Immune Disorder Medications

Epinephrine

Class: Adrenergic Agonist

MOA:

• stimulates A1, B1, and B2

Used for anaphylaxis

ADRS:

• tachycardia

• hypertension

• tremors

*Repeat every 5-15 minutes if symptoms don’t resolve

Interferon Alfa-2B

Cytokine Immunomodulator

MOA:

Binds interferon receptors

activates enzyme JAK-STAT pathway

enhances NK cell and cytotoxic T-cell activity

Used in Hep B and Hep C, melanoma, Kaposi’s sarcoma, leukemia

ADRS: flu-like symptoms, bone marrow suppression, hepatotoxicity

• Monitor CBC, AST/ALTs, mood changes

• refridgerate and do NOT shake

Immunosuppressants

inhibits immune cells and inflammatory processes

Types

1.) corticosteroids

2.) Conventional DMARDs

3.) Targeted DMARDs

4.) Transplant Immunosuppressants

Corticosteroids

Broad immune suppression by blocking COX 1

MOA:

bind glucocorticoid receptors —> suppress cytokines and T-cell activation

EX: prednisone, hydrocortisone, dexamethasone

• check blood sugar!!

Conventional DMARDs

First-line autoimmune

MOA: suppresses immune cell life and inflammation

EX: methotrexate, hydroxychloroquine, sulfasalazine (chrons)

Methotrexate Prototype

DMARDs Prototype

Used for:

• RA (administer 7.5-25 mg once weekly)

MOA:

• suppresses B and T lymphocytes

ADR:

• folic acid deficiency

• teratogenicity (NO pregnancy)

*monitor CBC and Liver

*give folic acid

*avoid alcohol and NSAIDs

*can’t give LIVE vaccines, but inactivated vaccines are ok

Targeted DMARDs

Advanced Immunotherapy

Types:

• TNF Inhibitors = block TNF-a

• Interleukin Inhibitors = block IL cytokines

• B cell inhibitors = targets CD20

• T-cell inhibitors

• JAK inhibitors

Used for RA and other autoimmune disorders

*make sure to test for TB first!

Etanercept Prototype

TNF Inhibitor, Targeted DMARDs

MOA:

• binds to TNF and prevents it from activating TNF receptors

Used for RA (50 mg once weekly or 25 twice weekly)

ADRs:

• injection site reactions

*screen for latent TB and Hep B first!!

Transplant Immunosuppressant Types

Types:

• Calcineurin Inhibitors

• antimetabolites

• alkylating agents

Cyclosporine Prototype

Calcineurin Inhibitor Transplant Immunosuppressant

Used to prevent cells from attacking new organ after transplant rejection

taken for life: lifelong drug

MOA:

• inhibits calcineurin

• blocks IL-2 production and T-cells

ADRS:

• nephrotoxicity

• low bone marrow and leukopenia (low WBC)

*Monitor BUN, liver

*avoid grapefruit juice = interacts with CYP450

*don’t give to pregnant people

Hydroxychloroquine

Used for Lupus

taken for several months to reach therapeutic level

ADRS:

• retinal damage/ vision issues

Adalimumab + infliximab

Immunosuppressants (TNF inhibitors)

same drug fam as etanercept