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IMMUNE SYSTEM DRUGS ยาที่มีผลต่อระบบภูมิคุ้มกัน - Coggle Diagram
IMMUNE SYSTEM DRUGS
ยาที่มีผลต่อระบบภูมิคุ้มกัน
The immune system
Nature immunity ไม่มีความจำเพาะเจาะจงต่อเชื้อจุลินทรีย์หรือเชื้อ
◻ Skin
◻ Mucus, saliva
◻ Coughing and sneezing
◻ Vaginal secretions (slightly acidic)
◻ Stomach, gastric acid
Acquire immunity
◻ Lymphocytes
⬜20–40% of white blood cells (WBCs)
⬜originate in the bone marrow but migrate to parts of the lymphatic system such as the lymph nodes, spleen, and thymus.
⬜ There are two main types of lymphatic cells.
■ B cell
■ T cell
Helper T cells, or Th cells (CD4),
◻ Coordinate immune responses by communicating with other cells.
■ Stimulate nearby B cells to produce antibodies
■ Activate phagocytes
■ Activate other T cells
Cytotoxic T lymphocytes (CTLs)
◻ = killer T cells
◻ These cells directly attack other cells carrying certain foreign or abnormal molecules on their surfaces.
◻ Attack to kill the infected cell
Immunization
◻ the process where by a person is made immune or resistant to an infectious disease.
◻ เป็นกระบวนการที่ร่างกายสร้างภูมิคุ้มกันเพื่อมาต่อต้านการติดเชื้อ
Immunity Types
◻ Passive immunization
◻ Direct transfer or administration of antibodies to a non-immune person to provide immediate protection.
◻ Lasts only for a few weeks or months.
◻ สร้างภูมิคุ้มกันโดย ให้ Abs ที่ผลิตขึ้นแล้วนอกร่างกาย (คน หรือสัตว์) ฉีดเข้าร่างกายโดยตรง
◻ ผลของภูมิคุ้มกันจะเกิดขึ้นทันที แต่ภูมิคุ้มกันจะคงอยู่ช่วงสั้น (weeks -months)
◻ Active immunization
◻ when exposure to a disease organism triggers the immune system to produce antibodies to that disease
◻ Exposure to the disease organism can occur through :
■ Infection ■ Vaccination
◻ If an immune person comes into contact with that disease in the future,their immune system will recognize it and immediately produce the antibodies needed to fight it.
◻ Long-lasting, and sometimes life-long.
◻ ภูมิคุ้มกันเกิดขึ้นอย่างช้าๆ ต้องใช้เวลาเพื่อให้ร่างกายสร้างภูมิคุ้มก
Types of active immunization
Toxoid
⬜ A bacterial toxin
■ Toxicity has been inactivated or by chemical (formalin) or heat treatment.
■ Immunogenicity are maintained.
■ Without resulting in toxin-induced illness
⬜Ex. Diphtheria (คอตีบ), Tetanus (บาดทะยัก) , Botulism (clostridium botulinum)
Live attenuated vaccine
⬜ A living microorganisms (viruses, bacteria) that have been weakened under laboratory conditions.
⬜ Excellent immune response
⬜eg. Tuberculosis (BCG), Oral polio vaccine (OPV), Measles (หัด),Rotavirus, Yellow fever (ไข้เหลือง)
Inactivated vaccine (Killed vaccine)
⬜ Virus/bacteria particles which are grown in culture and then killed using a method such as heat or formaldehyde
⬜ Cannot cause disease
Whole cell
⬜ polio vaccine (Salk vaccine) , influenza vaccine , typhoid vaccine,pertussis vaccine, อหิวาตกโรค ไข้สมองอักเสบ พิษสุนัขบ้า Hepatitis virus A vaccine
Subunit vaccine
⬜ Hepatitis virus B vaccine, influenza vaccine
Immunomodulator
Immunosuppressants
◻ Calcineurin Inhibitors
⬜Cyclosporine
◻ Mechanism of Action
⬜Calcineurin inhibitor => Suppresses cellular and humoral immunity(mainly T cells)
⬜ยับยั้งการสร้างสาร IL-2 โดยยาจับกับ cyclophilin receptor ทำให้ยับยั้งการทำงานของโปรตีน calcineurin ทำให้เกิดการยับยั้งกระบวนการตัดหมู่ฟอสเฟตจาก NF-AT (Nuclear factor of activate T-cell) ซึ่ง NF-ATจำเป็นสำหรับการสร้างสาร interlukin (IL) ซึ่งจำเป็นสำหรับระบบภูมิคุ้มกันที่อาศัย T-cell
◻ Use:
⬜Prophylaxis of organ rejection (Graft versus host disease)
⬜Bone marrow transplantation
⬜Rheumatoid Arthritis (โรคข้ออักเสบรูมาตอยด์)
⬜Psoriasis (สะเก็ดเงิน)
an autoimmune disorder affecting the skin resulting in red to silvery patches of dry and scaly skin.
