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Pharm > immuno drugs > Flashcards

immuno drugs Flashcards

1
Q

Cyclophosphamide

A

Cytotoxic and Antiproliferative Agent (T and B)

pro-drug, needs to be activated by cP450
cell cycle-nonspecific (CCNS) alkylating agent (entire cycle)

tx: anti-cancer agent, sev. rheumatologic conditions
suppressive: infections may happen
* SIGNAL 3*: can inactivate cell cycle

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2
Q

cyclophosphamide SEs: short term

A

GI: Nausea, vomiting, diarrhea; stomatitis; abdominal discomfort or pain.

Dermatologic: Alopecia (frequent).

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3
Q

Azathioprine [ImuranR]

A

Cytotoxic and Antiproliferative Agent (T*>B cells)

derivative of 6-mercaptopurine (anti-metabolite)

cell cycle specific: only targets S phase
inhibits adenosine deaminase

kidney transplants
RA

SIGNAL 3

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4
Q

Azathioprine [ImuranR] SEs: short and long term

A

GI: N/V (12%), diarrhea

  1. Hematologic: leukopenia or thrombocytopenia, macrocytic anemia, severe bone marrow depression. dose-related
  2. GU: temporary depression in spermatogenesis and reduction in sperm viability and sperm count

Pregnancy category D (fetal harm)*

may cause serious infections
carcinogen


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5
Q

Methotrexate [RheumatrexR]

A

Cytotoxic and Antiproliferative Agent (T and B)

inhibits dihydrofolic acid reductase (THF)
cell cycle specific
-targets 2nd phase of imm. response

tx for RA, Crohn’s, malignancy

SIGNAL 3

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6
Q

Methotrexate [RheumatrexR] potential for toxicity from high-dose regimens or delayed excretion is reduced by ??? during the final phase of methotrexate plasma elimination

A

leucovorin calcium

protects normal cells

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7
Q

Methotrexate [RheumatrexR] SEs

A 
GI: N/V/D, stomatitis
*hepatotoxicity 
*nephrotoxicity
*obstructive pulmonary disease (COPD)
infections
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8
Q

Cyclosporine [SandimmuneR]

A

T-Cell Suppressant

comes from a fungus

inhibits SIGNAL 1 by inhib. calcineurin phosphatases

inhib. IL-2–>inhib. T cell activation
suppresses CMI, some humoral immunity,
*reversible inhib.

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9
Q

Cyclosporine [SandimmuneR] may be affected by concomitant use of ???

because it requires ?? for metabolism

A

HIV protease inhibitors
anticonvulsants
azole antifungals

cytochrome P450 3A enzymes

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10
Q

Cyclosporine [SandimmuneR] SEs

A

nephrotoxicity (mild–>chronic progressive)

(peritubular cap. congesion, interstitial fibrosis w. tubular atrophy)

HTN

*can cross placenta!: terotgen

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11
Q

Cyclosporine [SandimmuneR] uses

A

organ transplants (take with corticosteroids, azathioprine)

RA

psoriasis

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12
Q

MYCOPHENOLATE MOFETIL [CellceptR]

A

T-Cell Suppressant

reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH)–>
inhib guanosine nucleotide synthesis

(affects T and B cells)

SIGNAL 3

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13
Q

MYCOPHENOLATE MOFETIL [CellceptR] SEs

A

GI
severe neutropenia

use in combo with cyclosporine, corticosteroids

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14
Q

Muromonab-CD3 (Orthoclone OKT3R)

A

T- cell suppressant

murine monoclonal Ab (IgG2a) blocks TCR (CD3) Ag

block calcineuria–>block IL-2–>block cell cycle/clonal expansion

tox: hypersn to murin products
* SIGNAL 1*

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15
Q

Lymphocyte Immune Globulin (AtgamR)

A

T-cell suppressant

  • SIGNAL 1*
    tox: may cause hypersn: prepped from horse IgG

risk for systemic infection

use with antimetabolite/cortster.

don’t use in pregnancy

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16
Q

Daclizumab (ZenapaxR)

A

T-cell suppressant

“humanized” (90%)
binds to the IL-2 receptor (vs. CD3) blocks IL-2

tox: GI
* SIGNAL 3*

17
Q

RHo Immune Globulin (RhoGamR)

A

Ab agains Rh Ag

immunosuppressive:
prevents Rh- mother from becoming sensitized to Rh Ag–>prevents hemolytic disease of the newborn (42-96 hrs)

