Immunology Flashcards
what is the site of B cell localization and proliferation in the lymph node?
Follicle
Where are the follicles in a lymph node located?
Outer cortex
What do primary follicles look like in a lymph node?
Primary follicles are inactive and are dense and dormant
What do secondary follicles look like in a lymph node?
Secondary follicles have pale central germinal centers and are active
where are macrophages located in the lymph node?
medullary sinus
Where are plasma cells located in the lymph node?
Medullary cords
Where are T cells located in a the lymph node?
Paracortex
were do T and B cells enter the lymph node from the blood?
They enter via endothelial venules into the paracortex
What part of the lymph node enlarges in a cellular immune response?
Paracortex enlarges
where do lymph from the upper limb and lateral breast drain?
Axillary lymph node
where do lymph from the stomach drain?
Celiac lymph node
Where do lymph from the duodenum and jejunum drain?
Superior mesenteric lymph node
Where does lymph from the sigmoid colon drain?
Colic to inferior mesenteric lymph node
Where does lymph from the lower portion of the rectum of the anal canal above the pectinate line drain to?
Internal iliac
Where does lymph from the anal canal below the pectinate line drain to?
Supericial inguinal lymph node
Where does lymph from the testes drain to?
Superficial and deep plexuses to the para-aortic
Where does lymph from the scrotum drain?
Superficial inguinal lymph node
Where does lymph from the superficial thigh drain?
superficial inguinal lymph node
Where does lymph from the lateral side of the dorsum of the foot drain?
Popliteal lymph node
What drains the lymph of the right arm, right chest and right half of the head?
Right lymphatic duct
Where are T cells located in the spleen?
Periarterial lymphatic sheath (PALS) within the white pulp of the spleen
Were are B cells found in the spleen?
In follicles within the white pulp of the spleen
What do macrophages in the spleen do?
Remove damaged RBCs and remove encapsulated organisms
What do you see with splenic dysfunction?
Decreased IgM –> decreased complement activation –> decreased C3b opsonization –> increased susceptibility to encapsulated organisms
What are the encapsulated organisms you can have problems with in asplenia?
SHiNE SKS
- Strep penumo
- Haemophilus influenza type B
- Neisseria meningitides
- Salmonella
- Klebsiella pneumoniae
- group b Strep
- E. coli
A patient presents with Howell jolly bodies (nuclear remnants), target cells and thrombocytosis - what don’t they have?
The patient doesn’t have a spleen
Name 3 situations where a patient would be missing a spleen
sickle cell patient with auto infarction
Trauma
Hereditary spherocytosis
What is the purpose of the thymus?
The thymus is the site of T cell differentiation and maturation
Is the thymus encapsulated?
Yes
What is the thymus derived from?
Epithelium of the 3rd bronchial pouches
note that lymphocytes are of mesenchymal origin
What type of cell is located in the cortex of the thymus?
The cortex is dense with immature T cells
What type of cell is located in the medulla of the thymus?
The thymus is pale with mature T cells and epithelial reticular cells containing Hassall’s corpuscles.
Where does positive and negative selection of T cells occur in the thymus?
Positive selection (MHC restriction) occurs in the cortex and negative selection (non-reactive to self) occurs in the medulla
What type of immunity consists of neutrophils, macrophages, dendritic cells, eosinophils, basophils, mast cells, natural killer cells (lymphoid origin), and complement
Innate immunity
What type of immunity has receptors that recognize pathogens that are germline encoded?
Innate immunity
Which form of immunity has no memory
innate immunity
Which form of immunity has receptors that recognize pathogens by undergoing VDJ recombination during lymphocyte development?
Adaptive immunity
What form of immunity has a slow response on first exposure but the memory response is faster and more robust?
Adaptive immunity
Which type of immunity consists of T cells, B cells and circulating antibodies?
adaptive immunity
What is the purpose of MHC?
They present antigen fragments to T cells and bind TCR
what do MHC-I bind?
TCR and CD8
What cells express MHC-I?
