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STEP > Immuno > Flashcards

Immuno Flashcards

1
Q

Head and neck lymph drainage

A

Cervical nodes

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2
Q

Lung lymph drainage

A

Hilar nodes

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3
Q

Trachea and esophagus lymph drainage

A

Mediastinal nodes

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4
Q

Upper limb, breast, skin above umbilicus lymph drainage

A

Axillary nodes

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5
Q

Liver, stomach, spleen, pancreas, upper duodenum lymph drainage

A

Celiac nodes

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6
Q

Lower duodenum, jejunum, ileum, colon to splenic flexure lymph drainage

A

Superior mesenteric nodes

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7
Q

Colon from flexure to upper rectum lymph drainage

A

Inferior mesenteric nodes

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8
Q

Lower rectum to anal canal (above pectinate line), bladder, vagina (middle 1/3), cervix, prostate lymph drainage

A

Internal iliac nodes

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9
Q

Testes, ovaries, kidneys, uterus lymph drainage

A

Para-aortic nodes

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10
Q

Anal canal (below pectinate line), skin below umbilicus (except popliteal area), scrotum, vulva lymph drainage

A

Superficial inguinal nodes

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11
Q

Dosolateral foot, posterior calf lymph drainage

A

Popliteal nodes

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12
Q

Lymph drainage of right side of body over diaphragm

A

Right lymphatic duct

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13
Q

Lymph drainage of everything but right side of body above diaphragm

A

Thoracic duct

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14
Q

Thoracic duct drains into ____________________

A

Left subclavian and internal jugular vvs.

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15
Q

Spleen is under _____ ribs

A

9-11

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16
Q

T cells in the ______________ in the _________ pulp of spleen

A

PALS, white

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17
Q

B cells in _____________ in the ____________ pulp of spleen

A

Follicles, white

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18
Q

Splenic dysfunction leads to

A

Less IgM–>less complement activation –> less C3b opsonization–>more susceptible to encapsulated bugs

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19
Q

Thymus is derived from

A

3rd pharyngeal pouch

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20
Q

Thymoma

A

Benign neoplasm of thymus, assn w/ MG and sup. vena cava syndrome

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21
Q

Pathogen recognition in innate immunity

A

TLRs –. recognize PAMPs like LPS, glagellin, nucleic acids

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22
Q

MHC I binds ________ and _____________

A

TCR and CD8

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23
Q

MHC I structure

A

1 long alpha chain and b2 microglobulin

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24
Q

MHC I is in

A

All nucleated cells

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25
Q

MHC I fxn

A

Present endogenous antigens to CD8+ T cells – loaded into MHC in RER after delivery via TAP

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26
Q

MHC II binds ______ and _______

A

TCR and CD4

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27
Q

MHC II structure

A

2 chains – alpha and beta

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28
Q

MHC II is in

A

ONLY APCs

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29
Q

MHC II fxn

A

Present exogenous ags to CD4 helper T cells (loaded after release of invariant chain in acidified endosome)

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30
Q

HLA A3 disease

A

Hemochromatosis

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31
Q

HLA B8 diseases

A

Addison disease, MG, Graves

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32
Q

HLA B27 diseases

A

Psoriatic arthritis, Ankylosing spondylitis, IBD-assc arthritis, Reactive arhtritis (PAIR – seronegative arthropathies)

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33
Q

HLA DQ 2 disease

A

Celiac disease

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34
Q

HLA DQ8 disease

A

Celicac disease

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35
Q

HLA DR2 diseases

A

MS, hay fever, SLE, Goodpasture

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36
Q

HLA DR3 diseases

A

DM 1, SLE, Graves, Hashitmotos, Addison’s

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37
Q

HLA DR 4 diseases

A

RA, DM 1, Addison’s

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38
Q

HLA DR 5 diseases

A

Pernicious anemia, Hashimotos

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39
Q

NK Cell activity is enhanced by

A

IL 2, IL 12, IFN alpha, IFN beta

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40
Q

NK cell activation in ADCC

A

CD16 on NK binds to Fc region of bound Ig

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41
Q

Positive selection of T cells – location and selected

A

Thymic cortex – those with TCRs that can bind self-MHC move on

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42
Q

Negative selection of T cells – location and selected

A

Thymic medulla – TCRs with high self affinity undergo apoptosis

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43
Q

AIRE fxn

A

Expresses tissue-restricted self ag in thymus to prevent autoimmune rxn – deficiency –> autoimmune polyendocrine syndrome 1

