Immune 1 Flashcards
Pathogen associated molecular patterns (PAMPs)
a limited number of molecular patterns common to a wide variety of pathogens
What tissues initiate the acquired immune system?
Lymphoid tissue
What targets antigens?
A cell-mediated
A humoral adaptive response
Hypersensitivity
resulting immune response is too strong - poison ivy or asthma attack
Atopy
The tendency to develop an allergy, or hypersensitivity, is greatly determined by inheritance (referred to as atopy)
What is the key to a healthy immune response?
A key to a healthy immune response is the body’s ability to recognize its own cells and the cells of a foreign microbe
What happens to create adaptive immunity to an antigen?
gene rearrangement leads to an irreversible change in the DNA of the lymphocyte, all of the progeny of that cell inherits gene encoding having the same receptor specificity, which in turn is the reason why adaptive immunity is specific and long-lived
Rubor
redness
tumor
swelling
dolor
pain
calor
warmth
functio leasa
loss of function
What does the adaptive immune system split into once reaching an inflammatory response?
Humoral immunity
Cellular immunity
Widespread invasion and inflammation can lead to large amount of cytokine release, what does this cause?
fever, tachycardia, and organ failure, possibly leading to shock or death
Antibodies
large protein molecules released from the lymphocytes that bind with and help destroy an offending antigen by marking it for destruction
What part of the immune system are B cells?
Humoral
immunoglobulin (Ig)
An antibody that is a protein
4 kinds of IgG are found where?
Blood
IgA is found in?
Seromucous secretions
IgM is found in?
blood
IgD is found in?
Lymphocytes
IgE is found in?
skin and external surfaces
What cells manage cellular immunity?
T cells
What kind of hypersensitivity is allergic rhinitis?
IgE type 1 hypersensitivity
What leads to allergic rhinitis sxs?
Mast cell degranulation caused by attaching of IgE antibodies
Allergic rhinitis tx
Oral antihistamines - can cause systemic effect
Spray antihistamines - bypass systemic effects
Nasal spray antihistamine examples
azelastine nasal (Astelin, Astepro) and olopatadine nasal (Patanase)
Tx steps for allergic rhinitis
Antihistamines
IN Steroids
Nasal mast cell stabilizers, decongestants, anticholinergics, and leukotriene receptor antagonists also used
IN steroids compared to antihistamines
Slower to act than antihistamines (1-2 wks to work)
Why are systemic steroids not used in allergic rhinitis?
Because of their systemic adverse effects, only recommended in intractable allergic rhinitis not responding to other therapy
IN Steroid examples
beclomethasone
budesonide
flunisolide
fluticasone
mometasone
triamcinolone
IN steroids SE
Headaches, pharyngeal candidiasis, pharyngitis, nasopharyngeal irritation, epistaxis, and septal perforation
Nasal Mast Cell Stabilizer do what?
Prevent the release of histamine from mast cells by stabilizing their membranes
What is cromolyn and what is it used for?
Mast cell stabilizer - Prophylactic and must be used prior to allergic antigen exposure
Nasal Mast Cell Stabilizer SE
Bad taste
Decongestants do what?
Sympathomimetics - vasoconstriction in the superficial mucosal blood vessels, decreasing swelling of the nasal mucosa and rhinorrhea
Decongestants available
Available in a myriad of OTC formulations
Oxymetazoline (nasal)
Pseudoephedrine (Oral)
Topical decongestant use >3-4 days can cause what?
rhinitis medicamentosa, which is a rebound effect
What do anticholinergics do to tx allergic rhinitis?
reduce nasal hypersecretion and congestion
Topical anticholinergics for allergic rhinitis?
ipratropium bromide (Atrovent)
Leukotriene Receptor Antagonists example
Montelukast (Singulair)
Pharm tx of allergic conjunctivitis
Topical vasoconstrictors
Antihistamines
Mast cell stabilizers
What do topical vasoconstrictors do to tx allergic conjunctivitis?
can reduce eye redness and ocular itching by stimulating alpha-adrenergic receptors
What do antihistamines do to the allergic response?
Antihistamines: compete with histamine on H1 effector cells inhibiting the release of histamine
hydroxypropyl cellulose class
artificial lube
tetrahydrozoline hydrochloride class
vasoconstrictors
azelastine hydrochloride class
antihistamine
emedastine difumarate class
antihistamine
levocarbastine hydrochloride class
antihistamine
ketorolac tromethamine class
nsaid
diclofenac sodium class
nsaid
ketoifen fumarate class
mast cell
cromolyn sodium class
mast cell
olopatadine hydrochloride class
mast cell
lodoxamide tromethamine class
mast cell
dexamethasone class
steroid
prednisolone class
steroid
Prolonged use of topical ocular meds must be monitored becasue?
Associated w/ glaucoma
What immune response is AD related to?
IgE production
Mainstay AD flare tx
Mainstay of pharmacological treatment for flare-ups is the topical corticosteroids - Using the lowest potency topical steroid for the shortest duration is always best
2nd line tx for AD flare
Calcineurin inhibitors, tacrolimus (Protopic ointment), and pimecrolimus (Elidel cream) are topical immunosuppressive agents considered to be second-line agents
What can creams cause?
Contact dermatitis
Why are creams preferred over the more potent ointments?
Creams are less greasy
When using topical steroids, where should they NOT be applied?
Untreated skin or bacterial infections
Topical Calcineurin Inhibitors examples
Pimecrolimus and Tacrolimus
Cyclosporine (oral)
Topical Calcineurin Inhibitors MOA
Inhibit calcineurin, which blocks T-cell activation and the subsequent release of inflammatory causing cytokines
Calcineurin Inhibitors uses
Atopic dermatitis
Prevention of organ rejection in transplant
Crohn disease
Graft-versus-host disease
Myasthenia gravis
Rheumatoid arthtitis
Calcineurin Inhibitors SE
Hypertension
Redness and burning sensations of the skin
Infection, neoplasm
Nephrotoxicity
What happens to Calcineurin Inhibitors when taken w/ food?
Absorption is decreased
Calcineurin Inhibitors black box warning
Tacrolimus - cancer and serious infections
Cyclosporine - HTN and nephrotoxicity
Statins + Calcineurin Inhibitors
Leads to increase in concentrations of many drugs (statins)
Calcineurin Inhibitors require what when taken long term?
Drug level monitoring
Goal of allergen immunotherapy
With immunotherapy, the goal is to induce a tolerance for the allergen
Which type of allergies is immunotherapy most effective for?
Most beneficial for those who have IgE-mediated allergic rhinitis, asthma, or insect hypersensitivity
Immunotherapy does not work for these types of allergies?
Not helpful in atopic dermatitis, urticaria, or in food/antibiotic allergies
