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PH9.1 | PH9.1 | Immunomodulators — SDL Guide — SDL Guide (Part 3)
Self-Assessment
Test your understanding of immunomodulator pharmacology with the following questions.
- A transplant recipient on cyclosporine is started on fluconazole for an oesophageal candidal infection. What will happen to cyclosporine blood levels and why? What action should you take?
- Classify the following drugs as immunosuppressant or immunostimulant, and state their mechanism: (a) tacrolimus, (b) filgrastim, (c) mycophenolate mofetil, (d) rituximab, (e) BCG intravesical therapy.
- A patient with RA fails methotrexate and is considered for infliximab. Name two mandatory pre-treatment screening investigations and explain the rationale.
- Why is mycophenolate mofetil relatively lymphocyte-selective compared to azathioprine?
- A renal transplant recipient develops features of calcineurin inhibitor nephrotoxicity. If switching to sirolimus is considered, what is the key ADR difference between sirolimus and calcineurin inhibitors relevant to this decision?
SELF-CHECK
BCG is used as intravesical immunotherapy for superficial bladder cancer. What is its primary mechanism of anti-tumour action?
A. Directly kills bladder tumour cells via cytotoxic antibiotic action
B. Acts as a live antigen that activates macrophages and cytotoxic T-cells via innate immune pattern recognition
C. Stimulates G-CSF release to recruit neutrophils to the bladder
D. Inhibits angiogenesis by blocking VEGF pathways in the tumour microenvironment
Reveal Answer
Answer: B. Acts as a live antigen that activates macrophages and cytotoxic T-cells via innate immune pattern recognition
BCG (live attenuated Mycobacterium bovis) administered intravesically triggers innate immune activation — macrophages and cytotoxic T-cells are recruited and activated via pattern recognition receptors (Toll-like receptors), creating a local anti-tumour immune response. It does not act as a direct cytotoxic agent; its effect is immunological, making it the most effective intravesical treatment for non-muscle-invasive bladder cancer.