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26 Cards in this Set
- Front
- Back
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What do we mean by immunosuppression? |
Decreasing the activity of immune system through cytotoxic effects or through bone marrow suppression. |
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What do we mean with immunomodulation? |
Altering the immune response without bone marrow suppression or cytotoxic agents. Involves often inhibiting function of certain WBCs or cytokines. |
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Name the four types of immunosuppresants |
- Corticosteroids - Drugs that inhibit lymphocyte signalling - Cytotoxic drugs - Antibodies with immunosuppressing effect |
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Name 2 corticosteroids |
Prednisone and dexamethasome |
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When are corticosteroid drugs indicated? |
- Autoimmune disorders - Bronchial asthma - Organ transplant recipients - Adrenal insufficiency |
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Mechanism of action of glucocorticoids? |
Diffuse into the nucleus of cells and bind to glucocorticoid receptors so it can regulate the expression of many genes: - Decreased transcription of IL2 - Decreased transcription of TNFa and IL1 - Inhibit monocyte and neutrophil chemotaxis - Decreases lymphocyte count Also decreases synthesis of phospholipase A2. |
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Side effects of glucocorticoids? |
Iatrogenic Cushings syndrome, adrenal suppression or serious bacterial or viral infections. |
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Drugs that inhibit lymphocyte signalling |
Cyclosporin, tacrolimus, rapamycin |
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Mechanism of action of cyclosporine and tacrolimus? |
They inhibit a protein called calicineurin. Calcineurin activates transcription of IL2 and IL2 receptors on T-cells. This inhibition leads to indirect decrease of IL-2 mediated T-cell proliferation. |
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Mechanism of rapamycin? |
It binds to mTOR, which no longer can activate T-cell proliferation. |
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Side effects of cyclosporine? |
It is nephrotoxic |
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Name the cytotoxic drugs used in immunosuppression |
Azathioprine, cyclophosphamide |
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Indications of azathioprine? |
Used in organ transplantation, acute glomerulonephritis and autoimmune diseases. |
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Indications of cyclophosphamide? |
Used in organ transplantation and autoimmune disorders |
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Mechanism of action of azathioprine? |
Prodrug of mercaptopurine, which is a cytotoxic anticancer drug. Interferes with purine synthesis and is cytotoxic to all rapidly proliferating cells like lymphocytes when there is a inflammation |
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Mechanism of action of cyclophosphamide? |
Cytotoxic alkylating agents which alkylates DNA and damages it. |
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Contraindications of azathioprine? |
Broken down by xanthine oxidase, so should not be used together with allopurinol, which inhibits XO |
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When do we use hyperimmunoglobulin? |
Passive immunization in rabies and tetanus. They can bind to and inactivate the virus or toxin |
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Mechanism of Rh(D) immunoglobulin? |
They bind to Rh+ of the fetus so mothers antibodies dont recognize it. |
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Mechanism of action of Adalimumab and infliximab? |
Bind to TNFa, prevents it from activating immune system. |
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Mechanism of action of Rituximab? |
Binds to CD20, cell surface receptor found on B-cells. This makes the immune system kill B-cells, leading to B-cell depletion. |
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Name an immunostimulant used in bladder cancer |
BCG (TB vaccine) |
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Which interferon is used as an immunomodulator, and what is its indications? |
Interferon-α. Used to treat hepatitis B, C and certain cancers |
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Classification of drugs used to treat rheumatoid arthritis |
- Symptom-improving drugs - Disease-modifying antirheumatic drugs (DMARDs) |
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Which symptom-improving drugs are used to treat rheumatoid arthritis? |
NSAIDs, corticosteroids |
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Which are the most important DMARDs? What is the first-line treatment for RA? |
Methotrexate (first-line), cyclophosphamide, cyclosporine, adalimumab, infliximab, rituximab |
