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Pharmacology > Lecture 1 and 2: Immunopharmacology > Flashcards

Lecture 1 and 2: Immunopharmacology Flashcards

1
Q

What are three possible long-term effects that are associated with corticosteroids (prednisone, methylprednisolone, dexamethasone)?

A

1) Iatrogenic Cushing’s Syndrome
2) Osteoporosis Infections
3) Ulcers

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2
Q

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?

A

Corticosteroids
- Increase concentration of PMN’s

  • Decrease concentration of lymphocytes (T and B cells), monocytes, eosinophils, and basophils in peripheral blood
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3
Q

How do corticosteroids affect the functions of leukocytes and tissue macrophages?

A

1) Reduce response to antigens and mitogens
2) Reduce production of IL-1, IL-2, and TNF-a

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4
Q

Corticosteroids inhibit which two enzymes?

A

PLA2 (inhibition results in lower prostaglandin and leukotriene synthesis)

and

COX-2 (inhibition results in lower prostaglandin formation)

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5
Q

How do corticosteroids affect vasoconstriction, complement effects, and antibody production?

A

Vasoconstriction: Increase, thereby reducing capillary permeability

Complement: Inhibit

Ab production: Reduce

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6
Q

True or False: The adverse effects associated with glucocorticoid therapy include: adrenal suppression, dyslipidemia, glucose intolerance, and increased bacterial and mycotic infections

A

True

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7
Q

Which four conditions can be treated with corticosteroids?

A

1) Allergic disorders
2) Hematological disorders
3) Hepatic and renal disorders
4) Collagen disorders

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8
Q

Which of the following corticosteroids are long-acting and can be administered orally, IV, or IM?
A. Prednisone
B. Dexamethasone
C. Methylprednisolone

A

B. Dexamethasone

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9
Q

Which four drugs are cytotoxic and anti-proliferative agents (T and B cells)?

A

1) Cyclophosphamide
2) Azathioprine
3) Methotrexate
4) Mycophenolate Mofetil

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10
Q

True or False: Methotrexate is nitrogen gas while Mycophenolate Mofetil is a purine analog

A

False - Cyclophosphamide is nitrogen gas while Azathioprine is a purine analog

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11
Q

Which four drugs are Signal 3 Inhibitors?

A

Cyclophosphamide
Mycophenolate Mofetil
Methotrexate
Azathioprine

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12
Q

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

A

D. Azathioprine

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13
Q

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

A. Cyclophosphamide

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14
Q

____ 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

A

Cyclophosphamide ; Azathioprine

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15
Q

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

A. Cyclophosphamide

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16
Q

True or False: Azathioprine inhibits adenosine deaminase, thereby inhibiting the production of adenosine MP

A

True

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17
Q

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

A

D. Azathioprine

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18
Q

True or False: Methotrexate can cause fetal harm, has a risk of carcinogenesis, and can temporarily decreased spermatogenesis (!!!)

A

False - Azathioprine

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19
Q

____ competitively inhibits dihydrofolic acid reductase, thereby interfering with DNA synthesis, repair, and cellular replication

A

Methotrexate

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20
Q

Delayed ___ ____ is one of the major factors responsible for toxicity of methotrexate

A

Delayed drug clearance

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21
Q

How can you decrease the potential for toxicity associated with methotrexate?

A

Leucovorin calcium

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22
Q

Alopecia is an AE associated with ____ use

A

Cyclophosphamide

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23
Q

True or False: Leukopenia and Thrombocytopenia are AE associated with Cyclophosphamide and Azathioprine

A

True

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24
Q

Which of the following is associated with hepato/nephrotoxicity, leukopenia, and COPD?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Azathioprine

A

B. Methotrexate

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25
Q

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

A

B. Methotrexate

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26
Q

Which three conditions can be treated by Methotrexate?

A

Cancers (neoplasms)
Juvenile RA
Adult RA

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27
Q

What primary causes nephrotoxicity in methotrexate use?