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44
Q

Th1 Cell secretes

A

IFN gamma (activates macs) and IL 2

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45
Q

Th1 cell activates

A

Macs and cytotoxic T cells

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46
Q

Th1 differentiation induction

A

IFN gamma and IL12 (from macs)

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47
Q

Th1 inhibited by

A

IL4 and IL10 (from Th2)

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48
Q

Th2 secretes

A

IL 4,5,6,10,13

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49
Q

Th2 recruits

A

Eosinophils, promotes IgE prdxn by B cells

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50
Q

Th2 differentiation induction

A

IL2, IL4

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51
Q

Th2 inhibited by

A

IFN gamma from Th1

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52
Q

Treg CD expression

A

CD 3, CD 4, CD 25, FoxP3

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53
Q

Treg cytokines

A

IL10, TGF beta – anti-inflammatory (suppress CD4/8 fxn)

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54
Q

IPEX

A

X linked def of FoxP3–> autoimmunity; sx: enteropathy, endorinopathy, nail dystrophy, autoimmune derm conditions, diabetes in male infants

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55
Q

Survival signal in T cell activation

A

B7 on dendritic cell (CD80/86) w/ CD 28 on naive T cell

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56
Q

B cell class switching

A

CD40 on B cell binds CD40L on Th

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57
Q

VJ is light or heavy chain?

A

Light

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58
Q

VDJ is light or heavy chain?

A

Heavy

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59
Q

Naive B cell Igs on surface

A

IgD and IgM

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60
Q

IgG properties

A

Main ab in delayed responce, most abundant Ig in serum; fixes complement, crosses placenta (passive immunity), opsonizes bacteria, neutralizes toxins/viruses

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61
Q

IgA properties

A

Prevents attachment of bacteria/virus to mucous membranes; monomer in circ vs dimer w/ J chain in secretions; crosses epithelial cells via trancytosis; GI tract – protects against gut infxns; most common ab overall – in tears, saliva, mucus, breast milk

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62
Q

IgM properties

A

Primary response, fixes complement, monomer on a B cell, pentamer when secreted (w/ J chain)

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63
Q

IgE properties

A

binds mast cells/basophils; cross links when exposed to allergen –> type I hypersens. and release of histamine; immunity to worms by eosinophil act.; lowest conc.

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64
Q

Thymus independent ags

A

No peptide component (cannot be presented by MHC) – weak immunogenicity

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65
Q

Thymus dependent ags

A

Protein component –> class switching and immunologic memory due to direct contact w/ B/Th cells

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66
Q

Cytokine that induces acute phase reactants

A

IL6

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67
Q

CRP

A

Acute phase opsonin that fixes complement/facilitates phagocytosis

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68
Q

Ferritin

A

Acute phase protein that binds/sequesters iron to keep it from bacteria

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69
Q

FIbrinogen

A

Acute phase coag factor that promotes endothelial repair (correlate w/ ESR)

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70
Q

Hepcidin

A

Acute phase protein that decreases iron absorption (degrades ferroportin) and iron release (from macs) –> anemia of chronic disease

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71
Q

Serum amyloid A

A

Acute phase protein that when elevated for a long time –> amyloidosis

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72
Q

Albumin

A

Downregulated by acute phase –> use of amino acids for positive reactants

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73
Q

Transferrin

A

Downreg by acute phase –> sequester iron in macs

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74
Q

Classic pathway of complement activated by

A

IgG or IgM

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75
Q

Alternative pathway of complement activated by

A

micro surface molecules

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76
Q

Lectin pathway of complement activated by

A

mannose or other sugars on microbes

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77
Q

Complement factor that opsonizes

A

C3b

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78
Q

Complement factor that causes anaphylaxis

A

C3a,4a,5a

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79
Q

Complement factor that causes neutrophil chemotaxis

A

C5a

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80
Q

Complement factor that causes cytolysis

A

MAC – C5b-C9

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81
Q

Major body opsonins

A

C3b and IgG (C3b also helps clear immune complexes)

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82
Q

Inhibitors of complement

A

DAF/CD55 and C1 esterase inhibitor

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83
Q

C3 Deficiency

A

Recurrent pyogenic sinus/respiratory tract infxns, increased susceptibility to type 3 hypersens. reactions