Expressed on all nucleated cells, not expressed on RBCs
cells use MHC-I to show CD8 cells that they are normal healthy cells
Which MHC mediates viral immunity?
MHC-1
Which MHC pairs with Beta2-microglobulin to get to the cell surface?
MHC-I
What do MHC-II bind?
TCR and CD4
What cells express MHC-II?
Antigen presenting cells
Which MHC loads the antigen following release of invariant chain in an acidified endosome?
MHC-II
What disorder is HLA-A3 associated with?
Hemochromatosis
What disorders is HLA-B27 associated with?
Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter’s syndrome
(PAIR)
What disorder is HLA-DQ2/DQ8 associated with?
Celiac disease
What disorders is HLA-DR2 associated with?
Multiple sclerosis, hay fever, SLE, Goodpasture’s
What disorders is HLA-DR3 associated with?
DM type 1, Grave’s disease
What disorders if HLA-DR4 associated with?
Rheumatoid arthritis, DM type 1
What disorders are HLA-DR5 associated with?
Pernicious anemia (B12 deficiency), Hashimoto’s thyroiditis
what is the only lymphocyte that is a member of the innate immune system?
NK cells
what CD markers are found on an NK cell?
CD16 and CD56
what do NK cells secrete to activate macrophages?
IFN-gamma
What’s so great about CD16?
Helps cells to recognize and kill Ig-coated cells via antibody dependent cell mediated cytotoxicity
Which cytokines are known to increased the activity of NK cells?
IL-2, IL-12, IFN-Beta, IFN- alpha
when are NK cells induced to kill another cell?
When exposed to a non-specific activation signal on a target cell and/or to an absence of class I MHC on target cell surface
What do B cells secrete to neutralize viruses?
IgG
what do CD4 T-cells do?
Help B cells make antibody and produce cytokines to activate other cells of the immune system
What do CD8 T-cells do?
Kill virus-infected cells directly
In what part of T cell selection occurs in the thymic cortex and involves T cells expressing TCRS that are capable of binding surface self MHC molecules will survive?
Positive selection
In what part of T cell selection occurs in the thymic medulla and involves TCRs with high affinity for self antigens undergoing apoptosis?
negative selection
What are the two necessary signals for naïve T cell activation?
Signal 1 - foreign antigen is presented on MHC II and recognized by TCR on Th cells. Antigen is presented on MHC-I to Tc cells
Signal 2 - “costimulatory signal” is given by interaction of B7 and CD28
What are the two necessary signals for B cell activation and class switching?
Signal 1 - b cell receptor mediated endocytosis; foreign antigen is presented on MHC II and recognized by TCR of Th cells
Signal 2 - CD40 receptor on B cell binds CD40 ligandon TH cell
what cytokine(s) does Th1 cells secrete?
IFN-Gamma
what cytokine(s) does Th2 cells secrete?
IL-4, IL-5, IL-10, IL-13
What do Th1 cells do?
activate macrophages
What do Th2 cells do?
recruits eosinophils for parasite defense and promotes IgE production by B cells
What inhibits TH1 cells?
IL4 and IL10
What inhibits TH2 cells?
IFN-gamma
what is the macrophage-lymphocyte interaction?
Activated lymphocytes released IFN gamma and macrophages release IL1 and TNF alpha which they each stimulate each other
what cells kill virus infected, neoplastic and donor graft cells by inducing apoptosis?
Cytotoxic T cells
what makes cytotoxic T cells so toxic?
They release cytotoxic granules containing preformed proteins like perforin which helps to deliver the content of granules into the target cell and granzyme which is a serine protease, activates apoptosis inside the target cell
granulysin is antimicrobial and also induces apoptosis
which T cells express CD3, CD and CD25?
Regulatory T cells
What T cells suppress CD8 and CD4 cells?
Regulatory T cells
what cytokines to activates regulatory T cells secrete?
anti-inflammatory cytokines like IL10 and TGF-Beta
what portion of IgM and IgG fix complement?
The Fc portion (CH2 part of Fc)
how many antigenic specificities are expressed per B cell?
one
What occurs following antigen stimulation that allows for antibiotic diversity?
