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Oncology > Drug Hypersensitivity > Flashcards

Drug Hypersensitivity Flashcards

1
Q

What is the difference between HSR and SEs?

A

SEs: predictable drug reaction related to pharmacologic actions of the drug
HSR: unpredicted immunologic reaction

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2
Q

What are drug related risk factors for HSRs?

A
  1. chemical / drug class (PCNs)
  2. biologics increase risk
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3
Q

What are patient related risk factors for HSRs?

A
  1. hereditary (parent allergic and so is child)
  2. previous drug reactions
  3. genetic predisposition (metabolism, MCH alleles)
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4
Q

What are disease related risk factors for HSRs?

A
  1. alteration of metabolic pathways
  2. variations in immunologic responses
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5
Q

How are anti-drug antibodies generated?

A
  1. haptenation
  2. sensitization
  3. Ellicitation
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6
Q

What is haptenation?

A

small molecules that elicit immune response only when attached to a larger carrier (PCN molecules on carrier protein)

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7
Q

What is sensitization?

A
  1. haptenation
  2. B cells and T cells must recognize the same antigen
  3. epitope on an allergen is recognized by surface Ig on B cell
  4. allergen is internalized and degraded by B cell and presented to CD4 T cells by MHC-II molecules
  5. activaed CD4 T cells help B cells differentiate into plasma cells
    6, plasma cells release anti-drug antibodies
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8
Q

What is elicitation?

A
  1. pre-existing anti-drug antibodies
  2. memory B cells capture drug-bound proteins –> rapid production of new anti-drug antibodies
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9
Q

How are IgE and IgG antibodies different?

A

IgE: t1/2= 2-5 days; engage FcE Receptors
IgG: t1/2=21 days; engage FcY receptors

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10
Q

What are the steps of a type 1 HSR?

A
  1. mast cells and basophils express FcERs
  2. receptor has high affinity for IgE
  3. each allergen-IgE2 complex binds to 2 FcE receptors (dimerization)
  4. tyrosine phosphorylation –> signaling –> degranulation –> histamine (minutes) –> synthesis of pro-inflammatory mediators (hours)
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11
Q

What are the steps of a type 2 HSR?

A
  1. binding of dug molecules on circulating blood cell membranes
  2. IgG mediated cytotoxic
  3. effectors (natural killer macrophage, neutrophils) cells that express FcYR
  4. Destruction of RBCs and platelets
  5. s/s of hemolytic anemia and thrombocytopenia can occur days after exposure
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12
Q

What are the steps of a type 3 HSR?

A
  1. formation of IgG- drug immune complexes in blood
  2. deposition immune complexes tissues
  3. activation of complement proteins, serum sickness
  4. tends to occur over 24-72 hours after initial exposure
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13
Q

What are the steps of a type 4 HSR?

A
  1. medicated by antigen specific T cells
  2. contact sensitizing agents (lipophilic highly reactive molecules)
  3. modification of CD4 or CD8 T cell epitopes (MCH-I or MCH-II ligands)
  4. SJS/ Tens occurs 1-3 weeks after exposure and lasts 4-8 weeks
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14
Q

What determines the type of allergic reaction that results?

A

dose and route of allergen (IV vs. oral)

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15
Q

What type of HSR is hemolytic anemia most associated with?

A

type 2

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16
Q

What is anaphylaxis?

A

most severe type 1 reaction; massive amount of histamine released in short amount of time

17
Q

How can you recognize anaphylaxis?

A

skin/ mouth/ throat + airway and/or cardiovascular distress within minutes

18
Q

How are type 1 reactions biphasic ?

A
  1. within minutes histamine is released causing hypotension, mucus production, smooth muscle contraction, and vascular leakage
  2. histamine triggers production of inflammatory mediators (leukotrienes, cytokines)
  3. within hours eosinophils and neutrophils infiltrate
19
Q

How can someone be desensitized to reduce recurrent risk of HSR?

A
  1. start with low dose 1/10,000
  2. double q15-20 min (6-17 steps)
  3. slowly degranulate mast cells
  4. down regulation of receptors
  5. transient depletion of histamine from cells
20
Q

Why is epinephrine used for immediate management of anaphylaxis?

A

alpha, beta1 and beta2 agonist; prevent/ reverse anaphylactic reactions

21
Q

How is probability of cross-reactivity of PCNs and cephalosporins characterized?

A

relatively low if patient does not have PCN allergy; 4-7 fold increase of allergic reaction in those with PCN allergy

22
Q

What factors may increase likelihood of allergic reaction with cephalosporins?

A

Risk depends on cephalosporin generation and side chains;
1st > 2nd > 3rd;
amino hydroxyphenyl side chains

23
Q

What cephalosporin would Amoxicillin most likely react with?

A

Cefadroxil due to amino-hydroxyphenyl R group

24
Q

What cephalosporin would Ampicillin most likely react with?

A

Cephalexin, Cefaclor, and Cephaloglycin due to amino-phenyl R group

25
Q

What reactions are associates with recombinant monoclonal antibodies?

A

Type 3

Oncology (22 decks)

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