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84
Q

C5-9 deficiencies

A

Neisseria infxns

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85
Q

C1 esterase inhibitor deficiency

A

Hereditary angioedema due to unregulated activation of kallikrein–>bradykinin; low C4; ACE inhibs are CI

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86
Q

CD55 deficiency

A

DAF deficiency – complement mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria

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87
Q

IL1 – secreted by, function

A

Macs; fever, acute inflammation – activated endothelium to express adhesion molecules, induces chemokine secretion to recruit WBCs

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88
Q

IL6 – secreted by, function

A

Macs; fever and production of acute phase proteins

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89
Q

IL8 – secreted by, function

A

Macs; neutrophil chemotaxis

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90
Q

IL12 – secreted by, function

A

Macs; diff. of T cells into Th1, activates NKs

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91
Q

TNFalpha – secreted by, function

A

Macs; activates endothelium, WBC recruitment, vascular leak, cachexia in malignancy and maintains granulomas in TB

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92
Q

Sepsis mediators

A

TNF alpha, IL1, IL6

93
Q

IL2 – secreted by, function

A

T cells; growth of helpter, cytotoxic, Tregs, and NKs

94
Q

IL3 – secreted by, function

A

T cells; growth and diff. of bone marrow stem cells (like GM-CSF)

95
Q

IFN gamma – secreted by, function

A

Th1 cells, NKs; response to ag or IL12 from Macs –> stimulates Macs to kill phagocytosed pathogens, inhibs diff of Th2 cells, activates NKs to kill virus infected cells, increases MHC expression and ag presentation by all cells

96
Q

IL4 – secreted by, function

A

Th2 cells; diff of T cells into Th2, growth of B cells, class switching

97
Q

IL5 – secreted by, function

A

Th2 cells; growth/diff of b cells, class switch to IgA, growth/diff of eos

98
Q

IL10 – secreted by, function

A

Th2 cells, Tregs; attenuates inflamm response, decreases expression of MHC II and Th1, inhibits active macs and dendritic cells

99
Q

Attenuate the immune response

A

IL10, TGF beta

100
Q

Chronic Granulomatous Disease

A

NADPH ox def; Phagocytes can utilize H2O2 made by invading organisms and convert to ROS, but catalase pos species can neutralize their own (Staph a, Aspergillis) –> infxns

101
Q

Fxn of pyocyanin and bacteria

A

P aeruginosa–>generates ROS to kill competing microbes

102
Q

Fxn of lactoferrin

A

In secretory fluids/neuts –> inhibits microbial growth by chelating iron

103
Q

IFNalpha/beta – secreted by, function

A

Glycoproteins made by cells infected with virus –> other uninfected local cells to prime them for viral defense (help degrade viral nucleic acid/protein)

104
Q

T Cell general proteins

A

TCR (binds MHC/ag),
CD3 (w/ TCR for transduction of signals),
CD28 (binds B7 on APC for co stim signal),

105
Q

Th surface proteins

A

CD4,
CD40L
CXCR4/CCR5 (coreceptors for HIV)

106
Q

Tc surface proteins

A

CD8

107
Q

Treg surface proteins

A

CD4

CD25

108
Q

B cell surface proteins

A 
Ig
CD19,20,21 (EBV receptor)
CD40
MHCII
B7 (costim when APC)
109
Q

Macs surface proteins

A 
CD14 (for PAMPs)
CD40
CCR5
MHCII, B7 
Fc and C3b receptors for phagocytosis
110
Q

NK cell surface protein

A

CD56

111
Q

Hematopoietic stem cell surface protein

A

CD34

112
Q

Superantigen MOA

A

Released by strep pyo/staph aureus –> cross link beta region on TCR to MHCII on APCs –> massive activation of CD4 T cell–>lots of cytokines

113
Q

Endotoxin/LPS MOA

A

Directly stim macs by binding TLR4/CD14 (no T cell involvement)

114
Q

Salmonella antigenic variation

A

Flagellar variants

115
Q

N. gonorrhea antigenic variation

A

Pilus protein

116
Q

Toxins where unvaccinated pts should be treated with preformed antibodies

A

Tetanus, botulinum, HBV, rabies, diptheria (passive immunity) – HBV and rabies give passive and active

117
Q

Live attenuated vaccine induces _____ immunity

A

Cellular AND humoral – usually lifelong, but can revert to virulent to CI in preg/immunodef

118
Q

Examples of live attenuated vaccines

A

BCG, intranasal flu, measles, mumps, Sabin polio, rotavirus, rubella, varicella, yellow fever