A

Precipitation of methotrexate in the renal tubules

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28
Q

How does Cyclosporine inhibit Signal 1?

A

By inhibiting calcineurin phosphatases

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29
Q

Cyclosporine inhibits the release of IL__ and activation of ___ cells

A

IL-2; T cells

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30
Q

Cyclosporine suppresses some ___ immunity and, to a greater extent, _____ immune reactions

A

humoral immunity; cell-mediated

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31
Q

How does cyclosporine cause anti-inflammatory and immunosuppressive effects?

A

Reversibly inhibits immunocompetent lymphocytes in G0 or G1 phase of cell cycle

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32
Q

Cyclosporine preferentially inhibits which type of lymphocytes?

A

T Lymphocytes (T helper)

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33
Q

Which drug is metabolized by Cytochrome P450 3A?

A

Cyclosporine

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34
Q

Which of the following crosses the placenta and is embryo and fetotoxic?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Cyclosporine

A

D. Cyclosporine

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35
Q

Mouth sores and HTN are AE associated with ____

A

Cyclosporine

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36
Q

Mild or chronic nephrotoxicity, as well as chronic-progressive type, is associated with use of which drug?

A

Cyclosporine

note: renal biopsies reveal interstitial fibrosis and peritubular capillary congestion

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37
Q

What are three clinical uses for cyclosporine?

A
  1. Allogenic transplants (kidney, liver, heart)
  2. RA
  3. Psoriasis
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38
Q

Cyclosporine is ALWAYS to be taken in conjunction with ____. It has also been used in combination with ____ and ____.

A

adrenal corticosteroids;
azathioprine, corticosteroids

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39
Q

Mycophenolate Mofetil (MMF) is hydrolyzed to form ___, a potent and reversible inhibitor of ____, which inhibits the synthesis of _____

A

MPA (mycophenolic acid); IMP dehydrogenase; guanosine nucleotide synthesis

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40
Q

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

A. MMF (Mycophenolate Mofetil)

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41
Q

True or False: MPA has potent cytostatic effects on lymphocytes. In particular, it inhibits proliferative responses of T and B lymphocytes.

42
Q

Which of the following suppresses antibody formation by B-Lymphocytes and prevents glycosylation of lymphocyte and monocyte glycoproteins involved in intracellular adhesion?
A. Cyclophosphamide
B. Methotrexate
C. Mycophenolate Mofetil
D. Cyclosporine

A

C. Mycophenolate Mofetil

43
Q

Black box warning for development of lymphoma and embryo-fetal toxicity is associated with which drug?

A

Mycophenolate Mofetil (MMF)

44
Q

Infections such as endocarditis, Tb, meningitis, and those of the myobacterial sort are AE associated with _____

45
Q

True or False: Sepsis, infections, vomiting, diarrhea, and leukopenia are the principal AE associated with Mycophenolate

46
Q

Bone marrow suppression is associated with all of the cytotoxic and anti-proliferative agents except ____

47
Q

Which three drugs are T cell suppressants?

A

Cyclosporine
MMF
Lymphocyte Immune Globulin

48
Q

Which three drugs are Ab Immunosppressives?

A

1) Rh Immune Globulin
2) Bevacizumab
3) Ranibizumab

49
Q

______ is a lymphocyte immune globulin that is obtained from serum Ig of horses immunized from lymphocytes from human thymus tissues
A. Ranibizumab
B. Bevacizumab
C. Rh Immune Globulin
D. Lymphocyte Immune Globulin

A

D. Lymphocyte Immune Globulin

50
Q

True or False: Lymphocyte Immune Globulin is associated with Signal 3

A

False - Signal 1

51
Q

______ reduces the number of thymus-dependent lymphocytes (T-cells) in the blood, as well as thymus-dependent areas of the spleen and lymph nodes

A

Lymphocyte Immune Globulin

52
Q

Fevers, chills, vertigo, as well as systemic infections are associated with use of ___. Therefore, as a precaution, a skin test for sensitivity for equine serum should be done prior to first infusion.

