Med Classes- Immune Modulating Quiz 2 Flashcards
Humanized monoclonal antibody
Example
MOA
-umab
Example: Alemtuzumab (Campath) (Lemtrada when used for MS)
MOA: Binds to CD52 on B & T lymphocytes, causing T & B cell depletion
Polyclonal antibody
Example
MOA
Example: Antithymocyte globulins (Atgam)
MOA: T cell depletion
Chimeric monoclonal antibody
Example
MOA
-ximab
Example: Basiliximab (Simulect), Rituximab (Rituxin)
MOA: Basiliximab: CD25 IL-2 receptor antagonist on activated T cells, nondepleting. Rituximab: Binds to CD20 depletes B cells
Proteasome Inhibitor
Example
MOA
-omib
Prototype & Example: Bortezomib (Velcade)
MOA: Proteasome inhibition leading to plasma cell depletion
AB - TB
Immune Globulin
Example
MOA
Example: IVIG
MOA: Exact mechanism unknown, immune modulation on T & B cells at high doses, low doses used to prevent infection by replacing immunoglobulins removed during plasmapheresis. Inhibits binding of antibodies to the transplanted organ and activation of complement.
Corticosteroid
Prototype
Examples
MOA
1st immune modulators
Prototype: Prednisone is the prototype prodrug, methylprednisolone is the prototype IV drug for glucocorticoids.
Example: Methylprednisolone (Medrol/Solumedrol), prednisolone (Prelone), prednisone (Orapred)
MOA: Non-specific interleukin and TNF inhibition
Antiproliferative
Prototype
Example
MOA
Prototype: Azathioprine (Imuran)
Example: Mycophenolate mofetil (CellCept), Mycophenolate sodium (Myfortic)
MOA: block lymphocyte proliferation by inhibiting nucleic acid synthesis.
Costimulation blocker
Prototype
Example
MOA
Indication
ADE
Prototype: Abatacept (Orencia) for RA
Example: Beltacepts (Nulojix)
MOA: binds to CD80 preventing T call activation pathway
Calciuneurin Inhibitor
Prototype
Example
MOA
Prototype: Cyclosporin (Sandimmune)(Neoral)
Example: Tacrolimus (Prograf/Astagraf XL, Envarsus XR)
MOA: inhibits the activity of calcineurin, which prevents T cell activation
mTOR inhibitor
Prototype
Example
MOA
Indication
ADE
Prototype: Sirolimus (Rapamycin/Rapamune)
Example: Everolimus (Zortress)
MOA: inhibit protein mTOR and block the proliferation of T-cells
Humanized monoclonal antibody
Indication
ADE
Monitoring
-umab
Alemtuzumab (Campath) (Lemtrada when used for MS)
Indication: Induction or treatment of rejection, also approved to treat CLL, MS
ADE: Infusion related effects (chills/fever), severe and prolonged leukopenia, thrombocytopenia, infections (CMV, HSV, and other viral and fungal infections)
Notes: since it has long immunosuppressive effects should initiate or continue prophylaxis for pneumocystis pneumonia and HSV
Polyclonal antibody
Indication
ADE
Antithymocyte globulins (Atgam)
Indication: at time of transplant to prevent early rejection with other antirejection meds, severe rejection or steroid resistant acute rejection.
ADE: chills/fever, leukocytopenia, thrombocytopenia, skin rash, pulmonary edema, infections (CMV and other viral infections)
Chimeric monoclonal antibody
Indication
ADE
-ximab
Basiliximab (Simulect), Rituximab (Rituxin)
Indication: Basiliximab: Induction, Rituximab: induction or treatment of rejection
ADE: Basiliximab: Generally well tolerated. Rituximab: Infusion (chill/fever), infections (reactivation of hep B, CMV, other viral and fungal infections), PML, leukopenia, thrombocytopenia, mucocutaneous reactions.
Proteasome Inhibitor
Indication
ADE
-omib
Bortezomib (Velcade)
Indication: treatment of antibody-mediated rejection
ADE: Leukopenia, anemia, thrombocytopenia, n/v, diarrhea, peripheral neuropathy, hypotension, hepatotoxicity (less common)
Immune Globulin
Indication
ADE
IVIG
Indication: Induction for highly sensitized patients and treatment of rejection
ADE: Infusion related reactions, headache, hypotension, hemolytic anemia, pulmonary edema, thromboembolic events, aseptic meningitis, acute renal failure
Corticosteroids
Indication
ADE
Prednisone/prednisolone/methylprednisolone
Indication: Numerous
ADE: HTN, HLD, hyperglycemia, peripheral edema, mood disturbance, osteoporosis, weight gain
Current protocols are attempting to decrease or avoid steroids in the maintenance phase of transplantation.
Antiproliferative
Indication
ADE
Azathioprine (Imuran), Mycophenolate mofetil (CellCept), Mycophenolate sodium (Myfortic)
Indication: add on drug for immune suppression, usually paired with a calcineurin inhibitor with or without a steroid.
ADE: Bone marrow suppression. ALLOPURINOL inhibits the breakdown of Imuran increasing risk for ADE therefore the patient with gout must be on a significantly lower dose.
Costimulation blocker
Indication
ADE
Contraindication
Abatacept (Orencia), Beltacepts (Nulojix)
Indication: Renal, liver & heart transplant
ADE: anemia, leukocytopenia, post transplant lymphoproliferative disease (PTLD
Notes: Contraindicated in those that are seronegative to EBV as it is a common cause of Post transplant lymphoproliferative disease (PTLD) especially affecting the CNS. MUST have EBV titers first.
Calciuneurin Inhibitor
Indication
ADE
Monitoring
Cyclosporin (Sandimmune)(Neoral), Tacrolimus (Prograf/Astagraf XL, Envarsus XR)
Indication: Renal, liver, and heart transplants; psoriasis, RA, Graft vs host disease (GVHD)
ADE: HTN, HLip, DM, Neurotoxicity, Renal toxicity, infections, hirsutism (excess hair growth) common with cyclosporine.
Notes: dosed based on 12 hour trough level, goal trough changes based on organ transplanted and center protocols. Regular renal, bp, bg, and lipid levels should be checked.
mTOR inhibitor
Indication
ADE
Sirolimus (Rapamycin/Rapamune), Everolimus (Zortress)
Indication: Renal and liver transplant, RA, psoriasis, cancer (breast, renal cell, neuroendocrine tumors) though cancer doses are much higher.
ADE: HTN, H. triglycerides, stomatitis, proteinuria, decreased wound healing, rash, myelosupression (bone marrow), pneumonitis