119
Q

Killed/inactivated vaccines induce ______ immunity

A

Humoral only – cannot revert but usually a weaker response and requires boosters

120
Q

Examples of killed/inactivated vaccines

A

Rabies, flu shot, Salk polio, hep A

121
Q

Vasoactive amines act at

A

Postcapillary venules

122
Q

Type I delayed phase is due to

A

Mast cells and basophils releasing cytokines

123
Q

Type II hypersensitivity

A

Abs bind cell surface ags –> cell drestruction, inflamm, cellular dysfxn

124
Q

Examples of cellular destruction type II HS

A

Autoimmune hemolytic anemia, immune thrombocytopenic purpura, transfusion rxns, hemolytic disease of newborn

125
Q

Examples of inflammation type II HS

A

Goodpasture syndrome, rheumatic fever, hyperacute transplant rejection

126
Q

Examples of cellular dysfuction type II HS

A

Graves disease, MG

127
Q

Type III HS

A

Immune complex (IgG complexes activate complement –> recruit neuts –> release lysosomal enzymes

128
Q

Examples of type III HS

A

SLE, polyarteritis nodosa, post streg glomerulonephritis (vasculitis, systemic)

129
Q

Serum sickness

A

Immune complexes form when abs are made to foreign proteins –> deposit in membranes and fix complement –> most often caused by drugs; sx: fever, urticaria, arthralgia, proteinuria, lymphadenopathy 5-10 days after exposure

130
Q

Arthus rxn

A

Intradermal injxn of ag in presensitized individual –> immune complexes in skin –> edema, necrosis, activation of complement

131
Q

Type IV HS types

A

Direct cell cytotoxicity: CD8+ T cells kill targeted cells
Delayed-type: sensitized CD4 Ths release cytokines activating macs and inflammation
NO Abs

132
Q

Examples of type IV rxns

A

Contact dermatitis, graft vs host disease, PPD, patch test

133
Q

Allergic/anaphylaxis in blood transfusion sx and time window

A

Urticaria, pruritis, fever, hypotension, respiratory arrest, shock
mintues to 2-3 hours

134
Q

Febrile nonhemolytic transfusion rxn – pathogenesis, sx, time window

A

Type II HS (host abs against donor HLA and WBCs or induced by cytokines that accumulate in storage
Sx: fevers, headaches, chills, flushing
1-6 hrs

135
Q

Acute hemolytic transfusion rxn – pathogenesis, sx, time window

A

Type II HS –> intravascular hemolysis (ABO incompatibility) or extravascular hemolysis (host rxn against foreign ag on donor RBCs)
Sx: fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravasc) or jaundice (extravasc)
w/in an hour

136
Q

TRALI – pathogenesis, sx, time window

A

Donor anti-leuk abs against recipient neuts and pulmonary endothelium
Sx: respiratory distress, non cardiogeneic pulmonary edema
W/in 6hrs

137
Q

Anti Achr

A

MG

138
Q

Anti-glomerular basement membrane

A

Goodpasture

139
Q

Anti-B2 glycoprotein

A

Antiphospholipid

140
Q

Anticardiolipin, lupus anticoag

A

SLE, antiphospholipid syndrome

141
Q

Anticentromere

A

CREST

142
Q

Antidesmoglein/desmosome

A

Pemphigus vulgaris

143
Q

Anti-glutamic acid debarboxylase

A

T1 DM

144
Q

Islet cell cytoplasmic abs

A

T1 DM

145
Q

Antihemidesmosome

A

Bullous pemphigoid

146
Q

Anti Jo1/synthetase

A

Polymyositis dermatomyositis

147
Q

Anti SRP

A

Polymyositis, dermatomyositis

148
Q

Anti helicase/Mi-2

A

Polymyositis, dermatomyositis

149
Q

Antimicrosomal

A

Hashimotos

150
Q

AntiTG

A

Hashimoto

151
Q

AntiTPO

A

Hashimoto

152
Q

Antimitochondrial

A

Primary billiary cirrhosis

153
Q

Antiparietal cell

A

Pernicious anemia

154
Q

Anti IF

A

Pernicious anemia

155
Q

AntiPLA2r

A

Primary membranous neprhopathy

156
Q

AntiScl70 (DNA topo I)

