Immunosuppressants

Immunosuppressants US Medical PG Question 1: Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea. He appears lethargic. Physical examination shows yellow sclerae. There is a generalized maculopapular rash on his face, trunk, and lower extremities, and desquamation of both soles. His serum alanine aminotransferase is 115 U/L, serum aspartate aminotransferase is 97 U/L, and serum total bilirubin is 2.7 mg/dL. Which of the following is the most likely underlying cause of this patient's condition?

• A. Preformed cytotoxic anti-HLA antibodies
• B. Proliferating transplanted B cells
• C. Activated recipient T cells
• D. Donor T cells in the graft (Correct Answer)
• E. Newly formed anti-HLA antibodies

Immunosuppressants Explanation: ***Donor T cells in the graft*** - The symptoms (rash, GI symptoms, liver dysfunction) after an allogeneic stem cell transplant are classic signs of **acute graft-versus-host disease (GVHD)**. This condition occurs when **immunocompetent T cells from the donor graft** recognize the recipient's tissues as foreign and mount an immune attack. - The rapid onset within two weeks post-transplant, elevated liver enzymes, jaundice (**yellow sclerae**, **elevated bilirubin**), severe pruritic rash, and GI symptoms (**abdominal cramps**, **profuse diarrhea**) are all characteristic manifestations of acute GVHD. *Preformed cytotoxic anti-HLA antibodies* - Preformed antibodies would typically cause **hyperacute rejection**, which occurs within minutes to hours of transplantation and involves widespread thrombosis and necrosis of the graft, not the systemic symptoms seen here. - This reaction is mediated by the recipient's antibodies attacking donor antigens, leading to immediate graft failure. *Proliferating transplanted B cells* - Transplanted B cells can contribute to chronic GVHD through antibody production, but they are not the primary mediators of **acute GVHD**; acute GVHD is predominantly a T cell-mediated process. - Proliferation of donor B cells is more commonly associated with post-transplant lymphoproliferative disorders (PTLD) or chronic GVHD, not the acute presentation described. *Activated recipient T cells* - In an allogeneic transplant, the recipient's immune system is usually heavily suppressed beforehand to prevent host-versus-graft rejection. - If recipient T cells were active, they would primarily cause **rejection of the donor stem cells** (graft rejection), not the systemic symptoms of GVHD, which is a reaction of the donor cells against the host. *Newly formed anti-HLA antibodies* - Newly formed antibodies the recipient develops against the donor's HLA antigens would cause graft rejection, a process often delayed but not presenting as the widespread organ damage of acute GVHD. - These antibodies are part of the host's attempt to reject the foreign graft, not the donor cells attacking the host.

Immunosuppressants US Medical PG Question 2: A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Blood investigations are shown: Aspartate aminotransferase (AST) 90 U/L Alanine aminotransferase (ALT) 50 U/L Total bilirubin 2 mg/dL Albumin 3 g/dL Alkaline phosphatase 100 U/L Alpha fetoprotein 600 micrograms/L Which of the following targeted agents is approved for advanced-stage hepatoma?

• A. Ustekinumab
• B. Daclizumab
• C. Sorafenib (Correct Answer)
• D. Abciximab
• E. Palivizumab

Immunosuppressants Explanation: ***Sorafenib*** - This patient's presentation with chronic hepatitis B, cirrhosis, a liver mass, and an **elevated alpha-fetoprotein** is highly suggestive of **hepatocellular carcinoma (HCC)**, also known as hepatoma. - **Sorafenib** is a **multi-targeted tyrosine kinase inhibitor** that inhibits tumor cell proliferation and angiogenesis by targeting VEGFR, PDGFR, Raf kinases, and other kinases involved in tumor progression. - It was the **first systemic therapy approved for advanced-stage HCC** and remains an important first-line treatment option for patients with advanced disease who are not candidates for surgical or locoregional therapies. *Ustekinumab* - **Ustekinumab** is a monoclonal antibody that targets the **p40 subunit of IL-12 and IL-23**, primarily used in the treatment of **psoriasis** and psoriatic arthritis, not HCC. - It works by blocking inflammatory pathways involved in autoimmune conditions. *Daclizumab* - **Daclizumab** is a humanized monoclonal antibody that targets the **CD25 subunit of the IL-2 receptor**; it was previously used for treating **multiple sclerosis** but has been largely discontinued due to safety concerns. - It is not indicated for the treatment of any form of cancer. *Abciximab* - **Abciximab** is a monoclonal antibody that targets the **glycoprotein IIb/IIIa receptor** on platelets, used as an **antiplatelet agent** in patients undergoing percutaneous coronary intervention. - Its mechanism of action is related to inhibition of platelet aggregation and thrombosis, not cancer therapy. *Palivizumab* - **Palivizumab** is a monoclonal antibody used for the **prevention of serious lower respiratory tract disease** caused by **respiratory syncytial virus (RSV)** in high-risk infants. - It provides passive immunity against RSV and has no role in cancer treatment.

