mimic the action of cortisol, an endogenous clucocorticoid (turns immune activity/inflammation down). catabolic effects (hyperglycemia, hypercalcemia, muscle breakdown), inflammatory effects (incr neutrophil counts but decr their migration into tissue, decr all other counts)
systemic steroids other SE
weight/water gain (moon face), skin (thin skin, violaceous striae/stretch marks, ulcers), avascular necrosis of the hips, Cushing's, adrenal suppression
mineralcorticoids v glucocorticoids
dexamethasone only antiinflammatory (glucocorticoid), no mineralcorticoid. prednisone is a glucocorticoid with minimal mineralcorticoid activity.
destroy or interfere with B cell's ability to mount an immune response. CD20 induces apoptosis and is found in 90% of B-cell neoplasms.
B-cell biologics kinetics
T1/2 dependant on how many CD20 receptors available to bind and take drug out of circulation. takes 9-12 months for counts to recover.
B-cell biologics SE
infusion rxns, progressive multifocal leukoencephalopathy (due to infection)
T-cell biologics targets
CD3, CD25, CD11a, LFA-3 (aka CD58), CD28
T-cell biologics SE
strong inflammatory reaction (cytokine-release syndrome) often occurs with the first dose of OKT3 (newer drugs have been designed to be nonactivating so as to avoid this problem).
mixed biologic targets
mixed biologic indications
alemtuzumab CA, transplant. tocilizumab doesn't destroy lymphocytes, so only use is RA.
binds and inhibits mTOR, stopping cell cycle progression. immunosuppressant/antineoplastic effects include inhibition of VEGF, proliferation, activation, and possibly more.
target of rapamycin (mTOR) inhibitors indication
target of rapamycin (mTOR) inhibitors interactions
mTOR inhibitors + calcineurin inhibitors = greater risk of nephrotoxicity
target of rapamycin (mTOR) inhibitors SE
messes with systems that have high cell turnover. also interstitial pneumonitis, metabolic effects (hyperglycemia, hyperlipidemia)
competes for binding to MHC II molecules on antigen presenting cells, and induces Th suppressor cells. these antiinflammatory factors may facilitate remyelination and provide a protective effect for axons.