◻ Adverse effect
⬜Nephrotoxicity
⬜Neurotoxicity (Tremor)
⬜Gingival hyperplasia
⬜Hirsutism
⬜Hyperkalemia
⬜Hyperglycemia
⬜Triglycerides increased
⬜Hypertension
⬜Headache Nausea
◻ Precautions:
⬜Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication.(Grapefruit products can increase the amount of this medication in your bloodstream.)
⬜Gingival hyperplasia => Brush your teeth and floss daily to minimize this problem.
⬜This drug may increase your risk for developing skin cancer.(avoid sunscreen)
⬜Tacrolimus
◻ Mechanism of Action
⬜ยับยั้ง Calcineurin แต่จับที่ FK-binding protein-12 (FKBP-12)
◻ Metabolism
⬜Metabolized in liver by CYP3A4
◻ Use:
⬜Prophylaxis of organ rejection in patients receiving allogeneic transplants มักใช้ร่วมกับยากลุ่ม glucocorticoids
◻ ADR
⬜Nephrotoxicity
⬜Neurotoxicity (Tremor)
⬜Headache
⬜Hyperkalemia
⬜Hypertension
◻ mTOR Inhibitors
⬜Sirolimus
◻ Mechanism of Action
⬜Inhibits T-cell activation and proliferation and inhibits antibody production (เนื่องจากการยับยั้ง mTOR จะปิดกั้นการแบ่งตัวของ T cell)
◻ Metabolism
⬜Oral
⬜CYP3A4
Use
ใช้ร่วมกับ cyclosporine หรือ tacrolimus และ gluccocorticoids ในผู้ป่วยที่รับการปลูกถ่ายไต (renal transparent)
◻ Adverse Effects
⬜Hypertriglyceridemia
⬜Hypercholesterolemia
⬜Thrombocytopenia
⬜Anemia
⬜Infection
⬜Hypokalemia
⬜Nausea vomiting
◻ Adrenocorticoids
⬜Dexamethasone
⬜Methylprednisolone
⬜Prednisolone, prednisone
◻ Miscellaneous
⬜Anakinra
◻ Antimetabolites
⬜Azathioprine, lefluomide
◻ Mechanism of Action
⬜Purine synthesis inhibitor => inhibiting the proliferation of cells, especially leukocyte
⬜Prevents mitosis and proliferation of rapidly dividing cells, such as activated B and T lymphocytes
◻ Use
⬜Prevention of transplant rejection (Renal transplantation)
◻ DI
⬜Allopurinol => Azathioprine (Azathioprine เมตาบอลิซึมโดยเอนไซม์Xanthine oxidase)
◻ Adverse Effects
⬜Leukopenia Infection
⬜N/V
⬜Methotrexate
⬜Hydroxychloroquine
⬜ Cyclophosphamide
◻ Mechanism of action
⬜Suppress bone marrow function
■ Prodrugs ถูก metabolite ที่ตับ โดย CYP 450
■ They crosslink DNAs resulting in inhibition of DNA synthesis in B cells และ T cells
◻ Use
⬜Systemic lupus erythematosus
⬜Autoimmune hemolytic anemias
⬜RA
⬜Organ transplantation
◻ Side effects:
Hemorrhagic cystitis
⬜Alopecia
⬜Nausea and vomiting
⬜Sterility
⬜Pancytopenia
⬜Mycophenolate Mofetil (MMF)
◻ Mechanism of Action
⬜Inhibits purine synthesis, preventing proliferation of T and B cells
Use
⬜Prophylaxis of organ rejection in patients receiving allogeneic renal,cardiac, hepatic, transplants
Adverse Effects
⬜GI symptoms (diarrhea)
