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Pharm Exam 3 > Immune 2 > Flashcards

Immune 2 Flashcards

1
Q

Type 1 rxn is mediated by what?

A

IgE

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2
Q

What does a type 1 rxn look like?

A

Immediate rxn of allergies or anaphylactic

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3
Q

Type 2 rxn are mediated by what?

A

IgM and IgG

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4
Q

Type 2 rxn are also referred to as what?

A

Type II (cytotoxic hypersensitivity)

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5
Q

Examples of type 2 hypersensitivity rxn?

A

Granulocytopenia
Thrombocytopenia
Hemolytic anemia

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6
Q

Type 3 rxn are mediated by what?

A

Mediated by the IgG class and somewhat by IgM

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7
Q

Type 3 rxn is also called?

A

Type III (immune complex hypersensitivity)

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8
Q

Examples of Type 3 rxn?

A

Systemic lupus (arthritis, nephritis, skin lesions)
Rheumatoid arthritis
Serum sickness (vasculitis, nephritis)
Farmers lung (alveolar inflammation)

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9
Q

Type 4 rxn is also known as?

A

Type IV (delayed-type hypersensitivity)

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10
Q

What initiates Type 4?

A

initiated by mononuclear leukocyte T cells and macrophages, not antibodies

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11
Q

When does Type 4 rxn appear

A

48-72 hrs later

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12
Q

What is an adverse drug rxn?

A

Predictable, unpredictable, or genetic

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13
Q

What are the steps for managing a drug hypersensitivity?

A
  1. determine the offending drug and discontinue it
  2. tx based on the type of rxn
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14
Q

What is the best tx for type 4?

A

Steroids

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15
Q

What is the best tx for type 3?

A

NSAIDs

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16
Q

What is the best tx of type 1?

A

Antihistamines, bronchodilators, or steroids

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17
Q

In which cases should immunotherapy and desensitization to drugs be considered?

A

When the pt needs the meds (should be done by a trained allergist) - PCN or insulin

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18
Q

Anaphylaxis is mediated by what?

A

IgE-mediated type I immune response to antigens and allergens that the pt has been previously exposed to

19
Q

What is an anaphylactoid rxn?

A

immediate systemic reaction that mimics anaphylaxis but is not IgE mediated (can occur on the first contact w/ the allergen)

20
Q

Tx of anaphylaxis steps

A

Maintaining an adequate airway and BP are crucial - monitor VS
Administer adrenalin (epinephrine) 0.2-0.5 mL of a 1:1000 (wt/vol) dilution (0.2- 0.5 mg) intramuscularly
Repeat adrenalin dose every 10-15 minutes as needed for first hour
+/- fluids or vasopressors if hypotensive
+/- steroids or diphenhydramine

21
Q

What does epinephrine do to the airway?

A

Potent alpha receptor which causes rapid vasoconstriction and bronchodilation

22
Q

Epinephrine SE

A

Palpitations, V Fib, and dysrhythmias

23
Q

Pts on BB may have epinephrine resistance, how is this overcome when tx someone w/ anaphylaxis?

A

require glucagon injection to counter resistance

24
Q

When tx a pt w/ a stinging insect rxn, what should be done about the stinger?

A

Attempt to remove w/o squeezing it

25
Q

What is the difference between a food intolerance and an allergy?

A

Intolerance - nonimmunologic, just an abnormal rxn
Allergy - less common, is an immunologic rxn

26
Q

What is oral allergy syndrome?

A

Type of food allergy - brief involving the mouth and throat

27
Q

What is the best way to tx food allergies?

A

Avoidance
Sx tx is helpful but does nothing to the immune response

28
Q

Common causes of contact derm?

A

poison ivy, household cleaners, and topical antimicrobials, anesthetics, and antihistamines

29
Q

How is contact derm mediated?

A

T-cell-mediated response

30
Q

Tx of contact derm

A

Remove offending allergen.
Apply wet compress of water, saline, or Domeboro solution if acute eruption is present.
Topical application of a class 2 or class 3 corticosteroid cream is advised for a brief period of time not to exceed 2 weeks

31
Q

Angioedema

A

episodic, asymmetric, nonpitting swelling of loose tissue, involving subcutaneous tissues, abdominal organs, and the upper airway

32
Q

What are the types of angioedema?

A

Histamine-mediated (allergic) – type 1
Bradykinin-mediated (non-allergic) iatrogenic or hereditary

33
Q

Tx of mild to moderate urticaria/ angioedema

A

Begin with non-sedating second-generation antihistamines such as fexofenadine (Allegra), loratadine (Claritin), or cetirizine (Zyrtec)
Consider adding older, sedating first-generation antihistamines such as diphenhydramine (Benadryl), or chlorpheniramine (Chlortrimeton) if symptoms persist or night-time pruritus and lack of sleep are a problem

34
Q

Tx of bradykinin mediated angioedema

A

Purified C1 inhibitor concentrate
Fresh frozen plasma
Icantibant

35
Q

Which pts are at risk of developing anti-D antibodies?

A

Rhesus (Rh) D-negative women who are exposed to fetal D-positive red cells

36
Q

What happens to the immunoglobulins injected in emergent situation such as the tx of rabies?

A

Within a few months, at most, the immunoglobulins of passive immunity are gone and the antigen forgotten

37
Q

How long does active immunity take to amount?

A

Active immunization usually requires up to 2 weeks for immunity to become adequate

38
Q

Live attenuated vax compared to dead vax?

A

more potent than inactivated

39
Q

Live vax examples

A

Measles
Mumps
Varicella
Rubella
Herpes zoster
Rotavirus
Nasal influenza

40
Q

When should live vax be given if a pt is also on immunoglobulin tx?

A

should not be given <2 weeks prior to immunoglobulin therapy or at least 3 months after immunoglobulin therapy

41
Q

How long should a pt wait after stopping an antiviral to get vax w/ a live vax?

A

It is recommended that the patient wait 24-48 hours after cessation of antiviral treatment before receiving a live attenuated viral vaccine

42
Q

Which pts should NOT be given live vax?

A

Pregnancy
Immunosuppression by disease
Immunosuppression by medication

43
Q

Toxioid vaccine examples

A

tetanus, diphtheria, and pertussis

44
Q

Who should not receive polysaccharide vaccines?

A

Kids

Pharm Exam 3 (7 decks)

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