Corticosteroid

Use: (1) Allergic disorders (2) Hematologic disorders (3) Hepatic and renal disease (4) Collagen disorders

 MOA: (1) Concentration, distribution, and function of peripheral leukocytes and macrophages (2) Inhibit phospholipase A₂ and COX₂

Toxicity Long Term: (1) Iatrogenic Cushing Syndrome (2) Osteoporosis (3) Infections (4) Ulcer

No Short term side effects

Corticosteroids

Use: (1) Allergic Disorders (2) Hematologic disorders (3) Hepatic and renal disease (4) Collagen disoders

MOA: (1) Concentration, distribution and function of peripheral leukocytes and macrophages (2) Inhibit phospholipase A₂ and COX₂

Toxicity long term: (1) Iatrogenic Cushing Syndrome (2) Osteoporosis (3) Infections (4) Ulcers

No short term side effects

Cytotoxic and Antiproliferative Agents (T & B)

Purine Analog - inhibits nucleotide synthesis

MOA: (1) Antimetabolite, Signal 3 inhibitor (2) Cell-cycle specific inhibiting nucleotide synthesis (3) Inhibits T cells more than B cells

Use: Renal Allotransplantation and Rheumatoid Arthritis

Toxicity: N/V, Bone Marrow Suppresion, Infections

Should not be used for treatment of RA in pregnant women

Increases patients' risk for carcinogenesis

Serious infection can occur (all immunosuppresants)

Cytotoxic and Antiproliferative Agents (T & B)

Folic Acid Analog

MOA: (1) Antimetabolite blocking synthesis of purine nucleotides, signal 3 inhibitor (2) cell-cycle specific (3) inhibits B and T cells

Cells sensitive to methotrexate are actively proliferating (e.g. malignancies, bone marrow, fetal cells, etc.)

Use: Crohn's, Rheumatoid Arthritis, Leukemias and other tumors

Toxicity: N/V, Bone Marrow suppression, hepatotoxicity

Cytotoxic and Antiproliferative Agents (T & B)

Nitrogen Mustard

MOA: (1) Alkylating agent, Signal 3 inhibitor (2) non cell cycle specific (3) inhibits B & T cells (especially those that have undergone Ag differentiation)

Use: Rheumatoid Arthritis; Leukemias & other tumors

Toxicity: Nausea/Vomiting, Bone Marrow Suppression, aspermia (faaaack)

Serious and sometimes fatal infections can develop with cyclophosphamide

T-Cell Suppressants

Cyclic Polypeptide

MOA: (1) Calcineurin phosphatase & signal 1 inhibition (2) T-Cell suppression (3) Inhibits release of IL-2 necessary to active T-cells (recall immuno!)

Use: Renal/Liver/Heart transplant rejection, Rheumatoid arthritis, extreme psoriasis

Toxicity: (1) Nephrotoxicity (Important for Exam) (2) Hypertension (3) Embryotoxic

Used with adrenal corticosteroids

T-Cell Suppressant

Mycophenolic acid derivative

MOA: (1) Inhibition of synthesis of purines (specifically guanosine), signal 3 inhibition (2) Inhibit B and T cells

Use: Renal/Liver/Heart transplant rejection, used with cyclosporine and corticosteroids

Toxicity: GI, Neutropenia, Infections (meningitis, endocarditis, tuberculosis)

T-Cell Suppressant

Murine Immune Globulin

MOA: (1) [CD3] receptor & signal 1 inhibition (2) T-Cell suppression

Use: Renal/Liver/Pancreas/Heart transplant rejection

Toxicity: Fever & Chills, sensitivity to murine products

T-Cell Suppressant

Horse Immune Globulin

MOA: IgG bound lymphocytes are eliminated

Use: Renal transplant rejection

Toxicity: Fever and chills, sensitivity to equine serum

T-Cell Suppressant

Human IgG1 monoclonal antibody

MOA: IL-2 receptor/Signal 3 inhibitor (these two are the same thing!) = no IL-2 mediated activation of lymphocytes

Use: Renal/Cardiac Transplant Rejection

Toxicity: GI disorders

Antibody Immunosuppressive

Human Immune Globulin

MOA: Suprresses immune response of Rh-negative individuals to Rh-positive blood cells

Use: Erythroblastosis fetalis (hemolytic disease of newborn)

Contraindicated in Rho+ patients

Agent for replacement therapy

Human Immune Globulin [IgG & IgM]

MOA: Passive immunity increased; helps prevent certain infectious disease in susceptible individuals

Use: (1) Hypogammaglobulinemia (2) Prevent infection in HIV patients (3) Patients with Guillain-Barre Syndrome, idiopathic thrombocytopenic purpura, and infections with bone marrow transplants

Made from other humans, can cause allergic reaction and can carry blood born pathogens

Immunomodulator

166 aa protein

MOA: (1) antiviral and immunoregulatory activity (2) not completely understood

Use: Relapsing-remitting MS

Toxicity: (1) flu-like symptoms (2) depression/suicidal ideation (3) injection sight reactions

Most serious effects are depression, suicidal ideation, and injection sight reactions!

Immunomodulator

140 aa protein

MOA: (1) Phagocyte activating effects (promotes killing of intracellular bacteria) (2) Antibody-dependant cellular cytotoxicity

Use: (1) Chronic granulomatous disease (goal - reduce frequency of infections) (2) Osteoperosis

Toxicity: Flu-like symptoms

Chronic granulomatous disease is an inherited immune system disorder in which phagocytes do not function properly