Immunosuppressants US Medical PG Question 3: A patient with HCC and a long history of alcohol dependence and chronic hepatitis C has been using the mTOR inhibitor sirolimus 100 mg for cancer treatment. Her cancer has shown a partial response. She also has a history of hypertension and poorly controlled type 2 diabetes mellitus complicated by diabetic retinopathy. Current medications include enalapril and insulin. She asks her oncologist and hepatologist if she could try everolimus for its purported survival benefit in treating HCC. Based on clinical considerations, which of the following statements is most accurate?

• A. The patient should start everolimus 50 mg because of the survival benefit relative to sirolimus 100 mg
• B. The patient is not a good candidate for everolimus due to her history of hypertension
• C. The patient should start everolimus 100 mg because of the survival benefit relative to sirolimus 100 mg
• D. The patient should start everolimus 50 mg because of her history of alcohol use disorder and hepatitis C
• E. The patient is not a good candidate for everolimus due to her history of diabetes (Correct Answer)

Immunosuppressants Explanation: ***The patient is not a good candidate for Noxbinle due to her history of diabetes*** - The current medication is sirolimus, an **mTOR inhibitor** and its successor everolimus, also an mTOR inhibitor, is not beneficial for this patient due to her **poorly controlled type 2 diabetes mellitus**. - mTOR inhibitors, including everolimus, are known to **worsen hyperglycemia** and **accelerate the progression of diabetes**, making it contraindicated in patients with already complicated diabetes. *The patient should start everolimus 50 mg because of the survival benefit relative to sirolimus 100 mg* - There is **no established evidence** that everolimus at any dose offers a superior survival benefit compared to sirolimus in HCC, particularly after a partial response to sirolimus. - **Switching mTOR inhibitors** without a compelling clinical reason, especially with existing comorbidities, is not standard practice. *The patient is not a good candidate for everolimus due to her history of hypertension* - While mTOR inhibitors can contribute to **hypertension**, this patient is already on **enalapril** for her existing hypertension. - Her **poorly controlled diabetes** presents a more direct and severe contraindication due to the metabolic side effects of everolimus. *The patient should start everolimus 100 mg because of the survival benefit relative to sirolimus 100 mg* - No clinical data supports a **superior survival benefit** of everolimus 100 mg over sirolimus 100 mg in HCC. - Given the patient's existing **poorly controlled diabetes**, increasing the dose of an mTOR inhibitor or switching to an equivalent dose of another would heighten the risk of severe metabolic complications. *The patient should start everolimus 50 mg because of her history of alcohol use disorder and hepatitis C* - The patient's history of alcohol dependence and chronic hepatitis C are **risk factors for HCC** but do not directly contraindicate a specific dose of everolimus more than her diabetes. - While liver impairment due to these conditions might influence dosing of various medications, the **primary concern for everolimus** in this case remains the uncontrolled diabetes.

Immunosuppressants US Medical PG Question 4: A 67-year-old man is seen on the surgical floor after a transplant procedure. The previous day, the patient had a renal transplant from a matched donor. He is currently recovering and doing well. The patient has a past medical history of IV drug use, diabetes mellitus, oral cold sores, hypertension, renal failure, and dyslipidemia. The patient's current medications include lisinopril, atorvastatin, insulin, and aspirin. Prior to the procedure, he was also on dialysis. The patient is started on cyclosporine. The patient successfully recovers over the next few days. Which of the following medications should be started in this patient?

