Drug Action and Characteristics for Step 1

Drug	Action	Mechanism Category	Class of Immunosuppressant	Possible Side Effects	Distinguishing Factor of Side Effect	Possible Use Cases	Additional Information for Step 1
Glucocorticoids	Regulate gene expression	Gene Regulation	Steroid	Weight gain, osteoporosis	Osteoporosis	Asthma, autoimmune diseases	Cushing's syndrome risk
Cyclosporine	Inhibits calcineurin phosphatase activity	Enzyme Inhibition	Calcineurin Inhibitor	Kidney dysfunction, hypertension	Kidney dysfunction	Organ transplantation	Gingival hyperplasia
Tacrolimus	Inhibits calcineurin phosphatase activity	Enzyme Inhibition	Calcineurin Inhibitor	Kidney dysfunction, diabetes	Diabetes	Organ transplantation	Less nephrotoxic than Cyclosporine
Sirolimus	Inhibits mTOR kinase activity; blocks T cell proliferation	Enzyme Inhibition	mTOR Inhibitor	Hyperlipidemia, anemia	Hyperlipidemia	Kidney transplantation	Not nephrotoxic
Azathioprine	Inhibits DNA synthesis	DNA Synthesis Inhibition	Antimetabolite	Bone marrow suppression, liver toxicity	Liver toxicity	Rheumatoid arthritis	Prodrug of 6-mercaptopurine
Methotrexate	Inhibits AICAR transformylase; anti-inflammatory	Enzyme Inhibition	Antimetabolite	Liver toxicity, folic acid deficiency	Folic acid deficiency	Cancer, rheumatoid arthritis	Folinic acid as rescue therapy
Mycophenolate mofetil	Inhibits Inosine monophosphate dehydrogenase	Enzyme Inhibition	Antimetabolite	Diarrhea, leukopenia	Leukopenia	Organ transplantation	Selective for lymphocytes
Leflunomide	Inhibits dihydroorotate dehydrogenase	Enzyme Inhibition	Pyrimidine Synthesis Inhibitor	Liver toxicity, hypertension	Hypertension	Rheumatoid arthritis	Teratogenic
Cyclophosphamide	Alkylates DNA	DNA Alkylation	Alkylating Agent	Bone marrow suppression, bladder toxicity	Bladder toxicity	Cancer, lupus	Hemorrhagic cystitis risk
Infliximab	Binds to TNF-a preventing its action	Cytokine Inhibition	TNF-alpha Inhibitor	Infections, infusion reactions	Infusion reactions	Crohn's disease, rheumatoid arthritis	Chimeric antibody
Adalimumab	Binds to TNF-a preventing its action	Cytokine Inhibition	TNF-alpha Inhibitor	Infections, injection site reactions	Injection site reactions	Rheumatoid arthritis, psoriasis	Fully human antibody
Etanercept	Binds to TNF-a preventing its action	Cytokine Inhibition	TNF-alpha Inhibitor	Infections, injection site reactions	Injection site reactions	Rheumatoid arthritis, psoriasis	Fusion protein
Omalizumab	Binds to IgE preventing its action	Immunoglobulin Inhibition	IgE Inhibitor	Anaphylaxis, injection site reactions	Anaphylaxis	Asthma, chronic urticaria	Monoclonal antibody
Tofacitinib	Inhibits JAK enzymes	Enzyme Inhibition	JAK Inhibitor	Infections, elevated liver enzymes	Elevated liver enzymes	Rheumatoid arthritis, psoriatic arthritis	Oral administration
Rituximab	Binds to CD20. Causes depletion of circulating B cells	Cell Depletion	CD20 Monoclonal Antibody	Infusion reactions, infections	Infusion reactions	Non-Hodgkin lymphoma, rheumatoid arthritis	Chimeric antibody
Tocilizumab	Antagonists at IL-6 receptors	Cytokine Inhibition	IL-6 Inhibitor	Elevated liver enzymes, infections	Elevated liver enzymes	Rheumatoid arthritis, giant cell arteritis	Monoclonal antibody
Sarilumab	Antagonists at IL-6 receptors	Cytokine Inhibition	IL-6 Inhibitor	Elevated liver enzymes, infections	Elevated liver enzymes	Rheumatoid arthritis	Monoclonal antibody
Abatacept	Interferes with T-cell activation	T-cell Modulation	CTLA-4 Inhibitor	Infections, headache	Headache	Rheumatoid arthritis, juvenile idiopathic arthritis	Fusion protein