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11 Cards in this Set
- Front
- Back
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3 general principles of immunosuppression:
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1. Primary immune response is more easily treated and suppressed than a secondary (all those memory cells tend to get in the way).
2. The same drugs don't work the same way on all immuno-diseases 3. better to suppress the immune system before, rather than after, exposure to the immunogen. So to recap - primary easier than secondary, better to treat before exposure to the immunogen, and drugs don't always work the same way on each immune condition. |
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Talk about IL1, IL2, and APC's in adaptive immunity:
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IL1 is hugely important in "priming" generic T-cells into CD4 T-cells. Also requires antigen presentation.
IL1 is also important in activation of B cells by Cd4's. IL2's big job is being secreted by CD4 cells, helping to make CD8 cells super-killer. Note that dendritic cells are the big APC's we're thinking about. |
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What are the big activators of B cells to make antibodies?
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IL's 4,5, and 6. These are made by the Cd4 cells after activation by antigen presentation, by the B cells themselves.
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Generally, what can you use immunosuppressive drugs for and what are the risks?
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Use them for organ transplantation, specific suppression (as in babies with Rh- moms) or autoimmune disease.
Also, the risks are decreased immunity/infection, and cancers (lymphomas) |
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What does cyclosporine do, what's a drug that has a similar mechanism of action, and what's the effect?
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these stop the creation of IL2 from CD4 cells, which really stop the creation of Cd8 cells. Remember that solid organ rejection is usually cellularlly mediated, so inhibiting this is usually a great idea.
These work in the CD4 helper T cell. Both bind immunophilins, stop phosphotase and CALCINURIN, |
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What's Rho-Gam?
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IgG antibody against the rho ANTIGEN of the red cell.
GIven to pregnant moms who are RH- but about to have an RH+ baby. This prevents the creation of an immune response to baby's red cells when they cross over during birth. |
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what do corticosteroids do? most common? Toxicities?
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two mechanisms of action: 1. rapidly bring down the number of activated CD8 and B cells. Also stop prostiglandin formation (more in the next lecture).
Also, stop production of IL1 - remember that this should seriously hurt the creation of primed CD4 T-helper cells, which are required for a lot of the immune response to happen. Most common one is prendosone. Toxic effects - Adrenal Suppression, cataracts, infections, osteoporosis, glucose intolerance, psychoses, growth inhibition. |
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what are some seroid-sparing drugs? name 'em.
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the cytotoxic group - these have a lot of side effects. These work at the final step, killing already differentiating CD8/B cells.
mycophenolate mofetil - inhibits purine synthesis, IMPDH. Azathioprine - also purine synthesis. stops t cells better. Cyclophosphamide - Kills B better than T, so won't stop GVHD. |
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talk about the drugs that are just antibodies, risks, etc:
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ATGAM - good for kiling off both T cells and B cells. Made by injecting these into horses, getting antibodies. Risks include serum sickness and acute anaphylaxis.
Rhogam is one, we just talked about that. Muromnab CD3 - antibodies against Cd3, which is on all lymphocytes. "cytokine release syndrome." Daclizumab - IL2 antagonist Infliximab - humanized, binds TNFalpha. Good for chron's disease. |
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what are the mechanisms of drug allergy?
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4 types.
1. immediate - comes from IgE issues. Small drugs can look like alergens. Can crosslink IgE's on mast cells, cause degranulation. 2. IgG or IgM - these are already bound to RBC's. Cause complement lysis of these when drug is reintroduced. This is responsible for the SLE symptoms seen with procanamide or hydralazine. Type 3 : Complex issue Serum sickness and vasculitis and stevens johnson syndrome from sulfonamide. Type 4 - cell mediated - seen in contact dermatitis. Note that these are the same as all autoimmune diseases : A-CIC. Antibody, complement, complex, and cell-meidiated. |
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what drugs block TNF-alpha?
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etanercept - good for arthritis. recombinant TNF receptor, binds it up and inactivates it.
Thalidomide - very effective. |