• A. Azithromycin
• B. TMP-SMX (Correct Answer)
• C. Acyclovir
• D. Low dose acyclovir
• E. Penicillin

Immunosuppressants Explanation: ***TMP-SMX*** - **TMP-SMX (trimethoprim-sulfamethoxazole)** is the **most critical** prophylactic medication for all solid organ transplant recipients on immunosuppression. - It provides essential prophylaxis against **Pneumocystis jirovecii pneumonia (PJP)**, a life-threatening opportunistic infection with high mortality if not prevented. - PJP prophylaxis is a **universal recommendation** for all transplant patients and is typically continued for 6-12 months post-transplant. - Additionally offers protection against **Toxoplasma gondii**, **Nocardia**, and common urinary tract infections, making it particularly valuable in renal transplant recipients. *Azithromycin* - Azithromycin is a macrolide antibiotic used for specific bacterial infections and sometimes for **Mycobacterium avium complex (MAC)** prophylaxis in severely immunocompromised patients. - It is not standard prophylaxis in routine post-transplant care and does not protect against PJP, the most critical opportunistic infection in this setting. *Acyclovir* - High-dose acyclovir is used to **treat active HSV or VZV infections**, not for routine prophylaxis. - This patient has no active viral infection requiring treatment doses at this time. *Low dose acyclovir* - Low-dose acyclovir (or valacyclovir) is indeed used for **HSV/VZV prophylaxis** in transplant patients, especially those with a history of cold sores. - Many transplant centers do initiate this medication alongside TMP-SMX in the post-transplant period. - However, in a **single-best-answer** context, **TMP-SMX takes priority** as it prevents PJP, which is universally life-threatening and has higher incidence without prophylaxis compared to severe HSV reactivation. - TMP-SMX is considered the **essential first-line** prophylaxis that all transplant patients must receive. *Penicillin* - Penicillin is a narrow-spectrum antibiotic effective against certain gram-positive bacteria. - It has no role in post-transplant opportunistic infection prophylaxis and does not protect against PJP, HSV, or other transplant-related infections.

Immunosuppressants US Medical PG Question 5: An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. A clinical trial shows that over 5 years, the mortality rate from HCC was 25% in the control group and 15% in patients treated with Noxbinle 100 mg daily. Based on this data, how many patients need to be treated with Noxbinle 100 mg to prevent, on average, one death from HCC?

• A. 20
• B. 73
• C. 10 (Correct Answer)
• D. 50
• E. 100

Immunosuppressants Explanation: ***10*** - The **number needed to treat (NNT)** is calculated by first finding the **absolute risk reduction (ARR)**. - **ARR** = Risk in control group - Risk in treatment group = 25% - 15% = **10%** (or 0.10). - **NNT = 1 / ARR** = 1 / 0.10 = **10 patients**. - This means that **10 patients must be treated with Noxbinle to prevent one death from HCC** over 5 years. *20* - This would result from an ARR of 5% (1/0.05 = 20), which is not supported by the data. - May arise from miscalculating the risk difference or incorrectly halving the actual ARR. *73* - This value does not correspond to any standard calculation of NNT from the given mortality rates. - May result from confusion with other epidemiological measures or calculation error. *50* - This would correspond to an ARR of 2% (1/0.02 = 50), which significantly underestimates the actual risk reduction. - Could result from incorrectly calculating the difference as a proportion rather than absolute percentage points. *100* - This would correspond to an ARR of 1% (1/0.01 = 100), grossly underestimating the treatment benefit. - May result from confusing ARR with relative risk reduction or other calculation errors.

Immunosuppressants US Medical PG Question 6: A 57-year-old woman comes to the clinic complaining of decreased urine output. She reports that over the past 2 weeks she has been urinating less and less every day. She denies changes in her diet or fluid intake. The patient has a history of lupus nephritis, which has resulted in end stage renal disease. She underwent a renal transplant 2 months ago. Since then she has been on mycophenolate and cyclosporine, which she takes as prescribed. The patient’s temperature is 99°F (37.2°C), blood pressure is 172/102 mmHg, pulse is 88/min, and respirations are 17/min with an oxygen saturation of 97% on room air. Labs show an elevation in serum creatinine and blood urea nitrogen. On physical examination, she has 2+ pitting edema of the bilateral lower extremities. Lungs are clear to auscultation. Urinalysis shows elevated protein. A post-void bladder scan is normal. A renal biopsy is obtained, which shows lymphocyte infiltration and intimal swelling. Which of the following is the next best step in management?

