Immunopharmacology
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Questions and Answers

What should be done to the dose of Azathioprine for patients receiving Allopurinol?

  • Reduce to 1/4 or 1/3 of the usual amount (correct)
  • Maintain the usual dose without changes
  • Stop Azathioprine completely
  • Increase to 1.5 times the usual amount

    • What is the mechanism of action of Azathioprine?

  • Promotes T-cell activation
  • Inhibits cell division by blocking vitamin K
  • Increases interferon production
  • Interferes with purine nucleic acid metabolism (correct)

    • Which of the following conditions is Azathioprine NOT indicated for?

  • Hypertension (correct)
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Crohn's disease

    • Which adverse effect is commonly associated with Leflunomide?

    <p>Elevation of liver enzymes</p> Signup and view all the answers

    Which statement about Teriflunomide is true?

    <p>Does not require a loading dose</p> Signup and view all the answers

    What is the active metabolite of Leflunomide after it is metabolized in the body?

    <p>Teriflunomide</p> Signup and view all the answers

    Which adverse effect is most commonly associated with the use of Pyrimidine synthesis inhibitors?

    <p>Myelosuppression</p> Signup and view all the answers

    What mechanism of action do Pyrimidine synthesis inhibitors utilize?

    <p>Reversible inhibition of dihydroorotate dehydrogenase</p> Signup and view all the answers

    Which of the following is a less common adverse effect of Pyrimidine synthesis inhibitors?

    <p>Renal toxicity</p> Signup and view all the answers

    In what context are Pyrimidine synthesis inhibitors commonly used?

    <p>Chronic GVHD in hematopoietic stem cell transplant recipients</p> Signup and view all the answers

    Which adverse effect is specifically associated with hepatic issues when using Pyrimidine synthesis inhibitors?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What outcome results from the decreased levels of pyrimidine synthesis due to the action of Pyrimidine synthesis inhibitors?

    <p>Decreased lymphocyte activation</p> Signup and view all the answers

    Which metabolic product primarily leads to Hepatotoxicity in patients using Leflunomide?

    <p>Teriflunomide</p> Signup and view all the answers

    What should be closely monitored in patients using Pyrimidine synthesis inhibitors due to the risk of an adverse effect?

    <p>Liver function tests</p> Signup and view all the answers

    Which Pyrimidine synthesis inhibitor is categorized as a prodrug?

    <p>Leflunomide</p> Signup and view all the answers

    What mechanism does cyclosporine primarily utilize to exert its effects?

    <p>Inhibition of calcineurin</p> Signup and view all the answers

    Which of the following conditions is cyclosporine NOT typically used to treat?

    <p>Peptic Ulcer Disease</p> Signup and view all the answers

    Which side effect is commonly associated with cyclosporine use?

    <p>Growth suppression</p> Signup and view all the answers

    How does cyclosporine act on T cells?

    <p>Inhibits gene transcription of IL-2 and IFN-𝛄</p> Signup and view all the answers

    What is a primary route of administration for cyclosporine?

    <p>Oral or intravenous</p> Signup and view all the answers

    Which of the following is a potential metabolic effect of cyclosporine?

    <p>Adrenal suppression</p> Signup and view all the answers

    What is one of the key differences between cyclosporine and tacrolimus?

    <p>They differ primarily on their binding site</p> Signup and view all the answers

    Which of the following side effects may occur due to cyclosporine use?

    <p>Behavioral changes</p> Signup and view all the answers

    What type of nephrotoxicity can cyclosporine lead to?

    <p>Acute tubular necrosis</p> Signup and view all the answers

    What is a common result of cyclosporine-related immunosuppression?

    <p>Increased susceptibility to infections</p> Signup and view all the answers

    What is the primary purpose of immunosuppressive agents?

    <p>To suppress the immune response</p> Signup and view all the answers

    Which of the following is a common use for immunosuppressive agents?

    <p>Reducing inflammation in inflammatory diseases</p> Signup and view all the answers

    What is a significant side effect of chronic use of immunosuppressive agents?

    <p>Higher risk of infection</p> Signup and view all the answers

    How do immunosuppressive agents typically function in treating transplant rejection?