A

Diffuse scleroderma

157
Q

Anti smooth muscle

A

Autoimmune hepatitis type 1

158
Q

Anti SSA (Ro) SSB (La)

A

Sjorgrens

159
Q

AntiTSHr

A

Graves

160
Q

Anti presyn. voltage gated Ca channel

A

Lambert Eaton myasthenic syndrome

161
Q

IgA anti endomysial

A

Celiac

162
Q

IgA Anti TTG

A

Celiac

163
Q

p-ANCA

A

MPO! Microscopic polyangiitis, eosinophilic granulomatosis w/ polyangiitis (Churg Strauss), ulcerative colitis

164
Q

c-ANCA

A

PR3! Granulamatosis w polyangiitis (Wegener)

165
Q

Rheumatoid factor (IgM against IgG Fc)

A

RA

166
Q

Anti-CCP

A

RA

167
Q

ANA

A

SLE (but nonspecific)

168
Q

Anti-dsDNA

A

SLE

169
Q

Anti Smith

A

SLE

170
Q

Anti histone

A

Drug induced lupus

171
Q

Anti-U1 RNP

A

Mixed connective tissue disease

172
Q

Bruton agammaglobulinemia – genetics, sx, findings

A

X linked defect in BTK (B cell maturation)
Sx: recurrent bacterial and enteroviral infxns after 6 mts
Find: No B cells in peripheral blood, univerally low Ig, scanty lymph nodes/tonsils
NO VACCINES

173
Q

Select IgA def – genetics, sx, findings

A

Most common one
Sx: usually assymptomatic, some airway/GI infxn, autoimmune disease, atopy, anaphylaxis to IgA products
Find: low IgA, normal IgG/IgM, lots of giardiasis

174
Q

CVID – genetics, sx, findings

A

Defect in B cell diff
Sx: after age 2 –> increased risk of autoimmune disease, bronchiectasis, lymphoma, sinopulmnoary infxn
Find: low plasma cells, low Ig

175
Q

Thymic apalsia – genetics, sx, findings

A

Digeorge – 22q11 deletion/failure to develope 3/4th pharyngeal pouch –> no thymus or parathyroids
Sx: Tetany (hypocalcemia), recurrent viral/fungal infxns (low T cells), conotruncal abnormalities (tet of Fallot, truncus arteriosus)
Find: low T cells, low PTH, low Ca, no thymic shadow on CXR

176
Q

IL12r deficiency – genetics, sx, findings

A

Ar – less Th1 resposne
Sx: Disseminated mycobacterial/funcal infxns – may present after BCG vax
Find: low IFNgamma

177
Q

Hyper IgE syndrome – genetics, sx, findings

A

AD – def of Th17 cells due to STAT3 mutation –> impaired recruitment of neuts (Job syndrome)
Sx: coarse facies, cold staphylococcal abscesses, retained primary teeth, high IgE, derm problems (eczema), bone fractures from minor trauma
Find: high IgE, low IFN gamma, high eos

178
Q

Chronic mucocutaneous candidiasis – genetics, sx, findings

A

T cell dysfxn
Sx: Noninvasive candida infxns of skin/mucous membranes
Findings: No t cell prolif in response to candida ags or cutaneous rxn to candida ags

179
Q

SCID – genetics, sx, findings, tx

A

IL-2R gamma chain – X linked or ADA deficiency – Ar
Sx: Failure to thrive, chronic diarrhea, thrust, recurrent infxns of all kinds
FInd: Low t cell receptor excision circles, no thymic shadow on CXR, no germinal centers, no T cells by flow cyto
Tx: No live vax, give antibiotic prophylaxis, IVIG, bone marrow transplant curative

180
Q

Ataxia telangectasia– genetics, sx, findings

A

Defects in ATM gene –> failure to repair DNA double strand breaks –> cell cycle arrest
Sx: cerebellar defects (ataxia), spider angiomas (telangectasia), IgA def
Find: High AFP, low IgA, IgG, and IgE, lymphopenia, cerebellar atrophy, high risk of lymphoma/leukemia

181
Q

Hyper IgM– genetics, sx, findings

A

Usually defective CDL on Th –> class switching defect, is Xr
Sx: Severe pyogenic infxns in early life, opportunistic infxns w/ PCP, cryptosproridum, CMV
Find: Low IgG, IgA, IgE, fails to make germinal centers

