Immunosuppression drugs

Question 1

mechanism of glucocorticoids in immunosuppression

Answer 1

bind/inhibit NF-kB;

prevent many cytokines from forming – inhibits T and B cell function

Question 2

mTOR inhibitors

Answer 2

sirolimus everolimus

my Tortoise even sings!

Question 3

azathioprine mechanism

Answer 3

metabolized to 6-mercaptopurine antagonizes purine metabolism and may inhibit synthesis of DNA, RNA

Question 3

what IS meds are favored in pregnancy?

Answer 3

cyclosporine,

tacrolimus

azathioprine

prednisone

Question 4

induction agents

Answer 4

ATG

alemtuzumab - CD52 Ab

basiliximab - IL2 Ab

Question 5

antimetabolite agents

Answer 5

azathioprine

mycophenolate mofetil(MMF)

Question 6

belatacept

Answer 6

blocks costimulation!

targets B7 on APCs and blocks CD28 mediated T-cell costimulation

Question 7

mTOR inhibitor mechanism

Answer 7

sirolimus, everolimus

bind FKBP, then bind mTOR/inactivate it prevent cell cycle progression; cause apoptosis

Question 8

cyclosporine toxicities

Answer 8

hirsutism

gingival hyperplasia

hyperlipidemia

hyperuricemia, gout

HTN

nephrotoxic

Question 9

azathioprine adverse effects

Answer 9

myelotoxic - thrombo/leukopenia

UV radiation sensitive

Allopurinol decreases breakdown of 6MP which cane increase toxicities

Question 10

mTOR inhibitor adverse effects

Answer 10

proteinuria(from apoptosis)

hyperlipidemia

oral ulcers

anemia

thrombocytopenia, leukopenia

not nephrotoxic

Question 11

tacrolimus toxicities

Answer 11

nephrotoxic

neurotoxic

hyperglycemia - diabetes risk

no gingival hyperplasia or hirsutism like cyclosporine

Question 12

calcineurin inhibitors

Answer 12

cyclosporine - binds cyclophilin and inhibits calcineurin

tacrolimus - binds FKBP1 and inhibits calcineurin

no calcineurin activity means no IL2 production – no T cell differentiation

Question 13

what do you give for rejection therapy?

Answer 13

solumedrol/prednisone taper

thymoglobulin

IVIG

Question 14

mycophenolate mofetil mechanism

Answer 14

inhibits inosine monophosphate dehydrogenase – blocks de novo purine synthesis

hurts cells that cant utilize salvage pathway(lymphocytes)

metabolized to mycophenolic acid – active drug

Question 16

non-lymphocyte depleting induction agent

Answer 16

basiliximab - Mab against IL2-R

Question 17

lymphocyte depleting agents

Answer 17

ATG - anti thymus(anti-T)

alemtuzumab - CD52 Mab(found on lymphocytes and monocytes)

Question 18

what does IL2 do?

Answer 18

IL2 is what Tcells make when stimulated so they can differentiate and proliferate T-cell makes IL2 then it binds to the t-cell’s own IL2Rs