  • SIGNAL 1*
  • don’t use in Rh+ pts or Rh- who have dev. Rh Abs
18
Q

Immune Globulin (GammagardR)

A

IgG and IgM

donor human plasma

agent for replacement thereby
broad spectrum of IgG antibodies against bacterial, viral, parasitic, and mycoplasma antigens

binding to IL-1 α, IL-6, TNF-α, and T-cell receptors–>suppress pathological cytokines and phagos

SIGNAL 1

19
Q

Immune Globulin (GammagardR) uses

A
  • hypogammaglobulinemia
  • HIV-inf. ped pts
  • idiopathic thrombocytopenic purpura
  • Guillain-Barre’ syndrome

systemic and local
infections in bone marrow transplantation patients

20
Q

INTERFERON BETA-1b [BetaseronR]

A

recomb. DNA technology

immunomodulator
trigger signalling cascades

relapsing-remmitting MS

21
Q

INTERFERON BETA-1b [BetaseronR] SEs

A

hypersensitivity

depression, suicide, other mental disorders

flu-like symptoms

injection site reactions

22
Q

INTERFERON GAMMA- 1b [ActimmuneR]

A

immunomodulator

generation of toxic oxygen metabolites (via NADPH oxidase) within phagocytes–>IC killing of organisms

tox: flu-like

tx for CGD:
enhances killing mech. does not fix pt. mutation

23
Q

genetic factor of drug reactions

A

slow vs. rapid acetylators

24
Q

assoc. illnesses that cause drug reactions

A

PCP develop drug reactions (skin rash to sulfa drugs)

25
Q

this accounts for 5-20% of all observed adverse drug reactions

A

allergic drug reactions

26
Q

Type 1 hypersensitivity

tx?

A

Anaphylactic (Immediate)

IgE binds via Fc portion to mast cell/basophil–>crosslink–>mediators released–>histamines, leukotrienes, etc.

prednisone, isoproterenol, epinephrine, theophylline

27
Q

TYPE II hypersensitivity

tx?

A

Cytotoxic reactions

IgG and IgM
attach to circulating cells

hemolytic disease of newborn
thrombocytopenia, agranulocytosis, autoimmune hemolytic anemia

remove offending drugs
corticosteroids

28
Q

Type III hypersensitivity

tx?

A

Serum Sickness or Arthus Reactions

Ab does not attach to circ. cell but rather BV wall: complex attaches Fc portion–>complement–>inc. vasc. perm–>neutrophils aggregate–>hemorrhagic vasculitic lesion

remove offending drugs
corticosteroids

29
Q

Type IV hypersensitivity

tx?

A

CMI (delayed)

Mediated by sensitized T lymphocytes and macrophages
contact dermatitis

corticosteroids

30
Q 
case: abd. pain, arthralgia, low grade fever, glomerulonephritis 
2 wks tx with prednisolone
elevated WBC, CRP
CT: thick duodenal and jejunal walls
purpuric lesions (jejunum)
*IgA deposition, vasculitis*
A

HSP

tx with high-dose gluccorts, tapered, then cyclosporine

31
Q

case
pain redness in one eye, 2 mos
deep violacious episcleral injection, dialed perilimabl vessels and edema
corneal thinning
elev. CRP ESR
test for antineutorphilic cytoplasmic Ab was +
OM, wl, epistaxis, SOB
Urine: granular red cell, nodular parenchemal casts

A

peripheral ulcerative keratitis in wegener’s granulomatosis

tx with oral corticosteroids, cyclophosphamide

32
Q

APC presents to T cell via TCR–>signaling pathway–>

A

produces IL-2–>signalling pathway that activates cell cycle

*cascade blocked by drugs

33
Q

Cyclophosphamide long term side effects

A

Hematologic: Leukopenia, thrombocytopenia, anemia.

GU: Amenorrhea, oligospermia, azoospermia, sterility; urinary bladder fibrosis;
hematuria; hemorrhagic ureteritis; renal tubular necrosis.

34
Q

Azathioprine uses

A

renal homotransplantation
RA
Crohn’s

35
Q

SIGNAL 1 DRUGS

A 
Cyclosporine
Muromonab-CD3
Lymphocyte Immune Globulin (AtgamR)
RHo Immune Globulin (RhoGamR)
Immune Globulin (GammagardR)
36
Q

SIGNAL 3 DRUGS

A 
Cyclophosphamide
Azathioprine
Methotrexate
Mycophenolate mofetil
Daclizumab

Pharm (45 decks)

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