Term
| How does treatment vary with different stages of chemo? |
|
Definition
Induction: high dose combo or therapy
Consolidation: repetition of induction therapy during remission
Intensification: induction therapy at higher doses Maintenance: Long term, lower dose therapy during remission |
|
|
Term
| When are immunosuppressants used? |
|
Definition
During organ transplantation
Diseases where inflammation is underlying cuase |
|
|
Term
| What is phase 1 activation of the mechanism of Immunosuppressants? |
|
Definition
Block T cell surface receptor
Block Transmission of prolif signals from cell surface receptors to nucleus
Block transcription of pro-inflam mediators |
|
|
Term
| What is phase II activation of the mechanism of immunosuppressants? |
|
Definition
| Block prolif of already activated T cells |
|
|
Term
| When is Induction regimens of immunosuppressants done? |
|
Definition
| At the time of transplantation to prepare for it. |
|
|
Term
| What factors should be considered during induction immuno therapy? |
|
Definition
MHC match
Prep of Organ
Hx of recipient |
|
|
Term
| Why isn't induction immuno therapy sustainable? |
|
Definition
| Relatively intense prolong-> toxicities |
|
|
Term
| What does Maintenance Immuno therapy generally consist of? |
|
Definition
triple-drug therapy that work at different levels of the inflammation cascade
Lower does/potency |
|
|
Term
| When is rescue immuno therapy used? |
|
Definition
in response to rejection episodes
Intense, high dose |
|
|
Term
| What drugs block presentation of Ag by APC to TCR and concurrent binding of costimulatory molecules? |
|
Definition
|
|
Term
| What drugs inhibit activation of calcineurin (a phosphatase)? |
|
Definition
|
|
Term
| What drugs block increased transcription of IL-2 gene? |
|
Definition
|
|
Term
| What drugs blocks IL-2 binding to CD25 of activated T-cells? |
|
Definition
|
|
Term
| What drug inhibits mTOR activation? |
|
Definition
|
|
Term
| What drugs block regulation of cell cycle? |
|
Definition
Mycophenolate mofetil
Azathioprine
Cyclophosphamide |
|
|
Term
| What are the immunosuppressant antibodies that bind to surface receptors? |
|
Definition
|
|
Term
| Which immunosuppressant is an anti-CD52 Ab? |
|
Definition
Alemtuzumab
(CD52 expressed on mature B and T cells, NK cells, monocytes, macrophages, platelets, and male reproductive tissues) |
|
|
Term
| What Antibody immuno has profound and long lasting lymphopenia that may require prophylaxis to prevent infections? |
|
Definition
|
|
Term
| Which antibody immunos effects are reversible? |
|
Definition
|
|
Term
| Who should not recieve Muromonab-CD3? |
|
Definition
| pts who develope human-mouse Ab titers >1:1000 (will be ineffective) |
|
|
Term
| What are the Calcineurin Inhibitors? |
|
Definition
|
|
Term
What is the mechanism of Calcineurin inhibitors?
(cyclosporine, tacrolimus) |
|
Definition
inhibts phase I activation of T cell
Inhibits calcineurin-> NFAT no dephosphorylated-> NFAT cant translocate to nuleus-> no cytokine production |
|
|
Term
| What Calcineurin inhibitor is more potent in inhibiting T cell prolif? |
|
Definition
| Tacrolimus 100x more potent then cyclosporine |
|
|
Term
| What is the major toxicity for the calcineurin inhibitors? |
|
Definition
|
|
Term
| What is the mechanism of corticosteroids? |
|
Definition
| Decrease number of circulation cells and inhibit cytokine production |
|
|
Term
| How do low doses of corticosteroids work in the nucleus? |
|
Definition
| decrease transcription of inflammatory mediators |
|
|
Term
| How do high doses of corticosteroids work in the nucleus? |
|
Definition
| increase transcription of ANTI-inflammatory gens |
|
|
Term
| What is the CD25 inhibitor? |
|
Definition
|
|
Term
What is the mechanism of the CD25 inhibitors?
(declizumab) |
|
Definition
| block IL-2R expressed on surface of activated Tcells |
|
|
Term
| What adverse effects do the CD25 inhibitors have? |
|
Definition
GI disorders
Severe Acute hypersensitivity rxns |
|
|
Term
|
Definition
|
|
Term
| What phase of activation does sirolimus inhibit? |
|
Definition
Second Phase
Binds FkBP12 but inhibits activation of rapamycin |
|
|
Term
| What is sirolimus synergistic with? |
|
Definition
|
|
Term
| What is sirolimus effect on B cells? |
|
Definition
| prevents B cell differentiation into Ab producing cells |
|
|
Term
| What toxicity of sirolimus can be Fatal with chronic exposure? |
|
Definition
hepatotoxicity
hepatic necrosis |
|
|
Term
| What are the cell cycle Disruptors? |
|
Definition
Mycophenolate mofetil
Azathioprine
Cyclophosphamide
Methotrexate |
|
|
Term
| What cell cycle disruptor inhibits inosine monophosphate DH? |
|
Definition
Mycophenolate mofetil
(->prevents guanosine production form inosine-> decre DNA syn-> stops cell cycle) |
|
|
Term
| What are the advantages of Mycophenolate mofetil? |
|
Definition
Blocks secondary Ab response mediated by memory B cells
Selective effect on lymphocyte prolif
No chromosomal Breaks |
|
|
Term
| What cell cycle disruptor is used as a precursor to 6-MP? |
|
Definition
|
|
Term
| If a patient has a variant TPMT genotype what happens when if they take Azathioprine? |
|
Definition
normal dose-> increased toxicity
(not metabolized to less active metabolites) |
|
|
Term
| What drug can increase the toxicity of Azathioprine? |
|
Definition
|
|
Term
| What tests need to be done before dosing of Azathioprine? |
|
Definition
TPMT
preg test
CCBC
metabolic panel |
|
|
Term
| Which cell cycle disruptor is metabolically activated? |
|
Definition
|
|
Term
| Which cell cycle disruptor has a side effect of hemorrhagic cystitis? |
|
Definition
|
|
Term
| What is the dose limiting toxicity of cyclophosphamide? |
|
Definition
|
|
Term
| What metabolite of cyclophosphamide binds with MESNA? |
|
Definition
|
|
Term
| What cell cycle disruptor inhibits DHFR? |
|
Definition
|
|
Term
| At what phase does methotrexate inhibit the cell cycle? |
|
Definition
|
|
Term
| What is leucovorin used for after methotrexate treatment? |
|
Definition
| to re establish the cell cycle in other cells |
|
|
Term
| What is the Costimulator Blockers? |
|
Definition
|
|
Term
| What costimulator blockers is used to treat psoriasis? |
|
Definition
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