Somatic hypermutation
what is the only immunoglobulin that can directly opsonize?
IgG
What is the only immunoglobulin that can cross the placenta?
IgG
What is the only immunoglobulin that participates in Antibody dependent cellular cytotoxic ?
IgG
What immunoglobulins are on the surface of mature naïve B cells?
IgM and IgD
Which cytokines cause class switching to IgA?
IL5 and TGF Beta
What is the valence of a secreted IgM?
IgM is a pentamer which gives a valence of 10 - can bind a total of 10 antigens
What immunoglobulin is at the lowest concentration in the serum?
IgE
What cytokines cause class switching to IgE?
IL4 and IL 13
what is a thymus independent antigen?
Lacks a peptide component so it can’t be presented by MHC to T cells - stimulates release of antibodies but does not result in immunologic memory
What is a thymus dependent antigen?
Contains a protein compound which causes class switching and immunologic memory as a result of direct contact of B cells with Th cells via the CD40/CD40L interaction
A patient presents with an anaphylactic response to a bee sting - what’s the first antibody made in this response?
IgM
What is the function of C3b?
Opsonization
C3b also helps to clear immune complexes
What is the function of C3a and C5 a?
anaphylaxis
What is the function of C5a?
Neutrophil chemotaxis
What is the function of C5b-9?
MAC
how does activation of the alternative pathway of complement occur?
by microbe surface molecules or it can also occur spontaneously
What two inhibitors help prevent complement activation on self cells?
C1 esterase inhibitor and DAF (decay-accelerating factor)
which two cytokines inhibit complement C9 binding?
CD55 (DAF) and CD59
A patient presents with hereditary angioedema - what is the disorder?
C1 esterase inhibitor deficiency
What drug is contraindicated in patients with C1 esterase inhibitor deficiency and why?
ACE inhibitors
it’s thought that the deficiency is due to increased bradykinin and ACE inhibitors also increase this
A patient presents with severe, recurret pyogenic sinus and respiratory tract infections and increased susceptibility to type III HS reactions (especially in glomerulonephritis) - what is the disorder?
C3 deficiency
A patient presents with recurrent Neisseria bacteremia - what is the disorder?
C5-9 deficiency
A patient presents with complement-mediated lysis of RBCs and paroxysmal nocturnal hemoglobinuria - what is the disorder?
DAF (GPI anchored enzyme) deficiency
DAF=CD55
This cytokine is an endogenous pyrogen - causing fever and inflammation. It also activates endothelium to express adhesion molecules; induces chemokine secretion to recruit leukocytes.
IL-1
What is the mnemonic for cytokines?
“Hot T-Bone stEAk”
IL-1: fever (hot) IL-2: stimulates T cells IL-3: stimulates Bone marrow IL-4: stimulates IgE production IL-5: stimulates IgA production
This cytokine is an endogenous pyrogen that is also secreted by TH2 cells - causes fever and stimulates production of acute phase proteins
IL6
This cytokine is a major chemotactic factor for neutrophils
IL8
This cytokine induces differentiation of T cells into TH1 cells, activates NK cells and is also secreted by B cells
IL-12
This cytokine mediates Septic shock - activates endothelium causing leukocyte recruitment and a leaky vasculature
TNF-alpha
What cytokines are secreted by TH1 cells?
IL2, 3, IFN-G
What cytokines are secreted by TH2 cells?
IL2, 3, 4, 5, 10
This cytokine stimulates growth of helper, cytotoxic and regulatory T cells
IL2
This cytokine supports the growth and differentiation of bone marrow stem cells - functions like GM-CSF
IL3
This cytokine activates macrophages and TH1 cells. It also suppresses TH2 cell and has antiviral and antitumor properties
IFN-Gamma
This cytokine induces differentiation into TH2 cells, promotes growth of B cells and enhances class switching to IgE and IgM
IL4
This cytokine promotes differentiation of B cells, enhances class switching to IgA, and stimulates growth and differentiation of eosinophils
IL5
This cytokine modulates the inflammatory response. It also inhibits actions of activated T cells and TH1, also secreted by regulatory cells.