A

Lymphocyte Immune Globulin

53
Q

True or False: Lymphocyte Immune Globulin does not have any adverse effects on the fetus

A

False - Lymphocyte Immune Globulin DOES have an adverse effects on the fetus

54
Q

True or False: Lymphocyte Immune Globulin can be used to minimize allograft rejection in RENAL transplant patients

55
Q

Lymphocyte Immune Globulin is used in combination with ___ and ____

A

antimetabolites; corticosteroids

56
Q

______ is a sterile, concentrated solution of immune globulin. Further, it is a cold alcohol fractionation of human plasma obtained from donors immunized to produce high levels of Rh0 antibodies.

A

Rh0 Immune Globulin

57
Q

Rh0 Immune Globulin is contraindicated in ___ patients and ____ patients who have already developed Rh0 antibodies

A

Rh0-positive patients
Rh0-negative patients

58
Q

_____is used to prevent Rh0 hemolytic disease of the newborn (Erythroblastosis fetalis) in a subsequent pregnancy

A

Rh0 Immune Globulin

59
Q

True or False: Rh0 Immune Globulin suppresses the specific immune response of Rh0-negative individuals to Rh-0 positive blood cells

60
Q

When should Rh0 Immune Globulin be administered to a Rh0 negative mother?

A

Within 72 hours after either birth of Rh0 (+) infant, miscarriage, abortion, etc.

61
Q

True or False: RhoGam (Rh Immune Globulin) can prevent sensitization to Rh0 factor in pregnant Rh- negative women

62
Q

_____ is a recombinant, humanized mab that binds to and NEUTRALIZES VEGF

_____ is a recombinant, humanized mab fragment that binds and INHIBITS VEGF

A

Bevacizumab: a recombinant, humanized mab that binds to and neutralizes VEGF

Ranibizumab: is a recombinant, humanized mab fragment that binds and inhibits VEGF

63
Q

True or False: Blurred vision is associated with use of Ranibizumab

A

False - Bevacizumab

64
Q

Intravitreal Bevacizumab can be used for age-related ___ edema

65
Q

____ inhibits VEGF binding to its receptors, thereby suppressing neovascularization and slowing LOSS OF vision

A

Ranibizumab

66
Q

What are four AE associated with Ranibizumab?

A

1) Conjunctival bleeding
2) Corneal edema
3) Cataracts
4) Eyelid pain

67
Q

True or False: Bevacizumab can be used to treat diabetic macular edema and diabetic retinopathy

A

False - Ranibizumab

68
Q

___ ____ is an agent for replacement therapy and is associated with Signal 1

A

Immune Globulin

69
Q

___ ___ is made of IgG and IgM from human plasma and passively supplies broad spectrum IgG ab against many antigens (bacterial, viral, parasitic, and mycoplasmic)

A

Immune Globulin

70
Q

True or False: Immune Globulin inhibits pathogenic autoantibodies

A

False - neutralizes

71
Q

True or False: Immune Globulin can bind to IL-1a, IL-6, TNF-a, and TCR, suppressing pathogenic cytokines and phagocytes

72
Q

The Ab in Immune Globulin can interfere with pathogenic effect of products of ___ activation

A

complement

73
Q

Clinical uses of Immune Globulin?

A

1) Hypogammaglobulinemia
2) HIV-infected peds patients
3) Idiopathic thrombocytopenic pupura
4) Guillian-Barre Syndrome

74
Q

Black box warning of thrombosis, renal dysfunction, and acute renal failure are associated with ____ ____

A

Immune Globulin

75
Q

Why can the risk of infectious agents not totally be eliminated w/r/t Immune Globulin?