⬜Neutropenia
⬜Mild anemia
⬜Infection
⬜CMV
Precautions
⬜(gingival hyperplasia
⬜Avoid contact with people who have the flu or any other infection
◻ Antibodies
⬜Polyclonal antibodies
⬜Antilymphocyte globulin(ALG)
⬜Antithymocyte globulin(ATG)
⬜Immune globulin intravenous(IGIV)
⬜Rh0 immune globulin moicrodose
⬜Hyperimmune Igs
⬜monoclonal antibodies
⬜Anti IL-2 receptor mAbs / Basiliximab, daclizumab
⬜Anti-CD2 Abs / Alefacept
⬜Anti-CD3 mAbs / Muromonab-CD3
⬜Anti-CD52 mAbs / Alemtuzumab
⬜Anti-TNF-alpha mAbs / Adakimumab, etanercept,infliximab
⬜Anti-IgE mAbs: Omalizumab
Immunostimulants
◻ Bacterial vaccines
◻ Colony stimulating factors
◻ Interferons
◻ Interleukins
◻ vaccines
◻ Aldesleukin
◻ Interferons
◻ Palivizumab
◻ Filgrastim
◻ Sargramostin
◻ Thalidomide
Immunostimulants
◻ Immunostimulants
⬜ Substances that stimulate the immune system
◻ Use
⬜immunodeficiency disorders
⬜Chronic infections
⬜ cancer
◻ Colony stimulating factors
⬜Are glycoproteins that promote production of white blood cells in response to infection.
⬜Used in patients who are undergoing cancer treatment that causes low white blood cell counts (neutropenia) and puts the patient at risk of infection.
⬜ eg. Filgrastim, Sargramostim,
⬜Filgrastim
◻ Mechanism
⬜stimulating the production of neutrophils by bone marrow.
◻ Use
⬜Decreasing the risk of infection in certain patients, including cancer patients who are receiving chemotherapy or a bone marrow transplant.
◻ ADR
⬜Bone or muscle pain
⬜Headache
⬜Nausea, vomiting
⬜Nosebleed
⬜Edema
⬜Chest pain
⬜Sargramostim
◻ Mechanism
⬜Stimulating production of white blood cells in bone marrow.
◻ Use
⬜bone marrow transplant. กระตุ้นการสร้างเม็ดเลือดขาวในผู้ป่วยมะเร็งหลังปลูกถ่ายไขกระดูก
◻ ADR
⬜Bone, muscle, or joint pain
⬜Diarrhea
⬜Hair loss
⬜Loss of appetite
◻ Interferons
◻ Mechanism of action
⬜Are proteins produced by tumor cells or host cells that are infected with viruses, bacteria and other unknown nucleic acids.
⬜Activate other cells that serve as part of the immune system and destroy invading pathogens.
⬜Interferon alpha
■Viral infections (chronic hepatitis, human papillomavirus)
■Hairy cell leukemia
■Kaposi sarcoma, Malignant melanoma
⬜Interferon beta
■Multiple sclerosis
⬜Interferon gramma
■Chronic granulomatous disease.
◻ Interleukins
◻ A group of cytokines which are synthesized by lymphocytes,monocytes, macrophages, and certain other cells.
◻ eg. Aldesleukin
Aldesleukin
◻ Mechanism of action
⬜เป็น IL-2 ที่สังเคราะห์ขึ้นกระตุ้นการเจริญของ T-cell
◻ Use
⬜Metastatic renal cell carcinoma
◻ ADR
⬜Hypotention
⬜Infection