182
Q

Wiskott Aldrich Syndrome – genetics, sx, findings

A

Mutation in WASp gene – leukocytes and plts cannot reorg actin cytoskeleton to present ags, Xr
Sx: Thrombocytopenia, eczema, recurrent pyogenic infxns, increased risk of autoimmune disease and malignancy
Find: High Ige, IgA, fewer/smaller platelets

183
Q

Leukocyte adhesion def type 1– genetics, sx, findings

A

Defect in LFA-1 integring (CD18) on phagocytes – impaired migration/chemotaxis, Ar
Sx: Recurrent skin/mucosal bacterial infxns, absent pus, impaired would healing, delayed separation of umbilical cord (>30d)
Find: Increased neuts but none at sites of infxn

184
Q

Chediak Higashi – genetics, sx, findings

A

Defect in LYST – microtubule dysfxn in phagosome/lysosome fusion. Ar
Sx: Recurrent pyogenic infxns by staph and strep, partial albinism, peripheral neuropathy, progressive neurodegen, infiltrative lymphohistiocytosis
Find: Giant granules in granulocytes and plts, pancytopenia, mild coag defects

185
Q

CGD – genetics, sx, findings

A

Defect in NADPH oxidase – less ROS and respiratory burst in neuts, usually Xr
Sx: Increased susceptibility to cat pos organisms
Finding: Abnormal dihyrorhodamine (flow cyto – less green fluorescence) and nitroblue tetrazolium does NOT turn blue

186
Q

T cell def infxns

A

Viral (CMV, EBV, JCV, VZV, respiratory/GI) and fungal/parasites (candida, PCP, cryptococcus)

187
Q

B cell def infxns

A

Encapsulated bacteria (SHINE my SKiS), enteroviral encephalitis, polio, GI giardiasis

188
Q

Granulocyte def infxns

A

Staph, Burkholderia cepacia, P. aeruginosa, Serratia, Nocardia, Candida (systemic), Aspergillus, Mucor

189
Q

Complement def infxns

A

Early: encapsulated species
Late: Neisseria

190
Q

Hyper acute transplant rjxn timing, pathogen

A

Minutes –> preexisting abs react to donor ag (type II) –> complement activation –> thrombosis of graft vessels, ischemia, necrosis –> must remove graft

191
Q

Acute transplant rjxn timing

A

Weeks to months

192
Q

Cellular acute transplant rjxn pathogen

A

CD8 T cells against donor MHCs (type IV HS rxn)

193
Q

Humoral acute transplant rjxn pathogen

A

Similar to hyper acute by abs after transplant

194
Q

Acute transplant rjxn sx

A

Vasculitis of graft vessels w/ interstitial lymph infilitrate – prevent/reverse w/ immunosuppressants

195
Q

Chronic rjxn timing, pathogen, sx

A

Months to years
CD4 t cells respond to RECIPIENT APCs presenting DONOR peptides – both cellular and humoral (type II and IV HS)
Recipient T cells react and make cytokines –> prolif of vascular smooth m., parenchymal atrophy, interstitial fibrosis, arteriosclerosis

196
Q

GVHD

A

Grafted immunocompetent T cells proliferate in the immunocompromised host and reject host cells w/ foreign proteins –> type IV HS leading to organ failure
Sx: Maculopapular rash, jaundice, diarrhea, hepatosplenomegaly
Bone marrow and liver transplants because lots of lymphs
Can be beneficial in leukemia (graft vs tumor)

197
Q

Cyclosporin MOA, indications, ADE

A

MOA: Calcineurin inhibitor (binds cyclophilin) –> blocks T cell activation by preventing IL 2 transcription
Indicated: Psoriasis, RA, transplants
ADE: NEPHROTOXIC, htn, hyperlipidemia, neurotox, gingival hyperplasia, hirsutism

198
Q

Tacrolimus MOA, indications, ADE

A

MOA: Calcineurin inhibitor binds FK506 binding protein – blocks T cell activation by preventing IL 2 transcription
Indication: transplants
ADE: NEPHROTOXIC, increased risk of diabetes and neurotox

199
Q

Sirolimus (rapamycin) MOA, indications, ADE

A

MOA: mTOR inhibitor – binds FKBP blocking T cell activation and B cell differentiation by preventing a response to IL 2
Indication: kidney transplants
ADE: Pancytopenia, insulin resistance, hyperlipidemia