A

Made from human plasma, which may allow for transmission of BBP

76
Q

Interferon _____ is a recombinant amino acid protein. Binding to its receptor initiates a complex cascade of intracellular events.
A. Interferon Beta-1b
B. Interferon Alpha-2A

A

A. Interferon Beta-1b

77
Q

Interferon beta has ___ and ____ activities

A

antiproliferative and immunoregulatory activities

78
Q

What are the three most serious AE associated with Interferon Beta 1B?

A

1) Depression
2) SI
3) Injection Site Reactions

79
Q

True or False: Interferon Gamma is used to treat relapsing-remitting MS

A

False - Inteferon Beta

80
Q

Which two drugs are given Intravitreal?

81
Q

True or False: Flu-like symptoms are associated with Interferon Gamma

82
Q

Which interferon has phagocyte-activating effects that are not seen with other inteferon preparations, including generation of toxic oxygen metabolites within phagocytes?

A

Interferon Gamma 1B

83
Q

What is Interferon Gamma-1B used to treat?

A

Chronic granulomatous disease

84
Q

True or False: Interferon Gamma 1b can enhance phagocyte function, leading to elevated superoxide levels and improved killing of Staph a.

85
Q

Gingivitis, inflammation of nares, and granuloma formation in the neck of symptoms of _____

A

chronic granulomatous

86
Q

Anaphylaxis is a ____ drug allergy while urticaria (cutaneous) and glomerulonephritis (renal) are _____

A

generalized; organ-specific

87
Q

True or False: women are more likely to have cutaneous reactions and children are less likely to have allergic reactions

88
Q

In Type 1 hypersensitivity reactions, initial exposure to drugs result in production of ___ antibodies, which binds to ___ cells and blood ___

A

IgE; mast cells; blood basophils

89
Q

___ and ___ are mediators of Type 1 Hypersensitivity Reactions

A

Histamine and Leukotrienes

  • note: these are release from mast cells /basophils
90
Q

Which four drugs can treat Type 1 hypersensitivity reactions?

A

1) Prednisone
2) Isoproterenol
3) Epi
4) Theophylline

91
Q

___ is a sympathomimetic catecholamine that is the most potent alpha receptor activator

____ will cause bronchodilation by inhibition of PDE III and IV

A

Epinephrine
Theophylline

92
Q

In Type 1 Hypersensitivity Reactions, re-exposure to allergen leads to cross-linking of membrane bound ___

93
Q

True or False: Theophylline decreases leakage from endothelial cells and decreases cytokine release from T Lymphocytes and Macrophages + decreases mediators released

94
Q

Clinical manifestations of Type ___ Hypersensitivity reaction include: Rh0 hemolytic disease in newborn, agranulocytosis, and autoimmune hemolytic anemia

A

Type 2 Hypersensitivity

95
Q

Type II hypersensitivity reactions involve __ and __ antibodies

A

IgG and IgM
- note: these are the mediators!

96
Q

How do you treat Type II and III Hypersensitivity Reactions?

A

Drug withdrawl and corticosteroids

97
Q

Which two Ab are involved in Type III Hypersensitivity Reactions?

A

IgM and IgG (note: these Ab generate drug-antibody complexes that often deposit in b. vessel walls, result in complement activation)

98
Q

Serum sickness is associated with which hypersensitivity?

99
Q

What results due to complement activation in Type III Hypersensitivity Reactions?

A

1) Increased vascular permeability
2) Aggregation of neutrophils
3) Hemorrhagic vasculitic lesion

100
Q

What is the major difference between type 2 and 3 hypersensitivity reactions?

A

Type 2 involves cells in circulatory system while Type 3 involves lysis of cells that line b. vessels

101
Q

Which type of hypersensitivity reaction is mediated by T lymphocytes and macrophages? How is this type treated?

A

Type 4 (cell mediated/delayed)
- Treatment: corticosteroids

102
Q

True or False: Both Interferons can be administered SC

Pharmacology (53 decks)

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