IL 10
Which two cytokines are involved with shutting down the immune response?
IL10 and TGF beta
What is the function of interferons?
They place uninfected cells into an antiviral state and they also activate NK cells to kill virus-infected cells
What do interferon alpha and beta do?
They inhibit viral protein synthesis (by degrading viral mRNA) to help neighboring cells avoid viral infection
What does Interferon gamma do?
Increases MHCI and II expression and antigen presentation in all cells
What CD marker binds to B7 on APCs?
CD28
What CD markers are found on TH cells?
TCR, CD3, CD28, CD4, CD40L
What CD markers are found on TC cells?
TCR, CD3, CD28, CD8
what cell surface proteins are found on B cells?
Ig
CD19, CD20, CD21
MHC-II, B7
what cell surface proteins are found on macrophages?
CD14, CD40
MHC-II, B7
Fc and C3b
What cell surface proteins aer found on NK cells?
CD16 (binds Fc portion of IgG for ADCC) and CD56
what is anergy?
Self reactive T cells become non-reactive without costimulatory molecule. B cells also become anergic, but tolerance is less complete than in T cells
how do superactigens cause problems?
Superactigens cross link the Beta region of the T cell receptor to the MHC class II on APCs. They can activate any T cell, leading to massive release of cytokines.
How do endotoxins/lipopolysaccharides from gram neg cells cause an effect?
they directly stimulate macrophages by binding to endotoxin receptor CD 14, TH cells are not involved
what is the duration of passive immunity?
Short span of antibodies - half life of 3 weeks
What are some examples of passive immunity?
IgA in breast milk, antitoxin, humanized monoclonal antibody, Palivizumab TX for RSV
what are some exposures that a patient can have that may make you give them passive immunity via pre-formed antibodies?
Exposure to: tetanus toxin, botulinum toxin, HBV, or Rabies
“To Be Healed Rapidly”
What are some examples of active immunity?
Natural infection, vaccines, toxoid
what type of vaccination produces a mainly cellular response with memory T cells?
Live attenuated vaccine
What type of vaccination produces a humoral immunity with the production of antibodies?
Inactivated or killed vaccine
what are examples of live attenuated vaccines?
Measles, mumps, polio (sabin), rubella, varicella, yellow fever
What type of hypersensitivity: Reaction develops rapidly after antigen exposure because of preformed antibodies
Type I hypersensitivity
What type of hypersensitivity: Anaphylactic and atopic
Type I HS
What type of hypersensitivity: Free antigen crosslinks IgE on presensitized mast cells and basophils, triggering release of vasoactive amines that act at postcapillary venules
Type I HS
What type of hypersensitivity: Cytotoxic (Ab mediated)
Type 2 HS
What type of hypersensitivity: IgM, IgG bind to fixed antigen on a cell leading to cellular destruction
Type 2 HS
What type of hypersensitivity: Antibody and complement lead to membrane attack complex
Type 2 HS
what are the 3 mechanisms of Type 2 HS?
