Immunopharmacology

Front 1

Prednisone:

MOA, CU, AR

Back 1

MOA: works on T cells and chronically on B cells

CU: solid/stem cell transplant, AI diseases, allergic rxns

AR: adrenal suppression, cushingoid rxns, growth inhibition

Front 2

Azathioprine:

MOA, CU, AR

Back 2

MOA: inh purine synthesis of T cells; stops T cell proliferation, slow release favors immunosuppression

CU: kidney transplant, AI (RA and psoriasis)

AR; bone marrow suppression, GI/hepatotox at high conc, drug interaction with allopurinol

Front 3

MMF:

MOA, CU, AR

Back 3

MOA: blocks IMPDH type II, T cell specific

CU: kindey transplants, AI disease

AR: myelosuppression (neutropenia), GI disturb, headaches, HTN

Front 4

Cyclophosamide/Methotrexate:

MOA, CU, AR

Back 4

MOA: NOT for transplant, B cells>T cells

CU: C--> cancer, SLE; M--> RA, psoriasis

AR: pancytopenia, GI, hemorrhagic cystitis, alopecia, poss sterility

Front 5

Cyclosporine:

MOA, CU, AR

Back 5

MOA: blocks calcineurin by binding to cyclophilin (NFAT), decreases IL-2

CU: solid organ transplants, GVHD, AI diseases

AR: nephrotox, HTN, neurotox, hyperglycemia, hyperlipidemia, cholestesis, hepatox at high conc, predisposed to infections, synergistic with other immunosupp

Front 6

Tacrolimus:

MOA, CU, AR

Back 6

MOA: blocks calcineurin by binding to FKBP, 10-100x more potent than cyclosporine, decreases IL-2 and others

CU: #1 for GVHD, same as cyclosporine, atopic dermatitis and psoriasis

AR: same as cyclosporine but more hyperglycemia

Front 7

Sirolimus:

MOA, CU, AR

Back 7

MOA: blocks MTOR, arrests T cells in G1

CU: solid organ transplant, sirolumus-eluting stents (stop sm mm prolif)

AR: myelosupp, hepatox, hyperlipidemia, hyperTGemia, diarrhea, NO NEURO/NEPHROTOX

Front 8

OTG/ALG/anti-CD25

MOA, CU, AR

Back 8

OTG--> anti-CD 3 (inh of activated T cells)
ALG--> anti-whole lymphocyte (broad immunosuppression)
anti-CD25 (Bab>Dab)--> anti-IL-2 (inh of helper T cells)

CU: prep/acute rejection of transplant

AR: transient immunosupp; cytokine release syndrome (fever, myalgia, diarrhea, vomiting); HS-rxn (serum sickness)

Front 9

Belatacept:

MOA

Back 9

MOA: inh co-stimulation by binding to B7

Front 10

What agents do you use in preparation (induction) of transplant?

Back 10

OTG/ATG/Ant-CD25 (Bab or Dab)

Front 11

What agents do you use for hyperacute and chronic rejection?

Back 11

Hyperacute--> none

Chronic--> same as acute (but tough)

Front 12

What agents do you use for acute rejection?

Back 12

1. cell cycle inh
2. calcineurin inh

Front 13

How do you treat GVHD?

Back 13

1. Steroids
2. add MMF, tacrolimus, sirolimus, Dab

Front 14

CU of IVIG

low doses and high doses?

Back 14

low doses--> humoral def

high doses--> "normalizing effect", severe asthma, AI disorders, Kawasaki syndrome

Front 15

CU of Rho Ig

Back 15

prevent sensitization of Rho(-) woman after giving birth to a Rho (+) infant

Front 16

What are hyperimmune Ig?

Back 16

high titers of Ig to Ags from CMV, RSV

Front 17

IFNs?

Back 17

alpha--> HBV, HCV, kaposi's sarcoma, leukemia, malig melanoma

beta--> multiple sclerosis

gamma--> use for granulomatous

all induce MHC Class I

only gamma induces MHC Class II

Front 18

TNFs?

Back 18

TNF-alpha--> soft tissure carcinoma, malignant melanoma

Front 19

ILs?

Back 19

IL-2--> metastatic melanoma, renal cell carcinoma