of toxicity (including: CBC w/dif and platelet count) is associated with:
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine
B. Methotrexate
Which three conditions can be treated by Methotrexate?
Cancers (neoplasms)
Juvenile RA
Adult RA
What primary causes nephrotoxicity in methotrexate use?
Precipitation of methotrexate in the renal tubules
How does Cyclosporine inhibit Signal 1?
By inhibiting calcineurin phosphatases
Cyclosporine inhibits the release of IL__ and activation of ___ cells
IL-2; T cells
Cyclosporine suppresses some ___ immunity and, to a greater extent, _____ immune reactions
humoral immunity; cell-mediated
How does cyclosporine cause anti-inflammatory and immunosuppressive effects?
Reversibly inhibits immunocompetent lymphocytes in G0 or G1 phase of cell cycle
Cyclosporine preferentially inhibits which type of lymphocytes?
T Lymphocytes (T helper)
Which drug is metabolized by Cytochrome P450 3A?
Cyclosporine
Which of the following crosses the placenta and is embryo and fetotoxic?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Cyclosporine
D. Cyclosporine
Mouth sores and HTN are AE associated with ____
Cyclosporine
Mild or chronic nephrotoxicity, as well as chronic-progressive type, is associated with use of which drug?
Cyclosporine
note: renal biopsies reveal interstitial fibrosis and peritubular capillary congestion
What are three clinical uses for cyclosporine?
- Allogenic transplants (kidney, liver, heart)
- RA
- Psoriasis
Cyclosporine is ALWAYS to be taken in conjunction with ____. It has also been used in combination with ____ and ____.
adrenal corticosteroids;
azathioprine, corticosteroids
Mycophenolate Mofetil (MMF) is hydrolyzed to form ___, a potent and reversible inhibitor of ____, which inhibits the synthesis of _____
MPA (mycophenolic acid); IMP dehydrogenase; guanosine nucleotide synthesis
Which of the following drugs prolongs survival of allogenic transplants in animals and reverse ongoing acute rejection?
A. MMF
B. Cyclosporine
C. Azathioprine
D. Cyclophosphamide
A. MMF (Mycophenolate Mofetil)