objective 2.7

Question 1

distinguish self from
nonself and to protect the body from foreign material
(pathogen, antigens), including cancer
Responsible for rejection of kidney, liver, pancreas, lung and
heart transplants.
́Can also sometimes attack itself, causing autoimmune diseases
or immune-mediated diseases

Answer 1

immune system

Question 2

re drugs that decrease or prevent an
immune response, thus suppressing the immune system.
́They are used to prevent or treat rejection of transplanted organs

Answer 2

immunosuppressant drugs

Question 3

what is immunosuppressive therapy used to treat?

Answer 3

Rheumatoid arthritis, systemic lupus erythematosus, Crohn’s
disease, multiple sclerosis (MS), myasthenia gravis, psoriasis, and
other autoimmune conditions

Question 4

what are the types of transplants?

Answer 4

kidney, heart, liver, lung, pancreas, small
bowel, bone marrow, and cornea

Question 5

the primary concern and occurs because of an immune
response targeted against the transplanted organ

Answer 5

rejection

Question 6

inhibit all stages of T-cell activation and are used for
induction, maintenance immunosuppression, and acute rejection

Answer 6

glucocorticoids

Question 7

Calcineurin inhibits T cells activation of the
immune system

Answer 7

calcineurin inhibitors

Question 8

inhibit cell proliferation

Answer 8

antimetabolites

Question 9

inhibit cell proliferation

Answer 9

biologics

Question 10

what are the indications of immunosuppressants?

Answer 10

́Therapeutic use varies from drug to drug.
́Primarily indicated for the prevention of organ rejection
́mycophenolate mofetil and tacrolimus are indicated for both
prevention of rejection and treatment of organ rejection.
́fingolimod hydrochloride and glatiramer are indicated in a type of
MS known as relapsing-remitting multiple sclerosis

Question 11

what are the AE of immunosuppressants?

Answer 11

• Significant. See table 50.2
• Place patients at risk for opportunistic infections
• Increase risk of certain cancers

Question 12

what are the interactions of immunosuppressants?

Answer 12

• Increased risk for drug interactions as those who have undergone transplants are on
  immunosuppressant drugs a lifetime, often on combination therapy.
• Have narrow therapeutic window therefore drug interactions significant
• Drugs that increase levels of immunosuppressant drugs can cause toxicity
• Drugs that reduce immunosuppressant drug levels can lead to organ rejection
• Grapefruit: increase levels of cyclosporin, tacrolimus and sirolimus
• Foods high in potassium: increase cyclosporin nephrotoxicity

Question 13

• Blocks T cell proliferation.
• Prophylaxis of organ rejection concurrently with other
  immunosuppressant drugs, such as cyclosporine and corticosteroids.
• Common adverse effects of liver damage

Answer 13

azathioprine

Question 14

• Monoclonal antibody used to prevent rejection of transplanted
  kidneys.
• Generally used as part of a multidrug immunosuppressive regimen
  that includes cyclosporine and corticosteroids
• Has a tendency to cause the allergy-like reaction known as cytokine
  release syndrome

Answer 14

basilizimab

Question 15

• Used for prevention of organ rejection/bone marrow.
• May be used for other immunological disorders.
• Has a narrow therapeutic range.
• Laboratory monitoring of drug levels to ensure therapeutic
  plasma concentrations and to avoid toxicity

Answer 15

ci/cyclosporine

Question 16

• Works by blocking T-cell autoimmune activity against myelin protein,
  which reduces the frequency of the neuromuscular exacerbations
  associated with MS

Answer 16

glatiramer

Question 17

• Approved for MS
• The only oral medication for relapsing forms of MS
• Significant adverse effects: headache, hepatotoxicity, flulike symptoms, back
  pain, atrioventricular block, bradycardia, hypertension, and macular edema

Answer 17

fingolimod

Question 18

• Indicated for the prevention & treatment of organ rejection. Suppresses T
  cell proliferation.
• Increased risk of congenital malformations and spontaneous abortions
  when used during pregnancy.
• Common side effects: hypertension, hypotension, peripheral edema,
  tachycardia, pain, headache, hyperglycemia, hyperlipidemia, electrolyte
  disturbances, and other conditions.

Answer 18

mycophenolate mofentil