ISST 12 Quiz 2

What is chronic joint inflammation and a genetically inherited autoimmune disease?

RA

What is the key driver of RA?

TNF

What are the targets of RA?

Cytokines

T cells

B cells

What does DMARD stand for?

Disease-Modifying Anti-Rheumatic Drugs

What is a folic acid analog that inhibits DHT and lowers RNA/DNA synthesis?

Methotrexate

What suppresses T cells+ B cell proliferation lowering cytokines like IL-1, IL-6, and TNF?

Sulfasalazine

What cross-links DNA preventing replication and supresses T and B cells?

Cyclophosphamide

What is a purine synthesis inhibitor that lowers B and T cells, ig production and IL-2?

Azathioprine

What is a pyrimidine synthesis inhibitor that lowers just.T cell proliferation and autoantibodies?

Leflunomide

What is an anti-malarial, suppresses T cells and leukocyte chemotaxis?

Hydroxychloroquine

What is a calcineurin inhibitor lowering IL-1 and 2 and T cell activation?

Cyclosporin

What is a mettaloproteinase inhibitor that prevents joint destruction?

Minocycline

What are the anti-TNF drugs?

Adalimumab

Golimumab

Infliximab

Certolizumab

Etanercept

What is a fully human monoclonal antibody?

Adalimumab

What is a chimeric mouse and human drug?

Inflixumab

What is a decoy receptor that binds to TNF-@ and TNF-B?

Etanercept

What are non TNF-biologics?

Toclizumab

Abatecept

Rituximab

Anakinra

What is an IL-1 receptor antagonist and a non TNF?

Anakinra

What is a non-tnf biologic that blocks IL-6 receptor?

Tocilizumab

What activates synovial fibroblasts?

TNF

IL-1

What causes joint destruction?

Metalloproteinases

What are the anti-malrials?

ChlFansidar

Atovaquone

Chloroquine

What anti-malarial has toxic heme accumulation?

Chloroquine

What anti-malarial inhibits ETC (cytochrome bc1)?

Atovaquone

What anti-malarial has sulfadoxine+pyrimethamine?

Fansidar

What anti-malarial is CI in G6PD deficiency?

Primaquine

What is a tissue + blood schizonticide?

Tafenoquine

What are possible therapeutic targets for RA?

Cytokines

T and B cells

What is a salicylate that suppresses T cell responses and inhibits in vitro B cell proliferation as well as inhibiting release of cytokines?

Sulfasalazine

What is a pyrimidine synthesis inhibitor that inhibits T cell proliferation and reduces B cell producing autoantibodies?

Leflunomide

What is an anti-malarial drug with anti-inflammatory effects(T cell suppression, leukocyte chemotaxis inhibition)?

Hydroxycholoroquine

What is a calcineurin inhibitor that inhibits IL-1/IL-2 receptor production and macrophage-T cell interaction as well as T cell responsiveness/differentitation via regulation of gene transcription?

Cyclosporine

What is a recombinant, humanized antibody Fab fragment conjugated to PEG, that neutralizes membrane bound and soluble TNF-@?

Certolizumab

What is a humanized IgG fusion protein that binds to soluble and membrane bound TNF-@?

Infliximab

What is a human monoclonal antibody that neutralizes inflammatory effects produced by TNF-@?

Golimumab

What is a humanized antibody to IL-6 that binds to soluble and membrane-bound IL-6 receptors?

Tocilizumab

What is a recombinant version of the Interleukin 1 receptor antagonist(IL1-RA) and competes with IL-1 binding to IL-1R blocking the effects of IL-1@ and Beta?

Anakinra

What is responsible for RA joint/cartilage destruction and a good therapeutic target?

Metalloproteinases

What describes a condition with Demyelination, gliosis, and irreversible neuronal damage or loss?

Multiple sclerosis

What is a glial cell that wraps axons in myelin sheaths in the CNS and affected by MS?

Oligodendrocyte

What is the key to saltatory conduction?

Myelin

• increased speed of nerve impulses by spreading out voltage gated Na+ channels

Which anti-malarial has toxic accumulation of heme inside parasite?

Chloroquine

What anti-malarial generates ROS and damages parasite?

Primaquine

Tafenoquine

What anti-malarial inhibits the ETC?

Atovaquone

Which antimalarial inhibits dihydrofolate reductase?

Pyrimethamine

Which antimalarial inhibits dihydropteroate synthase?

Sulfadoxine

What are blood schizonticides?

Doxycycline

Quinine

Choroquine

Atovaquone

Mefloquine

Artemether

Which are tissue schizonticides

Primaquine

Tafenoquine

What pattern has symptomatic attacks that can last days or weeks and >85% of cases at onset?

Relapsing Remiting MS

What pattern has steady decline with no periods of remission and associated with later onset >40 yo?

