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Pharm > Med Classes- Immune Modulating Quiz 2 > Flashcards

Med Classes- Immune Modulating Quiz 2 Flashcards

1
Q

Humanized monoclonal antibody
Example
MOA

A

-umab

Example: Alemtuzumab (Campath) (Lemtrada when used for MS)

MOA: Binds to CD52 on B & T lymphocytes, causing T & B cell depletion

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2
Q

Polyclonal antibody
Example
MOA

A

Example: Antithymocyte globulins (Atgam)

MOA: T cell depletion

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3
Q

Chimeric monoclonal antibody
Example
MOA

A

-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

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4
Q

Proteasome Inhibitor
Example
MOA

A

-omib

Prototype & Example: Bortezomib (Velcade)

MOA: Proteasome inhibition leading to plasma cell depletion

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5
Q

Immune Globulin
Example
MOA

A

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.

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6
Q

Corticosteroid
Prototype
Examples
MOA

A

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

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7
Q

Antiproliferative
Prototype
Example
MOA

A

Prototype: Azathioprine (Imuran)

Example: Mycophenolate mofetil (CellCept), Mycophenolate sodium (Myfortic)

MOA: block lymphocyte proliferation by inhibiting nucleic acid synthesis.

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8
Q

Costimulation blocker
Prototype
Example
MOA
Indication
ADE

A

Prototype: Abatacept (Orencia) for RA

Example: Beltacepts (Nulojix)

MOA: binds to CD80 preventing T call activation pathway

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9
Q

Calciuneurin Inhibitor
Prototype
Example
MOA
Indication
ADE

A

Prototype: Cyclosporin (Sandimmune)(Neoral)

Example: Tacrolimus (Prograf/Astagraf XL, Envarsus XR)

MOA: inhibits the activity of calcineurin, which prevents T cell activation

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10
Q

mTOR inhibitor
Prototype
Example
MOA
Indication
ADE

A

Prototype: Sirolimus (Rapamycin/Rapamune)

Example: Everolimus (Zortress)

MOA: inhibit protein mTOR and block the proliferation of T-cells

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11
Q

Humanized monoclonal antibody
Indication
ADE
Monitoring

A

-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

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12
Q

Polyclonal antibody
Indication
ADE

A

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)

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13
Q

Chimeric monoclonal antibody
Indication
ADE

A

-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.

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14
Q

Proteasome Inhibitor
Indication
ADE

A

-omib

Bortezomib (Velcade)

Indication: treatment of antibody-mediated rejection

ADE: Leukopenia, anemia, thrombocytopenia, n/v, diarrhea, peripheral neuropathy, hypotension, hepatotoxicity (less common)

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15
Q

Immune Globulin
Indication
ADE

A

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

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16
Q

Corticosteroids
Indication
ADE

A

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.

17
Q

Antiproliferative
Indication
ADE

A

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.

18
Q

Costimulation blocker
Indication
ADE
Contraindication

A

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.

19
Q

Calciuneurin Inhibitor
Indication
ADE
Monitoring

A

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.

20
Q

mTOR inhibitor
Indication
ADE

A

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

Pharm (14 decks)

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