- opsonization leading to phagocytosis or complement activation
- complement-mediated lysis
- antibody-dependent cell mediated cytotoxicity (ADCC) usually due to NK cells
What type of hypersensitivity: Immune complexes
Type 3 HS
What type of hypersensitivity: Antigen-antibody (IgG) complexes activate complement, which attracts neutrophils and the neutrophils release lysosomal enzymes
Type 3 HS
What type of hypersensitivity: An immune complex disease in which antibodies to foreign proteins are produced (takes 5 days) - immune complexes are formed and deposit in membranes where they fix complement leading to tissue damage
Type 3 HS - serum sicknes
What type of hypersensitivity: A local subacute antibody mediated HS reaction with intradermal injection of antigen inducing antibodies which form antigen-antibody complexes in the skin - characterized by edema, necrosis and activation of complement
Type 3 HS - arthus reaction
What type of hypersensitivity: Antigen + antibody + complement
Type 3 HS
What type of hypersensitivity: Delayed (T-cell mediated)
Type 4 HS
What type of hypersensitivity: Sensitized T lymphocytes encountered antigen and then release lymphokines leading to macrophage activation, no antibody involvement
Type 4 HS
What type of hypersensitivity: Delayed, cell mediated, is not transferable by serum
Type 4 HS
What type of hypersensitivity: rhinitis, hay fever, bee sting, allergies, eczema
Type I HS
What type of hypersensitivity: Autoimmune hemolytic anemia
Type II HS
What type of hypersensitivity: Pernicious anemia
Type II HS
What type of hypersensitivity: Idiopathic thrombocytopenic purpura, erythroblastosis fetalis, acute hemolytic transfusion reaction
Type II HS
What type of hypersensitivity: Rheumatic fever, Goodpastures syndrome
Type II HS
What type of hypersensitivity: Bullous pemphigoid, Pemphigus vulgaris
Type II HS
What type of hypersensitivity: SLE
Type III HS
What type of hypersensitivity: Polyarteritis nodosa
Type III HS
What type of hypersensitivity: Serum sickness, arthus reaction
Type II HS
What type of hypersensitivity: Poststreptococcal glomerulonephritis
Type III HS
What type of hypersensitivity: Multiple sclerosis
Type IV HS
What type of hypersensitivity: Guillain barre
Type IV HS
What type of hypersensitivity: Graft versus Host disease
Type IV HS
What type of hypersensitivity: PPD
Type IV HS
What type of hypersensitivity: Contact dermatitis, poison ivy, nickel allergy
Type IV HS
This is a type of blood transfusion that is severe, example being that patients that are IgA deficient have to receive blood products that lack IgA
Anaphylactic reaction
Type II HS reaction where host antibodies act against HLA antigens and leukocytes
Febrile nonhemolytic transfusion reaction
Type II HS reaction where intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs) occurs
Acute hemolytic transfusion reaction
A patient presents with recurrent bacterial infections after 6 months of birth and has normal pro-B, decreased maturation, decreased number of B cells and decreased immunoglobulins of all classes - what is this?
X linked Bruton’s agammaglobulinemia
Problem occurs after 6 months due to a decrease in maternal IgG - opsonization defect resulting in recurrent bacterial infections
What is the deficiency associated with a defect in BTK, a tyrosine kinase gene which results in no B cell maturation?
X linked Bruton’s agammaglobulinemia
A patient presents mostly asymptomatic but they sometimes have sinopulmonary infections, GI infections, autoimmune diseases and anaphylaxis to IgA containing blood products - what is the deficiency?
Selective IgA deficiency
A patient has <7mg/dl of IgA, with normal IgG, IgM and IgG vaccine titers.
Selective IgA deficiency
Patient may have false positive beta-hCG tests due to the presence of heterophile antibody
A patient presents with tetany, recurrent viral/fungal infections, and congenital heart and great vessel defects - what is the deficiency?
Thymic aplasia - DiGeorge syndrome
What is the defect in DiGeorge syndrome?
22q11 deletion, failure to develop 3rd and 4th pharyngeal pouches
The thymus and parathyroids fail to develop leading to decreased T cells, decreased PTH, decreased calcium, and absent thymic shadow on chest X ray
A patient presents with disseminated mycobacterial infections and decreased IFN-gamma - what is the defect and what is the deficiency?
IL-12 receptor deficiency - the defect is a decrease in Th1 response
A patient presents with FATED: coarse Facies, cold (noninflamed) staphylococcal Abscesses, retained primary Teeth, increased igE, Dermatologic problems (Eczema) - what is the disorder?
Hyper-IgE syndrome (Job’s syndrome)
What is the defect seen in hyper-IgE syndrome?
Th1 cells fail to produce IFN-gamma and therefore there’s an inability of neutrophils to respond to chemotactic stimuli
a patient presents with a T cell dysfunction with constant candida albicans infections of the skin and mucous membranes - what is the disorder ?
Chronic mucocutaneous candidiasis
What are some of the possible defects that can cause SCID?