200
Q

Basiliximab MOA, indications, ADE

A

MOA:blocks IL-2r
Indication: Kidney tranplant
ADE: Edema, HTN, tremor

201
Q

Azathioprine MOA, indications, ADE

A

MOA: Antimetabolite precursor of 6MP – inhibits lymph prolif by blocking nucleotide synth
Indication: Transplats, RA, Crohn disease, glomerulonephritis, autoimmune conditions
ADE: Pancytopenia, degraded by XO to tox increased by allopurinol in gout tx

202
Q

Mycophenolate mofetil MOA, indications, ADE

A

MOA: Reversibly inhibits IMP DH – prevents purine synth of B and T cells
Indication: Transplants, lupus nephritis
ADE: Gi upset, pancytopenia, HTN, hyperglycemia, invasive CMV infxn

203
Q

Corticosteroids MOA, indications, ADE

A

Inhibit NF-KB – suppresses B and T cell fxn by decreasing transcription of cytokines, induces T cell apoptosis
Indication: transplants, autoimmune/inflam disorders, adrenal insufficiency, asthma, CLL, non-Hodgkin lymphoma
ADE: Cushing syndrome, osteoporosis, hyperglycemia, diabetes, amenorrhea, adrenocoritcal atrophy, peptic ulcers, psychosis, cataracts, avascular necrosis of femoral head, adrenal insufficiency if stopped abruptly
OTHER: WBCs demarginate – looks like leukocytosis

204
Q

Use of aldesleukin (IL2)

A

Renal cell carcinoma, metastatic melanoma

205
Q

Use of epoetin alfa (EPO)

A

Anemias (w/ renal failure)

206
Q

Use of filgrastim (G-CSF)

A

Recovery of bone marrow and WBC counts by granulocyte stim

207
Q

Use of Sargramostim (GM-CSF)

A

Recovery of bone marrow and WBC counts by granulocyte and monocyte stim

208
Q

Use of IFN alpha

A

Chronic hep B/C, Kaposi sarcoma, malinant melanoma, hairy cell leukemia, condyloma acuminata, renal cell carcinoma

209
Q

Use of IFN beta

A

Multiple sclerosis

210
Q

Use of IFN gamma

A

CGD

211
Q

Use of romplostim (thrombopoetin analog) and eltrombopag (thrombopoietin receptor agonist)

A

Thrombocytopenia

212
Q

Use of oprelvekin (IL1)

A

Thrombocytopenia

213
Q

Alemtazumab target and use

A

CD52

CLL, MS

214
Q

Bevacizumab target and use

A

VEGF
Colorectal cancer, renal cell carcinoma, non-small cell lung cancer, Neovascular age-related macular degeneration, proliferative diabetic retinopathy, macular edema

215
Q

Cetuximab target and use

A

EGFR

Stage IV colorectal cancer, head and neck cancer

216
Q

Rituximab target and use

A

CD20

B cell non hodgkin lymphnoma, CLL, RA, ITP

217
Q

Trastuzumab target and use

A

HER2/neu

Breast cancer, gastric cancer

218
Q

TNF alpha inhibitors

A

Adalimumab, certolizumab, golimumab, infliximab, etanercept (decoy TNF alpha receptor)

219
Q

TNF alpha inhibitors use

A

IBD, RA, ankylosing spondylitis, psoriasis

220
Q

Dacalizumab target and use

A

CD25 (part of IL2 receptor)

Relapsing MS

221
Q

Eculizumab target and use

A

Complement part of C5

Paroxysmal nocturnal hemoglobinuria

222
Q

Natalizumab target and use

A

alpha4-integrin (WBC adhesion)
MS, Crohn disease
WARNING: Risk of PML in pts w JCv

223
Q

Ustekinumab target and use

A

IL12/IL23

Psoriasis, psoriatic arthritis

224
Q

Abciximab target and use

A

Plately glycoproteins IIBIIIA

Antiplt agent for preventing ischemic complications in pts undergoing PCI

225
Q

Denosumab target and use

A

RANKL

Osteroporosis, inhibits osteoclast maturation by mimicking osteoprotegrin)

226
Q

Dig immune Fab target and use

A

Dig tox

227
Q

Omalizumab target and use

A

IgE – prevents IgE binding to FcERI

Refractory allergic asthma

228
Q

Palivizumab target and use

A

RSV F protein

RSV prophylaxis for high-risk infants

229
Q

Ranibizumab target and use

A

VEGF

Neovascular age-related macular degeneration, proliferative diabetic retinopathy, macular edema

STEP (15 decks)

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