• A. Add diltiazem
• B. Nephrectomy
• C. Start intravenous steroids (Correct Answer)
• D. Add ceftriaxone
• E. Discontinue cyclosporine

Immunosuppressants Explanation: ***Start intravenous steroids*** - The patient presents with **decreased urine output**, elevated creatinine, and a recent kidney transplant with biopsy showing **lymphocyte infiltration** and **intimal swelling**, all highly suggestive of **acute cellular rejection**. - **High-dose intravenous steroids** (e.g., methylprednisolone) are the first-line treatment for acute cellular rejection to suppress the immune response and preserve graft function. *Add diltiazem* - **Diltiazem** is a calcium channel blocker used to treat hypertension and arrhythmias, and it can also interfere with cyclosporine metabolism, potentially increasing its levels. - While the patient has elevated blood pressure, adding diltiazem would not address the underlying **immune rejection** and would not be the primary intervention. *Nephrectomy* - **Nephrectomy** involves surgical removal of the transplanted kidney. This radical intervention is reserved for **irreversible graft failure** or severe complications like overwhelming infection or malignancy. - Given the acute presentation and possibility of reversing rejection with immunosuppression, nephrectomy is **premature** and not the next best step. *Add ceftriaxone* - **Ceftriaxone** is an antibiotic used to treat bacterial infections. - There is no clinical evidence in the stem (e.g., fever, signs of infection) to suggest a **bacterial infection** as the cause of her symptoms, making antibiotics inappropriate. *Discontinue cyclosporine* - **Cyclosporine** is an immunosuppressant essential for preventing transplant rejection. Discontinuing it would immediately increase the risk of more severe and potentially **irreversible rejection**. - While cyclosporine can cause nephrotoxicity, the biopsy findings of **cellular infiltration** point more towards rejection rather than primary drug toxicity, and the primary treatment for rejection involves increasing immunosuppression, not withdrawing it.

Immunosuppressants US Medical PG Question 7: A 28-year-old woman comes to the physician for a follow-up examination. Two months ago, she underwent left renal transplantation for recurrent glomerulonephritis. At the time of discharge, her creatinine was 0.9 mg/dL. She feels well. Current medications include tacrolimus and azathioprine. Her pulse is 85/min and blood pressure is 135/75 mmHg. Physical examination shows a well-healed surgical scar on her left lower abdomen. The remainder of the examination shows no abnormalities. The patient should be monitored for which of the following adverse effects of her medications?

• A. Gingival hyperplasia
• B. Kidney injury (Correct Answer)
• C. Polycythemia
• D. Hepatic necrosis
• E. Bone marrow suppression

Immunosuppressants Explanation: ***Kidney injury*** - **Tacrolimus** is a potent calcineurin inhibitor that can cause **nephrotoxicity** (kidney injury) by inducing afferent arteriolar vasoconstriction and direct tubular toxicity. - Close monitoring of **creatinine** and **tacrolimus trough levels** is essential to prevent and detect this adverse effect, especially in renal transplant patients where baseline function must be preserved. - This is the **most critical monitoring parameter** for tacrolimus therapy. *Gingival hyperplasia* - This adverse effect is more commonly associated with **cyclosporine**, another calcineurin inhibitor, rather than tacrolimus. - While both are immunosuppressants used in transplant, tacrolimus has a lower incidence of this cosmetic side effect. *Polycythemia* - Polycythemia is not a typical adverse effect of **tacrolimus** or **azathioprine**. - Renal transplant patients may sometimes experience erythrocytosis due to increased erythropoietin production from the native kidneys or the transplanted kidney, but it's not directly related to these immunosuppressive medications. *Hepatic necrosis* - While **azathioprine** can cause **hepatotoxicity**, it typically manifests as cholestatic injury or dose-dependent hepatitis, rather than acute hepatic necrosis. - Tacrolimus is not primarily associated with hepatic necrosis. *Bone marrow suppression* - **Azathioprine** is an antimetabolite that can cause **myelosuppression** (leukopenia, thrombocytopenia, anemia) by interfering with DNA synthesis. - While this requires regular **CBC monitoring**, in this clinical scenario, **nephrotoxicity from tacrolimus** is the more immediate concern given the recent renal transplant and the need to preserve graft function. - The question emphasizes creatinine monitoring (baseline 0.9 mg/dL mentioned), directing focus toward tacrolimus nephrotoxicity as the primary monitoring concern.