IL2 receptor defect (most common, X linked)
adenosine deaminase deficiency
A patient presents with decreased T cell recombinant excision circles, an absent thymic shadow, absent germinal centers on LN biopsy and absent T cells on flow cytometry - what is the disorder?
SCID
A patient presents with failure to thrive, chronic diarrhea, thrush, recurrent viral, bacterial, fungal and protozoal infections. What is the disorder?
SCID
How do you treat SCID?
Bone marrow transplant (no allograft rejection)
A patient presents with cerebellar defects leading to ataxia, spider angiomas and IgA deficiency - what is the disorder?
Ataxia-telangiectasia
A patient presents with a AR defect in the ATM gene, which codes for DNA repair enzymes and they have increased AFP - what is the disorder?
Ataxia-telangiectasia
A patient presents with severe pyrogenic infections early in life and as a CD40L defect on helper T cells - what is the disorder and what immunoglobulin findings would they have?
This is Hyper-IgM syndrome
They would have increased IgM, decreased IgG, IgA, and IgE
The defect in CD40L keeps them from being able to class switch
A patient presents with thrombocytopenic purpura, infections and eczema - what is the disorder?
Wiskott Aldrich syndrome
What is the defect seen in Wiskott Aldrich syndrome?
X linked, in WAS gene on X chromosomes so T cells are unable to reorganize actin cytoskeleton
WHat are the findings seen in Wiskott Aldrich syndrome?
Increased IgE and IgA and decreased IgM, and thrombocytopenia
A patient presents with recurrent bacterial infections, absent pus formation, and delayed separation of the umbilical cord. They also have neutrophilia. What is the dysfunction and what is the defect?
Dysfunction: leukocyte adhesion deficiency type 1
defect: Defect in LDA-1 integrin (CD18) on phagocytes
A patient presents with recurrent pyogenic infections by staph and strep, partial albinism and peripheral neuropathy and they also have giant granules in their neutrophils - what is the dysfunction and the defect?
This is Chediak-Higashi syndrome which is an AR defect in lysosomal trafficking regulator gene. Microtubule dysfunction in phagosome-lysosome fusions
A patient presents with increased susceptibility to catalase positive organisms and abnormal dihydrohodamine flow cytometry test. Their nitroblue tetrazolium dye reduction test is negative - it doesn’t change from yellow to blue/black. what is the dysfunction and what is the defect?
Chronic granulomatous disease
Lack of NADPH oxidase leading to decreased reactive oxygen species and absent respiratory burst in neutrophils
What is an autograft?
From self
What is a syngeneic graft?
From identical twin or clone
What is a allograft?
From nonidentical individual of the same species
What is a xenograft?
From different species
When is the onset of rejection after transplantation with a hyperacute rejection?
Within minutes
When is the onset of rejection after transplantation with a acute rejection?
Weeks later
When is the onset of rejection after transplantation with a Chronic rejection?
months to years
When is the onset of rejection after transplantation with a Graft versus host?
Varies
A patient has occluded graft vessels causing ischemia and necrosis - what is the type of rejection that occurred?
Hyperacute rejection
A patient has vasculitis of graft vessels with dense interstitial lymphocytic infiltrate - what is the type of rejection that occurred?
Acute rejection
A patient has irreversible damage with T cell and antibody mediated vascular damage that has caused obliterative vascular fibrosis - there is fibrosis of the graft tissue and blood vessels - what is the type of rejection that occurred?
Chronic rejection
A patient presents with a maculopapular rash, jaundice, hepatosplenomegaly and diarrhea. what is the type of rejection that occurred? When is this seen and in what cases can it be beneficial?
This is a graft versus host transplant rejection
Usually occurs in bone marrow and liver transplant (organs rich in lymphocytes)
This can potentially be beneficial in bone marrow transplant
What is the pathogenesis of hyperacute transplant rejection?
Antibody mediated (Type II) because of the presence of preformed anti-donor antibodies in the transplant recipient
What is the pathogenesis of acute transplant rejection?
Cell-mediated due to Cytotoxic T cells reacting against foreign MHCs. Reversible with immunosuppressants
What is the pathogenesis of chronic transplant rejection?
