Immunomodulators

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Author:
lazzsant
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113162
Filename:
Immunomodulators
Updated:
2011-10-31 09:49:25
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Immunomodulators
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Immunomodulators
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  1. Cytotoxic drugs
    PRPP synthetase & PRPP amidotransferase

    • Azathioprine
    • Mercaptopurine
    • thioguanine
  2. Azathioprine
    antimetabolite/ cytotoxic

    • USED:
    • Auotimmune
    • graft rejection
    • type IV hypersensitivity

    • MOA: use xanthine oxidase (inhibit enzymes to purine interconversion)
    • inhibits de novo synthesis & salvage pathway

    • A/E: BM suppression
    • leukopenia
    • thrombocytopenia
    • hepatotoxic
  3. Lymphotoxic drugs
    • Antilymphocytic globulin (ALG)
    • Antithymocytic globulins
    • Rho(D) immune globulin
    • Immune globulin IV
  4. ALG
    • Lymphotoxic
    • From horses

    • USED: prophylaxis of kidney transplant rejection
    • aplastic anemia

    MOA: bind T cells -> complement

    A/E: Type I or III hypersensitivity
  5. Antithymocytic globulins
    • Lymphotoxic
    • from rabbits

    Antibodies to CDs & HLA's

    USED: acute renal transplant rejection
  6. Rho(D) immune globulin
    MOA: supresses mother's immune response to Rh + antigens presented in first child birth.
  7. Immune globulin IV
    • lymphotoxic
    • human polyclonal

    Passive immunity

    • USED: Kawaski's
    • subacute lupus erythematous
    • thrombocytopenic purpura
  8. Monoclonal ab
    • Muromab
    • Daclizumab
    • Infliximab
    • Aspraginase
    • corticosteroids
  9. Muromonab
    CD3 orthoclone

    MOA: block CD3 ag

    USED: acute renal rejection w/ resistance to corticosteroid trtment

    • A/E:
    • cytokine release syndrome (use steroids or acetominophen)
    • Pulmonary edema
    • Bloodyscrasias, hearing loss, reactions, vision
  10. Cyclosporine
    MOA: binds cyclophilin A -> calcineurin inhibitor -> dec proto-oncogenes -> inc TGF-B -> no T cell proliferation

    Fungus derived and lipophilic (needs to be given in some vehicle)

    • A/E:
    • nephrotoxicity
    • neurotoxicity
    • hyperlipidemia
    • hyperuricemia
    • osteoporosis
    • hepatotoxicity
  11. Tacrolimus
    100X more potent than cyclosporine

    Binds FKB12 -> calcineurin inhibitor -> no T cell proliferation

    A/E: hyperkalemia, hyperglycemia, no LDL or uric effects, nephrotoxicity, neurotoxicity, hepatoxicity.
  12. Sirolimus
    • (Rapamycin)
    • marcoyclic lactone

    • Used: similar to cyclosporine with dec in ab.
    • to dec stenosis

    MOA: FKBP12 -> inhibits mTOR (no protein synthesis) stopping G1 -> S

    • A/E:
    • myelosuppressive, inc cholesterol & triglycerides
    • NOT NEPHROTOXIC
  13. Mycophenolate mofetil
    (replace azathioprine)

    Used: PROPHYLAXIS of allogenic, renal, hepatic, and cardiac transplant rejection.

    MOA: inhibit inosine monophosphate DH -> no guanine de novo synthesis

    A/E: not with pregnancy, sepsis w/ cytomegalovirus
  14. Immunostimulators cytokines or receptors
    • Etancercept
    • Infliximab
    • Daclizumab
  15. Daclizumab
    • (zenapax)
    • IL2 receptor

    USED: acute rejection of kidney, heart, or liver transplant.

    w/ cyclosporine, mycofenolate mofetil & corticosteroids -> severe infection
  16. Glucocorticoids
    • Used: acute rejection crisis
    • w/ cyclosporine, tacrolimus, or azathioprine
    • autoimmune

    • MOA: inhibit T cell proliferation
    • dec size of nodes and spleens
    • dec infl. mediators
    • dec chemotaxis

    A/E prednisone dec IgG
  17. Levamisole
    MOA: enhance T cell mediated response

    USE: Duke stage C colon cancer

    A/E: neutropenia, anemia, agranulocytosis
  18. Bacillus calmette guerin
    non-specific immunostimulant

    Use: Intravesica I therapy of bladder cancer

    Inhibits TNF-a production
  19. INF a
    • inc class I MHC
    • Dec class II MHC

    • Use: Hairy cell leukemia
    • Hep B/C
    • cancer
    • condyloma acuminatum
  20. INF b
    MS
  21. INF gama
    granulomatous disease

    MOA: activates phagocytes
  22. Aldesleukin
    IL

    inc cytotoxic and NK cells

    • USE: renal cancer
    • metastatic melanoma

    A/E: capillary leak syndrome
  23. oprelvekin
    IL

    inc platelet formation

    Use: thrombocytopenia
  24. Filgastim
    CFU-G -> inc granulocytes

    USE: BM recovery
  25. Sargramostin
    GM-CSF graulocyte and macrophages

    • USe: myeloid recovery (from high dose chemo)
    • Non-Hodgkins lymphoma
    • Acute lymphoblastic leukemia
    • Hodgkins and BMT
    • neutropenia of AIDS patient

    • CONTRA:
    • heart failure
    • pulmonary edema
    • yeast hypersenstivity (derived from yeast)
  26. epoetin- alpha
    anemia treatment


    Heart and liver toxic
  27. thrombopoetin
    • GM-CSF and IL13
    • megakarycytopoesis

    • USE: anemia
    • neutropenia
    • thrombocytopenia

    inc platelet recovery of hematopoietic stem cell transplant

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