Immunosuppressants US Medical PG Question 8: A 68-year-old woman comes to the physician for a follow-up examination. Three months ago, she underwent heart transplantation for restrictive cardiomyopathy and was started on transplant rejection prophylaxis. Her pulse is 76/min and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the gum tissue. There is a well-healed scar on her chest. Serum studies show hyperlipidemia. The physician recommends removing a drug that decreases T cell activation by inhibiting the transcription of interleukin-2 from the patient's treatment regimen and replacing it with a different medication. Which of the following drugs is the most likely cause of the adverse effects seen in this patient?

• A. Mycophenolate mofetil
• B. Azathioprine
• C. Tacrolimus
• D. Cyclosporine (Correct Answer)
• E. Prednisolone

Immunosuppressants Explanation: ***Cyclosporine*** - The patient's symptoms of **gingival hyperplasia**, **hypertension**, and **hyperlipidemia** are classic side effects associated with cyclosporine. - Cyclosporine is a calcineurin inhibitor that **decreases T-cell activation** by inhibiting IL-2 transcription, matching the drug description. *Mycophenolate mofetil* - Mycophenolate mofetil is an **antiproliferative agent** that inhibits purine synthesis, primarily affecting lymphocytes. - Its common side effects are mainly **hematologic** (leukopenia, anemia) and **gastrointestinal** (diarrhea, nausea), not gingival hyperplasia or hypertension. *Azathioprine* - Azathioprine is a **purine analog** that impairs DNA synthesis and inhibits lymphocyte proliferation. - Key side effects include **myelosuppression** (leukopenia, thrombocytopenia) and **hepatotoxicity**, which are not present here. *Tacrolimus* - Tacrolimus is also a **calcineurin inhibitor** that inhibits IL-2 transcription, similar to cyclosporine. - While it can cause **hypertension** and **hyperlipidemia**, it is less commonly associated with **gingival hyperplasia** than cyclosporine. *Prednisolone* - Prednisolone is a **corticosteroid** used for immunosuppression, acting broadly on the immune system. - Common side effects include **hyperglycemia**, **osteoporosis**, and **cataracts**, not specific gingival overgrowth.

Immunosuppressants US Medical PG Question 9: A 50-year-old woman comes to the physician for the evaluation of excessive hair growth on her chin over the past 2 weeks. She also reports progressive enlargement of her gums. Three months ago, she underwent a liver transplantation due to Wilson disease. Following the procedure, the patient was started on transplant rejection prophylaxis. She has a history of poorly-controlled type 2 diabetes mellitus. Temperature is 37°C (98.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 150/80 mm Hg. Physical examination shows dark-pigmented, coarse hair on the chin, upper lip, and chest. The gingiva and the labial mucosa are swollen. There is a well-healed scar on her right lower abdomen. Which of the following drugs is the most likely cause of this patient's findings?

• A. Daclizumab
• B. Cyclosporine (Correct Answer)
• C. Sirolimus
• D. Methotrexate
• E. Tacrolimus

Immunosuppressants Explanation: **Cyclosporine** * This patient's **combination of hirsutism** (excessive hair growth) **and gingival hyperplasia** (gum enlargement) is the classic presentation of cyclosporine toxicity, an immunosuppressant commonly used for transplant rejection prophylaxis. * Cyclosporine is a **calcineurin inhibitor** that prevents T-cell activation and is highly effective in preventing graft rejection. * The **simultaneous presence of both hirsutism and prominent gingival hyperplasia** is particularly characteristic of cyclosporine. *Daclizumab* * **Daclizumab** is a **monoclonal antibody** targeting the IL-2 receptor, which was previously used for transplant prophylaxis but has been discontinued for this indication. * It is not associated with hirsutism or gingival hyperplasia. *Sirolimus* * **Sirolimus** is an **mTOR inhibitor** used as an immunosuppressant, known for side effects like hyperlipidemia, myelosuppression, and delayed wound healing. * It does **not** typically cause hirsutism or gingival hyperplasia. *Methotrexate* * **Methotrexate** is an **antimetabolite** and immunosuppressant commonly used in autoimmune diseases and cancer, with side effects including bone marrow suppression, mucositis, and liver toxicity. * Hirsutism and gingival hyperplasia are **not** characteristic side effects of methotrexate. *Tacrolimus* * **Tacrolimus** is another **calcineurin inhibitor**, similar to cyclosporine, but with a different side effect profile. While tacrolimus can cause hirsutism, **gingival hyperplasia is significantly less common** with tacrolimus compared to cyclosporine. * The **presence of prominent gingival hyperplasia alongside hirsutism strongly favors cyclosporine** over tacrolimus. * Tacrolimus is more commonly associated with **neurotoxicity** (e.g., tremor) and **nephrotoxicity**.