    <p>By suppressing cellular immunity</p> Signup and view all the answers

    Which of the following conditions can be treated with the use of immunosuppressive agents?

    <p>Systemic lupus erythematosus (SLE)</p> Signup and view all the answers

    What is the role of corticosteroids such as Betamethasone and Dexamethasone in immunosuppressive therapy?

    <p>Block lymphocyte activation and proliferation</p> Signup and view all the answers

    What mechanism is primarily targeted by immunomodulating pharmaceuticals?

    <p>Reducing the concentration and function of inflammatory cytokines</p> Signup and view all the answers

    Why are immunosuppressive agents frequently combined in treatment protocols?

    <p>To achieve greater efficacy with decreased toxicity</p> Signup and view all the answers

    What is the mechanism of action of sirolimus and everolimus?

    <p>Inhibition of IL-2 response</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with sirolimus?

    <p>Cardiac toxicity</p> Signup and view all the answers

    What clinical use is associated with sirolimus and everolimus?

    <p>Kidney transplant rejection prophylaxis</p> Signup and view all the answers

    Which medication is known as the antidote for cyclophosphamide?

    <p>MESNA</p> Signup and view all the answers

    Which of the following is NOT a common adverse effect of mTOR inhibitors?

    <p>Renal failure</p> Signup and view all the answers

    Which effect is most notable for cyclophosphamide?

    <p>Hemorrhagic cystitis</p> Signup and view all the answers

    What type of drug is sirolimus classified as?

    <p>Immunosuppressant</p> Signup and view all the answers

    What can electrolyte disturbances from mTOR inhibitors lead to?

    <p>Electrolyte imbalances</p> Signup and view all the answers

    What is the primary target of sirolimus in immune response modulation?

    <p>IL-2 receptor</p> Signup and view all the answers

    What aspect of the immune system does sirolimus inhibit?

    <p>T-cell activation</p> Signup and view all the answers

    What is the most important and limiting adverse effect of intravenous immune globulin (IGIV)?

    <p>Nephrotoxicity</p> Signup and view all the answers

    Which of the following components does IGIV predominantly contain?

    <p>Monomeric IgG</p> Signup and view all the answers

    What type of antibodies does IGIV provide to patients?

    <p>Broad spectrum antibodies</p> Signup and view all the answers

    Which adverse effect is NOT associated with IGIV?

    <p>Hirsutism</p> Signup and view all the answers

    What is a potential neurological adverse effect of IGIV therapy?

    <p>Altered mental status</p> Signup and view all the answers

    What is one of the therapeutic functions of IGIV?

    <p>Modulating the immune system</p> Signup and view all the answers

    What specific type of immune response does the varying pool of antibodies in IGIV influence?

    <p>Humoral immune response</p> Signup and view all the answers

    Which of the following is a known contraindication of IGIV use?

    <p>Underlying renal insufficiency</p> Signup and view all the answers

    What role do anti-idiotypes play in the context of IGIV?

    <p>They modulate the immune response.</p> Signup and view all the answers

    Which of the following adverse effects may occur from using IGIV, besides nephrotoxicity?

    <p>Seizures</p> Signup and view all the answers

    What is the primary mechanism through which the medication reduces T helper cells?

    <p>Blocks IL-2 transcription</p> Signup and view all the answers

    What is a common behavioral change associated with steroid use?

    <p>Euphoria</p> Signup and view all the answers

    Which side effect is NOT associated with the use of the medication compared to cyclosporine?

    <p>Gingival hyperplasia</p> Signup and view all the answers

    What is a potential long-term effect of steroid use?

    <p>Adrenal suppression</p> Signup and view all the answers

    In what clinical situations is the medication typically utilized?

    <p>Psoriasis and atopic dermatitis</p> Signup and view all the answers

    What effect do glucocorticoids have on serum glucose levels?

    <p>Increase serum glucose</p> Signup and view all the answers

    How does the medication affect antibody production?

    <p>Decreases spontaneous immunoglobulin production</p> Signup and view all the answers

    Which of the following conditions is NOT treated using hyperimmune globulin preparations?

    <p>Common cold</p> Signup and view all the answers

    What differentiates the pharmacological effects of this medication from cyclosporine?

