Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Exam 1 > Immunology > Flashcards

Immunology Flashcards

1
Q

Rheumatoid Arthritis -

Blood tests? specific to RA

A

Anticyclic citrolinated protein - shows severity of RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rheumatoid Arthritis Blood checks?

A
  • Rheumatoid factor - autoantibody of RA
  • Antinuclear antibody - against nucleus for RA
  • Hb for anaemia
  • Anticyclic citrolinated protein/anti-CCP if Rh factor -ve
  • Xray/Radiology - shows inflammation & damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Rheumatoid Arthritis Acute phase tests?

A
  • Erythrocyte sedimentation Rate (ESR) - measure inflammation within 24hrs.
  • Works after hour but could be activated by surgery, injury & infections.
  • C-reactive protein (CRP) -
  • measures inflammation via protein made in innate system, • increases 4-6hr after inflammation.
  • Could be activated by surgery, injury & infections.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

C-reactive protein (CRP) in Rheumatoid Arthritis Blood test

A
  • measures inflammation via protein made in innate system, • increases 4-6hr after inflammation.
  • Could be activated by surgery, injury & infections.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Erythrocyte sedimentation Rate (ESR) in Rheumatoid Arthritis Blood test

A
  • measure inflammation within 24hrs.

* Works after hour but could be activated by surgery, injury & infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Rheumatoid Arthritis additional checks (.not blood)

A
  • Xray
  • functional ability of pt eg health assessment questionnaire
  • baseline tests for comparison in the future
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NICE Rheumatoid Arthritis first line

A
  • conventional/ cDMARD
  • monotherapy
  • eg MTX, leflunomide, sulfasalazine
  • ASAP
  • hydroxychloroquine if mild symptoms - weak DMARD.
  • treat to target, aim for remission
  • escalate dose as tolerated.
  • consider short term bridging with corticosteroid/ steroid cover whilst DMARD starts to work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

cDMARD stands for?

A

conventional disease modifying anti-rheumatic drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why add corticosteroid short term bridging with cDMARD in Rheumatoid Arthritis?

A
  • as DMARD has lag time until effects seen.

* review corticosteroid & remove once DMARD effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

weak DMARD eg

A
  • hydroxychloroquine.

* used if mild symptoms. not usually given.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Rheumatoid Arthritis considerations before treatment?

A
  • Pt preference
  • Pt characteristics eg co-morbidities
  • drug characteristics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CI/Cautions with MTX

A
  • Active infection
  • immunodeficiency syndromes
  • Ascities/pleural effusion
  • severe renal impairment
  • Alcoholism
  • NSAIDs
  • Blood dyscrasias - myelosuppression = SE
  • Pregnancy
  • Elderly - reduced hepatic and renal fn, reduced folate reserves.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MTX CI with Active infection why?

A
  • reduce immune system efficacy

* immunodeficiency syndromes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MTX CI with Ascities/pleural effusion why?

A

• MTX into fluid, accumulates, re-excreted, prolong serum 1/2 life, toxicity increase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MTX CI with Alcoholism/NSAIDS

A
  • severe renal impairment - MTX renal cleared
  • Alcoholism - increased risk of hepatotoxicity
  • NSAIDs - risk to renal fn and MTX excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MTX CI with pregnancy why?

A
  • Pregnancy - MTX teratogenic.

* Contraception for both during treatment and 3-6months after.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MTX strength of tablets in RA

A

• 2.5mg, 10mg NEVER for safety incase of accidental overdose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

RA - MTX weekly adjustments?

A

• increase by 2.5-5mg every 2-6 weeks to 20mg max dose or highest tolerated dose below max.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RA - MTX supply of tablets

A

only supply up to next appx to reduce risk of incorrect administration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MTX - folic acid?

A
  • 1/7 , take on different days.

* given to reduce antifolate SE of MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MTX - corticosteroid?