Immunosuppressants US Medical PG Question 10: A 63-year-old HIV-positive man comes to the physician for a routine health maintenance examination. Four years ago, he was diagnosed with HIV and was started on cART therapy. He tells the physician that he has been having difficulty adhering to his medication regimen. He has been unemployed for the past couple of years and relies on unemployment benefits to cover the costs of daily living. His father died of lymphoma at the age of 60 years. He wants more information about his risk of developing DLBCL. Which of the following is the greatest risk factor for the development of DLBCL in HIV-positive patients?

• A. Poor adherence to cART (Correct Answer)
• B. Income below $30,000 per year
• C. Male sex
• D. Positive family history of cancer
• E. Age over 55 years

Immunosuppressants Explanation: **Poor adherence to cART** - **Poor adherence** to cART leads to **uncontrolled HIV replication** and persistent **immunosuppression**, which significantly increases the risk of developing **DLBCL**. - **Immune dysregulation** caused by HIV directly contributes to a higher incidence of **AIDS-defining malignancies**, including DLBCL. *Income below $30,000 per year* - While **socioeconomic factors** can impact access to care and medication adherence, low income itself is not a direct biological risk factor for DLBCL. - Its influence is secondary to its effect on adherence and overall health status, rather than a primary risk factor for the malignancy. *Positive family history of cancer* - Although a family history of cancer can increase the risk for some malignancies, it is generally **not a significant risk factor** for **HIV-associated DLBCL**. - The primary drivers of HIV-associated DLBCL are linked to HIV-induced immunodeficiency, not specific inherited genetic predispositions for lymphoma. *Age over 55 years* - While the incidence of many cancers increases with **age**, for **HIV-associated DLBCL**, age is less prominent than the degree of **immunodeficiency** caused by HIV. - The stronger prognostic factor remains the state of the immune system, particularly a **low CD4 count**, which is often exacerbated by poor cART adherence. *Male sex* - While there are minor differences in cancer incidence between sexes, **male sex** is not a primary or significant independent risk factor for **HIV-associated DLBCL**. - The risk is predominantly driven by factors related to HIV infection itself and the resulting immune dysfunction.

Immunosuppressants Flashcard 1 of 7

Question: Which calcineurin inhibitor is associated with an even greater risk for diabetes vs the other calcineurin inhibitors?_____

Answer: Tacrolimus

Immunosuppressants Flashcard 2 of 7

Question: Is sirolimus (rapamycin) nephrotoxic?_____

Answer: No

Immunosuppressants Flashcard 3 of 7

Question: Azathioprine and 6-mercaptopurine are metabolized by _____ (enzyme)

Answer: xanthine oxidase

Immunosuppressants Flashcard 4 of 7

Question: Cyclophosphamide has a potent _____ effect; hence it can be used for a variety of autoimmune conditions

Answer: immunosuppressive

Immunosuppressants Flashcard 5 of 7

Question: Certolizumab is a monoclonal antibody against _____

Answer: TNF-

Immunosuppressants Flashcard 6 of 7

Question: Which chemotherapeutic drug is the most widely-used treatment of a organ/graft rejection?_____

Answer: Azathioprine/6-MP

Immunosuppressants Flashcard 7 of 7

Question: Azathioprine/6-MP have an _____ effect, hence why they are useful in the treatment of graft rejection, SLE, autoimmune hemolytic anemia, etc.

Answer: immunosuppressive