Primary progressive MS

What pattern has a change in course where decline does not have attacks and affects most patients with RRMS over time?

Secondary progressive MS

What is the diagnosing criteria for MS?

>2 episodes of sx

>2 signs of pathology in noncontigous tracts of the CNS(MRIs)

What identifies areas of BBB breakdown and high proton density?

MRIs

What are ancillary tests?

CSF analysis

• pleocytosis, intrathecal IgG

Speed of evoked potentials

• somatosensory, visual and brain stem

What stage shows autoreactive lymphocyte filtrates, breakdown of BBB w/o vasculitis, and T and B cell infiltration in CSF, previascular, and parancheyma?

Early stage

What stage shows reduced lymphocyte infiltration and development of perivascular tertiary lymphoid structure in CNS with a bigger role for CNS-resident cells like myelin-reactive microglia, ROS, RNS, and glutamate?

Late

• microglial activation

Which stage has accumulation of neurotoxic factors causing cellular stress and neurogenerative damage?

Smoldering(Late) stage

What can be seen in humoral response in MS?

Increase in IgG

What are non-specific IgGs seen in CFSs that are absent in the normal serum?

Oligoclonal bands

What have antibody-independent roles?

B cells

WHat therapy may impact antigen presentation?

Anti-CD20

What is a bioactive lysophospholipid metabolite that has a role in CNS development and inflammation?

S1P

What metabolism has been observed in neurodegenerative diseases like Alzheimers and parkinsons?

Sphingolipid

What can interfere with infiltration via S1PR1 modulation?

Fingoliomod

Siponimod

What can modulate S1PR1 and S1PR5?

Siponimod

What is it called when myeloid and lymphocyte hella depend on glycolysis?

Warburg effect

What happens if glycolysis is inhibited?

Harvests intermediates and makes more anti-inflammatory phenotypes

What is a key environment factor in MS?

EBV

What are classic immunomodulating anti-inflammatory drugs?

Interferon beta(1a and 1b)

Methylprednisolone

What are T cell AND B cell killers?

Rituxumab

Ocrelizumab

Methotrexate

Cladribine

What are T-cell modulators that don’t kill but change behavior?

Glatiramer acetate

Fingolimod

Natalizumab

What are oxidative stress MS drugs?

Dimethyl fumerate

What are muscle strength balance drugs for MS?

Dalfampridine

How often is IV methylprednisolone dosed?

Monthly

What is first line for RRMS and have 2 cytokines that balance pro and anti inflammatory agents in the brain?

Interferon Beta

What drug has flu like sx, injection site reaction, BMS, elevated LFTs, psych events, thyroid, and CV disease?

Interferon beta

What is a purine nucleoside analog that inhibits DNA synthesis but NOT specific?

Cladribine

What drug irreversibly inhibits dihydrofolate reductase inhibiting DNA synthesis and specific for S phase?

Methotrexate

What drug has AE of alopecia and dermatologic reactions?

Methotrexate

Which drug is indicated for MS and the first to be approved for PPMS and uses an epitope?

Ocrelizumab

What drug is 2nd line due to development of multifocal leukoencephalopathy?

Natalizumab

What is the first oral disease modifying drug approved for RRMS?

Fingolimod

What drug decreases CNS lymphocyte inflammation through the modulation of sphingosine 1-phosphate receptor?

Fingolimod

What is a non-interferon that is 1st line for RRMS and should be used in a 1st clinical episode of MS?

Glatiramer acetate

What drug is a 4 amino acid polymer similar to myelin basic protein and a component of myelin sheath?

Glatiramer acetate

What are the amino acids in Glatiramer acetate?

Glutamic acid

Lysine

Alanine

Tyrosine

What drug activates nuclear factor-like 2 pathway decreasing oxidative stress?

Dimethyl Fumerate(BG-12)

What is approved for all forms of MS and can assist in helping someone walk?

Dalfampridine

What drug blocks potassium channels prolonging action potentials

Dalfampridine

What form does dalfampridine come in?

Oral

What is empirical therapy for MS?

IV methylpredisolone

Methotrexate

Mitoxantrone

Clabribine

What is the best drug for PPMS?

Ocrelizumab

What is non-pharm for MS?

Complementary Alternative Medicine

Vitamin D, B6, B12

THC

CBD

What increase S/A, comes in contact with digestion products and microbiota and close to blood and lymphatics?

Vili

What determines what microorganisms are exposed to?

Environment

What determines what microorganisms can stay in the GI tract?

Internal factors

What determines what can easily influence the microbiota in a person?

Lifestyle management

Which immunity is reactive?

Systemic

Which immunity anticipates infection?

Gut

What are responsible for the gut anticipation controlling microbiota?

IgA and effector cells

• non-inflammatory