Irreversible! class I-MHC non-self is perceived by cytotoxic t cells as class I-MHC self that is presenting a non-self antigen
What is the pathogenesis of graft-versus-host transplant rejection?
Grafted immunocompetent T cells proliferate in the irradiated immunocompromised disease host and reject cells with “foreign” proteins, resulting in severe organ dysfunction
What drug binds to cyclophilins and the complex blocks the differentiation and activation of T cells by inhibiting calcineurin - thus preventing the production of IL-2 and its receptor
Cyclosporine
What drug has the following toxicity: nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia, tremor, gingival hyperplasia, hirsutism?
Cyclosporine
What drug binds to FK-binding protein, inhibiting calcineurin and secretion of IL2 and other cytokines?
Tacrolimus
What drug has the following toxicity: nephrotoxicity, hypertension, hyperlipidemia, hyperglycemia and tremor?
Tacrolimus
What drug inhibits mTOR and inhibits T cell proliferation in response to IL2?
Sirolimus
What drug is used for immunosuppression after kidney transplantation in combo with cyclosporine and corticosteroids, also used to drug eluting stents?
Sirolimus
What drug has the following toxicity: Hyperlipidemis, thrombocytopenia, leukopenia?
Sirolimus
What drug is an antimetabolite precursor of 6-mercaptopurine that interferes with the metabolism and synthesis of nucleic acids making it toxic to proliferating lymphocytes?
Azathioprine
What drug is used in kidney transplants and autoimmune disorders like glomerulonephritis and hemolytic anemia?
Azathioprine
What drug has the following toxicity: bone marrow suppression, active metabolite mercaptopurine is metabolized by xanthine oxidase so there can be toxic effects increased with use of allopurinol
Azathioprine
What drug is a monoclonal antibody that binds to CD3 on the surface of T cells and blocks cellular interaction with CD3 protein responsible for T cell signal transduction?
Muromonab
What is the toxicity seen with muromonab-CD3?
Cytokine release syndrome, hypersensitivity reaction
what drug binds to CD25 and blocks IL2 signaling?
Daclizumab
What drug inhibits IMP-dehydrogenase thereby preventing synthesis of guanine resulting in decreased cell replication?
Mycophenolate
When can you use mycophenolate?
Transplants and lupus nephritis
There’s increased risk of lymphoma though and it’s teratogenic (not used in pregnancy)
What recombinant cytokine can you use to treat renal cell carcinoma or metastatic melanoma?
Aldesleukin (IL2)
What recombinant cytokine can you use to treat Anemias (especially in renal failure)?
Epoetin alfa (Epo)
What recombinant cytokine can you use to treat Recovery of bone marrow?
Filgastrim (G-CSF) or Sargramostim (granulocyte macrophage colony stimulating factor)
What recombinant cytokine can you use to treat Hepatitis B and C, Kaposi sarcoma, leukemia, or malignant melanoma?
Alpha interferon
What recombinant cytokine can you use to treat Multiple sclerosis?
Beta interferon
What recombinant cytokine can you use to treat thrombocytopenia?
Oprelvekin (IL-11) or Thrombopoietin
What drug is not a monoclonal antibody but rather is a decoy receptor that’s anti-TNF alpha so it binds up all of the TNF-alpha?
Etanercept
What is the target for infliximab?
TNF-alpha
What is the target for Adalimumab?
TNF-alpha
What is the target for Abciximab?
Glycoprotein IIb/IIIa
What is the target for Trastuzumab (Herceptin)?
HER2
What is the target for Rituximab?
CD20
What is the target for Omalizumab?
IgE
What is infliximab used to treat?
Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis
What is Adalimumab used to treat?
Crohn’s disease, RA, psoriatic arthritis
What is Abciximab used to treat?
Prevents cardiac ischemia in unstable angina and in patients treated with percutaneous coronary intervention
What is Trastuzumab used to treat?
HER-2 overexpressing breast cancer
What is Rituximab used to treat?
B cell non-Hodgkin lymphoma
What is Omalizumab used to treat?
Additional line of treatment for severe asthma