A
  • DMARD delay up to 3 months.
  • oral prednisolone course or one off IM or IV methylprednisolone.
  • stopped appropriately
22
Q

MTX pt discussion

A
  • MTX - immunosuppressant
  • MTX monday, Folic acid Friday
  • miss dose = take next day, unless 3+ days late. continue on normal day following week.
  • long? 6wk to 3months to work. Corticosteroid til then = pain relief.
  • cytotoxic - away from children
  • teratogenic - contraception
  • MTX booklet - carry, fill in, keep up to date.
  • blood tests for A.SE/ adverse SEs
23
Q

MTX SE

A
  • GI
  • CNS - inform prescriber
  • hair thinning - fine once stopping med

Report:
• SOB, dry cough, fever - pulmonary toxicity
• Yellowing of eyes, N&V - hepatic impairmetn

24
Q

Avoid with MTX

A
  • contact with chicken pox
  • live vaccinations
  • OTC NSAIDs, ibuprofen
  • non-pasteurised foods
25
Contraception w MTX length?
3 - 6 months before and after
26
MTX tests and investigations?
* LFTs - MTX = hepatotoxic * RF - ensure MTX cleared and doesn't accumulate. * FBC - neutropenia, thrombocytopenia, lymphopenia, bone marrow suppression * Chest X ray - pulmonary toxicity
27
MTX Tests for newly started pt
LFTs/RT, FBC • before starting • 1-2 wks until stabilised • 2-3 months
28
DAS28 what is it?
28 joints in body tested for swelling, tenderness and ESR/CRP
29
DAS28 >5.1
active disease
30
DAS28 <3.2
low disease
31
DAS28 <2.6
remission
32
RA Step up therapy after MTX
``` • additional cDMARD eg sulfasalazine, leflunomide • bridging corticosteroid • symptomati relief • optimise new therapy • increased monitoring until stabilised ```
33
after 2nd line RA MTX & cDMARD
by EULAR could consider bDMARD or tDMARD
34
failure of cDMARD in RA, NICE recommend..
DAS28 >5.1 | give bDMARD
35
Infliximab is a?
TNFa inhibitor | tumour necrosis factor alpha
36
Infliximab binds to?
* with high affinity to monomers & trimers of soluble TNF & transmembrane TNF * form complexes of each. * prevents pro-inflammatory TNF binding to its receptors.
37
Infliximab made of?
* chimeric protein - human and murine origin * IgG light and heavy chains * fragment of antigen bindings - TNF binding areas * Fc region
38
Infliximab prevents inflammation by inducing.. ?
``` Induce: • reducing cytokine & chemokine production • reduce activation & proliferation • inflammatory cell apoptosis • reduced angiogenesis • reduced effect on bone ```
39
Pro inflammatory cytokine egs
``` IL-1 TNF-a IL-12 IL-6 IFNa/ß CXCL8 CCL2 ```
40
IL-1
* causes inflammation & fever | * induces acute phase proteins/ APP
41
TNF-a
* inflammation * induce APP/ acute phase proteins * induce cell death * neutrophil activation * cachexia (muscle wasting)
42
IL12
* Nk cells | * promotes Th1 to produce T-lymphocytes
43
IL6
* in liver * induce APPs * induce adaptive system (proliferation & antibody secretion via B-cells)
44
IFNa/ß
* induces antiviral state | * activates Nk cells
45
CXCL8
attracts neutrophils
46
CCL2
attracts monocytes
47
NFkB bound to?
Ikb
48
When NFkB released?
When cytokines released/ bacterial components etc, Ikb kinase activated and breaks down Ikb. (NFkB bound to Ikb)
49
After NFkB released?
* migrates to the nucleus to bind on the promoter sequences to transcribe pro-inflammatory cytokines. * DNA to RNA
50
Describe signalling pathway that leads to production of prostaglandins & leukotrienes
* Stimulus activates phospholipase A2 which activates phospholipids. * then arachidonic acid * then COX1, COX2 lipoxygenases. * lipoxygenases -> leukotrienes * COX -> different prostaglandins eg PGG2
51
Process that leads to a fever?
* Macrophage ingests toxin * broken down in a vacuole * releases endotoxins * macrophage proces IL1. * IL1 goes into blood stream then hypothalamus * IL1 induces production of prostaglandins which increase temp of body's thermostat. * fever

Exam 1 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions