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Pharm I - Eye > Immunopharmacology > Flashcards

Immunopharmacology Flashcards

1
Q

Agents that suppress the immune system play 2 important roles in medicine, what are they?

A
  • preventing rejection of organ or tissue grafts

- treatment of diseases that arise from dysregulation of immune response

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2
Q

What is the goal of immunologics?

A

to manipulate the immune response for a therapeutic effect

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3
Q

What is the immune system?

A

part of body that attacks and removes the body of antigens

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4
Q

T/F it is important the immune system recognizes self from non-self.

A

T

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5
Q

Name 4 types of WBC that are involved in immune responses.

A
  • neutrophils
  • lymphocytes
  • macrophages
  • NK cells
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6
Q

Name 2 types of adaptive immunity cells.

A

T & B cells

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7
Q

How does the normal immune response fxn?

A

to neutralize and remove toxins, viri, and pathogens from body

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8
Q

how does abnormal immune responses damage the body?

A
  • extensive tissue damage (hypersensitivty)

- reaction against self Ag (autoimmunity)

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9
Q

what are the three types of abnormal immune responses?

A
  • autoimmunity
  • hypersensitivity
  • immunodeficiency
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10
Q

what causes autoimmunity?

A

failure to distinguish self from non-self; mechanisms in place to attack FB attacks self

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11
Q

what are some examples of autoimmunity?

A
  • RA
  • SLE
  • MS
  • IDDM
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12
Q

what are some ways to treat autoimmunity?

A
  • diet changes

- immunosupressives

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13
Q

what is hypersensitivity?

A

over rxn to an foreign Ag

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14
Q

what are common examples of Ag that elicit hypersensitivity rxns?

A
  • environmental (pollen)

- drugs

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15
Q

what is a term frequently used for hypersensitivity rxns?

A

allergic rxns

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16
Q

what are some examples of hypersensitivty rxn outcomes?

A
  • asthma
  • allergic rhinitis
  • contact dermatitis
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17
Q

what is immunodeficiency?

A

decreased response of immune system

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18
Q

what are the risks of immunodeficiency?

A

infection and cancer

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19
Q

Where is immunodeficiency most common?

A

AIDS: depletes CD4 T helper cells gives rise to increased frequency of opportunistic infections

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20
Q

What are drugs that cause immunodeficiency called?

A

immunosuppressant

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21
Q

What are 6 types of immunosuppressives?

A
  • glucocorticoids
  • cyclosporine
  • tacrolimis
  • sirolimus
  • mycophenolate
  • thalidomide
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22
Q

what are 4 types of cytotoxic agents?

A
  • azathioprine
  • cyclophosphamide
  • leflunomide
  • hydroxychloroquine
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23
Q

what are 3 types of immunosuppressive antibodies?

A
  • IVIG
  • Rho immunoglobulin
  • Hyperimmune globulin
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24
Q

what are 3 types of monoclonal antibodies?

A
  • ximab
  • mumab
  • zumab
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25
Q

What is the goal of immunosuppressive drugs?

A

decrease immunity

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26
Q

With is the MOA of glucocorticosteroids?

A

modify fxn of lymphocytes

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27
Q

When are immunosupressive drugs used?

A
  • kidney transplants
  • chronic myeloid leukemia
  • transplants
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28
Q

what is tacrolimus used for?

A

immunosupressant
topically - psoriasis
orally - immunosuppression

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29
Q

what are the anti-inflammatory effects of glucocorticoids?

A
  • decrease concentration, distribution, and fun of leukocytes in tissue at site of inflammation
  • increase concentration of leukocytes in blood
  • suppress inflammatory cytokines, macrophages, and Ag presenting cell fxn
  • decrease release of inflammatory mediators
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30
Q

what are cytokines?

A

proteins produced by cells involved in inflammation

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31
Q

what are some examples of inflammatory mediators?

A
  • histamine
  • prostaglandins
  • leukotrienes
  • eosinophils
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32
Q

As doses of anti-inflammatories increase they cross over to being ______.

A

immunosupressive; very large doses can decrease production of Ab needed for an immune response

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33
Q

T/F Inflammation and the immune system are the same.

A

false: they are related

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34
Q

Cyclosporine and tacrolimus MOA?

A

inhibit production and release of IL-2 and other cytokines that are necessary for cytotoxic t cell activations when there is a allogenic challenge

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35
Q

what are cyclosporine and tacrolimus often paired with?

A

steroids

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36
Q

what are the uses for cyclosporine and tacrolimus?

A
  • transplant rejection prophylaxis
  • psoriasis
  • RA
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37
Q

what type of agent is mycophenolate considered to be?

A

antiproliferative agent

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38
Q

what is the MOA of mycophenolate?

A

inhibits key enzyme needed for new synthesis of guanosine (DNA precursor)

this blocks proliferation of B& T cells

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39
Q

What is mycophenolate used for?

A
  • prevention of organ rejections in patients receiving allogenic renal, cardiac, or hepatic transplants
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40
Q

MOA of cytotoxic drugs?

A

inhibit proliferation of cells in the body (thus decreasing immune system)

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41
Q

what is azathioprine used for?

A

cytotoxic drug

  • prevention of organ transplant rejection
  • inflammatory bowel disease
  • RA
  • Lupus
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42
Q

what is cyclophosphamide used for?

A

cytotoxic drug

  • tx of leukemia
  • non-hodgkin lymphomas
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43
Q

what is leflunomide used for?

A

cytotoxic drug

- RA

44
Q

MOA of immunomodulators?

A

modify but do not suppress the immune system (so that you don’t get more infections)

45
Q

what is the goal of immunomodulators?

A

decrease risk of opportunistic infections

46
Q

what is hydroxychloroquine used for?

A

immunomodulator

  • lupus
  • malaria
  • RA
47
Q

what is the risk of hydroxychloroquine?

A

glaucoma/eye plaques

48
Q

what are the three types of immunosuppressive antibodies?

A
  • intravenous immunoglobulin (IVIG)
  • Rho immune globulin
  • Hyperimmune globulin
49
Q

what is intravenous immunoglobulin?

A

a polyclonal (many different donors) human immunoglobulin

50
Q

what is the target for IVIG?

A

non-specific Ag target

51
Q

Ab in IVIG?

A

IgG

52
Q

MOA of IVIG in immune deficient individuals?

A

humoral Ab replacement

IgG Ab increases phagocytosis and elimination of pathogens from circulation

53
Q

indications for IVIG?

A
  • guillian barre
  • kawasaki’s disease
  • idiopathic thrombocytopenia purport (ITP)
54
Q

Adverse rxn of IVIG?

A

10% get chills, nausea, abdominal pain

55
Q

what drugs can be given to reduce S/E of IVIG?

A

steroids (diphenhydramine and meperidine)

56
Q

when are individuals more sensitive/allergic to IVIG?

A

IgA deficient

57
Q

what is rho (D) immune globulin?

A

solution of human IgG with a higher titer of Ab against Rh+

58
Q

what is Rh factor?

A

Ag found on RBC

59
Q

How is Rh- child a problem?

A

1st child born: mom and baby swap RBC and mom makes Ab against Rh+

2nd child: during 3rd trimester mom will make Ab against Rh+ child’s RBC causing severe anemia and death

60
Q

Rho D immune globulin given to mom at birth of Rh+ child. How does this benefit second Rh+ child?

A

Ab cover 1st child’s RBC so mom’s immune system never see them and don’t make Ab against them.

61
Q

what are hyperimmune immnoglobulns?

A

made from humans or animals with high titers of Ab to a particular disease

a bunch of different Ab for one disease

62
Q

what is the difference between IVIG and hyperimmune Ig?

A

hyperimmune is specific

IVIG is generalized

63
Q

What source is preferred for disease specific Ab?

A

humans:
- fewer rxns
- Ab lasts longer

64
Q

Define ximab, zumab, and mumab.

A

ximab: 70% human
zumab: 90% human
mumab: 100% human

65
Q

what are do we currently have immunoglobulins on the market for?

A

Human:

  • Hep B
  • Hep A
  • Measles
  • Rabies
  • Rubella
  • Varicella
  • Tetanus
  • Digoxin
  • Respiratory syncytial virus

Horse:

  • Botulism
  • Snakebite
  • black widow
66
Q

What are monoclonal antibodies?

A

antibodies made in lab for 1 Ag

67
Q

what source is used to make MABs?

A

mouse and human (chimeric mixture)

or humanized

68
Q

How are MABs used in targeting tumors or anti-tumor ab?

A

develop Ab to Ag only found on tumor

69
Q

What is Rituximab used for?

A

chemotherapy treatment

70
Q

How are MABs with isotopes attached used?

A

ab to Ag found on tumor and add radioactive isotope for imaging (some therapeutic use)

71
Q

How are MABs used as immunosuppressant and anti-inflammatory agents?

A

to stop or slow down the autoimmune process

72
Q

Examples of MABs used as immunosuppressants and anti-inflammatory agents?

A
  • humira
  • enbrel
  • remicade
73
Q

What conditions are immunosuppressive/anti-inflammatory MABs used for?

A
  • RA
  • organ rejection
  • crohn’s
74
Q

What are the S/E of drugs that alter the immune system?

A
  • infections
  • decreased ability to fight infections
  • cancer

should only be used when absolutely needed by someone who is experienced

75
Q

what risk do Humera/MABs also carry?

A

risk of TB

76
Q

what are the clinical uses of drugs that affect the immune system?

A
  • transplant medicine
  • autoimmune disorders
  • immunomodulation
77
Q

What antigens must match during solid organ or bone marrow transplant?

A

Human leukocyte Antigens (HLAs) or body will attack it

suppress immune system incase they do not match

78
Q

During chemotherapy and radiation cancer cells are killed; the bone marrow and immune system is also killed. Bone marrow transplants replace this loss. What is the risk of transplant? How is it managed?

A

T cells of transplanted marrow attacking host as a foreign object.
(graft-vs-host disease)

Managed with immunosupression

79
Q

What autoimmune disorders are immunosuppressives commonly used in?

A
  • chronic severe asthma
  • RA
  • SLE
80
Q

how are immunomodulator’s used to manipulate the immune system?

A
  • MABs used to manipulate cytokine release
  • Crohn’s
  • possibly useful in immunosuppressed (AIDs or cancer)
  • RA
81
Q

Hypersensitivity rxn against drugs should be noted in Hx as an allergy so that they do not receive drug again. How do we treat these drug rxns?

A 
zantec= H2
clariten = 2nd generation (x2wks)
benadryl = H1 (x2d)
steroids
epi if anaphylactic 
drug avoidance
82
Q

what causes idiosyncratic drug rxns?

A

we don’t know

83
Q

What are type I sensitivity rxns called?

A

immediate drug allergy

84
Q

examples of type I sensitivity rxns?

A
  • allergic rhinitis
  • allergic asthma
  • food allergy
  • anaphylaxis
85
Q

when does the early phase of type I hypersensitivity rxns start? phase 2?

A

stage I: minutes

stage 2: 2-24 hours after exposure

86
Q

what happens during stage I of type I hypersensitivity rxn? what does it result in?

A

release of histamine from mast cells

  • vasodilation
  • edema
  • congestion
87
Q

what happens during stage II of type I hypersensitivity rxn?

A

eosinophils, neutrophils, and t cells infiltrate the area

88
Q

MOA of type I hypersensitivity rxn?

A
  • IgG mediated rxn
  • drugs binds to host protein
  • immune system detects it
  • make IgE Ab against drug
  • next time body sees drug IgE causes mast cells to release histamine & leukotrienes
89
Q

what are the symptoms of type I hypersensitivity rxns?

A
  • urticaria
  • edema
  • bronchoconstriction
  • anaphylaxis (if enough histamine release)
90
Q

how can you confirm allergy to drug?

A

scratch test

scratch skin with a tiny bit of drug and see if it reacts in 10-15 minutes (can get false positives)

91
Q

If you need to use a drug someone is allergic to what do you do?

A

try desensitizing them to the drug

10:1 dilution and increase over hours to full therapeutic dose

92
Q

what is a type II hypersensitivity rxn?

A

Autoimmune/Ab mediated to drug

drug binds to and modified host cells (RBC or other tissue)

IgG or IgM binds to drug modified tissue, activates complement, and destroys tissue

93
Q

what is the antigen in type II hypersensitivity rxns?

A

drug-host cell complex

94
Q

treatment for type II hypersensitivity?

A

remove drug (autoimmunity resolve)

can give immunosuppressives while this happens if severe

95
Q

Examples of type II hypersensitivity rxns?

A
  • methyldopa
  • transfusion rxn
  • graves disease
  • myasthenia gracis
96
Q

what happens during type II hypersensitivity rxn with methyldopa?

A

this anti-HTN binds to RBC, activates immune system, causing destruction of RBC

= hemolytic anemia

97
Q

What is type III hypersensitivity rxn?

A

serum sickness and vasculitic reactions

drug-antibody complex occur in blood

complexes deposit on membranes causing symptoms

98
Q

what are the symptoms of type III rxns?

A
  • vasculitis (from deposit on blood vessel walls)
  • nephritis (from kidney glomerulitis)
  • arthritis (from deposits on synovial membranes)
  • rash

Sx occur 3-4 d after exposure

99
Q

treatment for type III rxns?

A
  • corticosteroids

- plasmapheresis

100
Q

what is plasmapheresis?

A

separation of plasm in blood from cells in blood to remove Ag-Ab complexes and replace with healthy plasma

101
Q

examples of type II hypersensitivity rxn?

A

non-human immunoglobulins

102
Q

what is type 4 hypersensitivity?

A

t-cell mediated allergy

t- cells release cytokines leading to tissue inflammatory and injury

103
Q

examples of type 4 hypersensitivity?

A
  • allergic contact dermatitis (poison ivy)
  • chemicals in cosmetics
  • medications
  • jewelry
  • cleaning products
  • industrial reagents
  • topical drugs
104
Q

what t- cells are involved in type 4 hypersensitivity rxns?

A
  • CD4 T helper cell

- CD8 T killer cell

105
Q

symptoms of type 4 hypersensitivity rxn?

A

1st exposure: nothing
2nd exposure: takes 2-3 days to see Ag

Skin rashes

106
Q

Treatment for type 4 hypersensitivity rxn?

A

drug avoidance

steroids

Pharm I - Eye (5 decks)

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