    <p>It has a higher potency in blocking immune response</p> Signup and view all the answers

    What is one of the adverse effects associated with glucocorticoids?

    <p>Weight gain</p> Signup and view all the answers

    What complication can result from the stimulation of mineralocorticoid receptors by steroids?

    <p>Hypertension</p> Signup and view all the answers

    What is the main role of immunosuppressive agents in the treatment of autoimmune diseases?

    <p>To suppress the immune response</p> Signup and view all the answers

    Which of the following is a common side effect of hyperimmune globulins administration?

    <p>Allergic reactions</p> Signup and view all the answers

    Which of the following conditions is commonly treated with immunosuppressive agents?

    <p>Systemic lupus erythematosus (SLE)</p> Signup and view all the answers

    What is a significant risk associated with chronic use of immunosuppressive agents?

    <p>Increased risk of infections</p> Signup and view all the answers

    Which statement is true regarding the effects of glucocorticoids?

    <p>They increase serum glucose</p> Signup and view all the answers

    What aspect of steroid action may lead to Cushing syndrome?

    <p>Increased fat deposition</p> Signup and view all the answers

    Which of the following best describes the action of Dexamethasone in treating inflammatory diseases?

    <p>It suppresses inflammatory cytokines</p> Signup and view all the answers

    Why are immunosuppressive agents often combined in treatment protocols?

    <p>To achieve greater efficacy with decreased toxicity</p> Signup and view all the answers

    Which virus is NOT typically associated with the use of IV hyperimmune globulin preparations?

    <p>Hepatitis C virus</p> Signup and view all the answers

    What aspect of the immune response do immunosuppressive agents primarily target?

    <p>Lymphocyte activation and proliferation</p> Signup and view all the answers

    What is a common adverse effect associated with the use of corticosteroids like Betamethasone?

    <p>Weight gain</p> Signup and view all the answers

    In the context of transplant rejection, what is the primary function of immunosuppressive agents?

    <p>To suppress cellular immunity</p> Signup and view all the answers

    Which medication is associated with targeting metastatic colorectal cancer in patients with specific genetic markers?

    <p>Cetuximab</p> Signup and view all the answers

    What is the primary mechanism of action of Bevacizumab?

    <p>Blocking VEGF</p> Signup and view all the answers

    Which of the following agents is known for its use in RSV prophylaxis for high-risk infants?

    <p>Palivizumab</p> Signup and view all the answers

    What class of drugs is utilized to enhance immune responsiveness in patients with immunodeficiencies?

    <p>Immunostimulant agents</p> Signup and view all the answers

    Which medication is primarily used for the treatment of B cell non-Hodgkin lymphoma?

    <p>Rituximab</p> Signup and view all the answers

    Which of the following cancers is primarily associated with the use of Ranibizumab?

    <p>Renal cell carcinoma</p> Signup and view all the answers

    Which type of cancer is Bevacizumab NOT typically used to treat?

    <p>Multiple myeloma</p> Signup and view all the answers

    Which of the following immunostimulant agents are typically used for chronic infectious diseases?

    <p>None of the above</p> Signup and view all the answers

    What is the common purpose for using immunostimulant agents?

    <p>To enhance immune strength</p> Signup and view all the answers

    Which protein is targeted by Cetuximab?

    <p>EGFR</p> Signup and view all the answers

    Study Notes

    Immunosuppressive Agents

    • Drugs designed to suppress the immune response, mainly used for autoimmune and inflammatory diseases.
    • Commonly classified as immunomodulating pharmaceuticals and cytotoxic agents.
    • Block lymphocyte activation and proliferation, enhancing efficacy when combined with other treatments.
    • Play a key role in preventing acute transplant rejection and treating conditions like systemic lupus erythematosus (SLE) and bronchial asthma.
    • Chronic use can elevate the risk of infections due to prolonged immune suppression.
    • Associated side effects include muscle wasting, osteoporosis, impaired wound healing, and changes in behavior.

    Cyclosporine

    • Functions primarily as a calcineurin inhibitor by binding to cyclophilin.
    • Inhibits transcription of immune-related genes including IL-2, IL-3, and IFN-𝛄.
    • Administered orally or intravenously, often combined with methotrexate for enhanced outcomes.
    • Utilized for preventing graft-versus-host disease and managing autoimmune disorders (e.g., rheumatoid arthritis, psoriasis).
    • Side effects may include hypertension, hypokalemia, and potential adrenal suppression.

    Proliferation Signal Inhibitors (Sirolimus, Everolimus)

    • mTOR inhibitors that block T-cell activation and B-cell differentiation by preventing response to IL-2.
    • Primarily used in kidney transplant rejection prophylaxis and steroid-refractory conditions.
    • Common adverse effects include myelosuppression, hepatotoxicity, diarrhea, and hypertriglyceridemia.

    Pyrimidine Synthesis Inhibitors (Leflunomide, Teriflunomide)

    • Leflunomide: a prodrug that metabolizes into Teriflunomide, which reversibly inhibits dihydroorotate dehydrogenase, affecting pyrimidine synthesis.
    • Disruption in pyrimidine synthesis leads to reduced lymphocyte activation.
    • Leflunomide is indicated for rheumatoid arthritis, while Teriflunomide is approved for relapsing remitting multiple sclerosis.
    • Common adverse effects include elevated liver enzymes, leukopenia, renal impairment, and a risk of teratogenicity in pregnant patients.

    Cytotoxic Agents

    • Azathioprine: a prodrug that converts to 6-mercaptopurine, affecting purine nucleic acid metabolism.
    • Should be used with caution in patients receiving allopurinol, as overdose can occur without dosage adjustments.
    • Clinical applications include rheumatoid arthritis, Crohn's disease, multiple sclerosis, and certain autoimmune disorders like idiopathic thrombocytopenic purpura.
    • Potential adverse effects include elevation of liver enzymes, renal impairment, and thrombocytopenia, contraindicated during pregnancy.

    Immunosuppressive Agents

    • Suppress the immune response, primarily used for autoimmune and inflammatory diseases.
    • Majority are immunomodulating drugs and cytotoxic agents initially used in cancer treatment.
    • Effective in reducing acute transplant rejection and managing diseases like systemic lupus erythematosus (SLE) and bronchial asthma.
    • Chronic use can increase infection risk and induce behavioral changes in patients.

    Glucocorticoids

    • Increase serum glucose levels leading to hyperglycemia and potential diabetes mellitus.
    • Cause fat deposition presenting as weight gain, "buffalo hump," and “moon facies,” associated with Cushing syndrome.
    • Side effects include hypertension, hypokalemia, and edema due to mineralocorticoid receptor stimulation.

    Hyperimmune Globulins

    • Composed of immunoglobulin preparations from selected human or animal donors with high antibody titers against specific infections.
    • Used in conditions such as respiratory syncytial virus, cytomegalovirus, varicella zoster virus, and rabies.

    Calcineurin Inhibitors

    • Include agents like Tacrolimus, which inhibits IL-2 transcription and blocks T-cell activation, significantly more potent than cyclosporine.
    • Adverse effects include nephrotoxicity, hypertension, liver dysfunction, and neurotoxicity.
    • Used in lower doses for autoimmune disorders and certain blood conditions.

    Immunostimulant Agents

    • Increase immune responsiveness in patients with selective or generalized immunodeficiency disorders.
    • Useful in treating chronic infectious diseases and cancer.

    Immunosuppressive Antibodies

    • Examples include immune globulin intravenous (IGIV) preparations that provide broad-spectrum antibodies to normalize the immune network.
    • Contain predominantly monomeric IgG with some dimers, aiding in immune modulation.

    Clinical Applications

    • Glucocorticoids are utilized for SLE and other autoimmune conditions.
    • Calcineurin inhibitors and antibodies are critical in organ transplantation and managing autoimmune diseases.
    • IGIV preparations are administered when broad immune support is necessary, without targeting a specific antigen.

    Side Effects and Toxicities

    • Common adverse effects of immunosuppressive therapy include nephrotoxicity, hypertension, hyperkalemia, and altered mental status.
    • Long-term steroid use leads to adrenal suppression and various metabolic disturbances.

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    Description

    This quiz covers the immune system and focuses on immunosuppressive agents, particularly Betamethasone. Test your knowledge on the mechanisms of these drugs and their applications in clinical practice. Ideal for students studying pharmacology or medicine.

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