Immunopharmacology (Exam V)

Question 1

How many lines of defense does the body have?
Which of these are innate/nonspecific?

Answer 1

• 3
• First & second line of defense are innate/nonspecific.

Question 2

What characterizes the body’s first line of defense?

Answer 2

• Physical barriers like skin.

Question 3

What characterizes the body’s second line of defense?

Answer 3

• Phagocytosis
• Inflammation
• Fever
• Antimicrobial proteins

Question 4

What characterizes the body’s third line of defense?

Answer 4

• B cells & T cells

Question 5

What is acquired natural passive immunity?
How long does it last?

Answer 5

• IgE antibodies from maternity.
• 6-9 months

Question 6

What is an example of acquired natural artificial immunity?

Answer 6

• Antivenom for snake bites

Question 7

Where are B-cells developed?
Where are T-cells developed?

Answer 7

• Bone marrow
• Thymus

Question 8

What do B cells do after interacting with an antigen?

Answer 8

• Turn into plasma cells (Ab producers)
• Turn into long-lived memory cells

Question 9

What is opsonization?

Answer 9

• The coating of an antigen

Question 10

MHC 1 is associated with what T-cell type?
MHC 2 is associated with what T-cell type?

Answer 10

• CD8 Killer cells
• CD4 helper cells

Question 11

What cells are characterized by cell-mediated immunity?
What cells are characterized by humoral immunity?

Answer 11

• T-cells
• B-cells (Ab immunity)

Question 12

What type of antibody is specific for a singular pathogen?

Answer 12

IgG

Question 13

Is primary or secondary immunodeficiency genetic?

Answer 13

• Primary immunodeficiency

Question 14

What characterizes Type I hypersensitivities?

Answer 14

• Mild or severe anaphylaxis (hay fever, food allergies, etc.)

Question 15

What characterizes Type II hypersensitivities?

Answer 15

• Antibody-mediated hypersensitivities (Blood incompatibilities)

Question 16

What characterizes Type III hypersensitivities?

Answer 16

• Immune Complex hypersensitivities (Rheumatoid arthritis)

Question 17

What characterizes Type IV hypersensitivities?
What is unique about this class of hypersensitivities?

Answer 17

• Cell-mediated Delayed hypersensitivities (poison ivy example)
• No Ab involvement, just T-cells.

Question 18

What are some examples of primary immunodeficiency?

Answer 18

• DiGeorge Syndrome (No thymus = no t-cells)
• Agammaglobinemia (no B-cells = no Ab’s)

Question 19

What is an example of secondary (acquired) immunodeficiency?

Answer 19

• AIDS

Question 20

What two scenarios for Type II Hypersensitivity reactions were discussed in lecture?

Answer 20

• Transfusion reaction
• Hemolytic disease of the newborn.

Question 21

What is the pathophysiology of Newborn Hemolytic Disease?
What is the treatment?

Answer 21

• Rh⁺ fetus in an Rh⁻ mother (firstborn) → (secondborn) IgG from first pregnancy attacks newborns RBCs.
• RhoGAM

Question 22

What is the hallmark sign of Type III Hypersensitivity reactions?

Answer 22

• Joint Pain

Question 23

What does Rheumatic mean?

Answer 23

• Joint Cavity

Question 24

What is the general pathophysiology of Type III Hypersensitivity reactions?

Answer 24

• Deposition of immune complexes in joints where WBCs migrate to and cause inflammation.

Question 25

What is Rheumatic Disease?

Answer 25

- Rheumatoid Factor antibodies made against IgG causing progressive inflammation.

Question 26

What is an Arthus reaction?

Answer 26

- Acute response to multiple vaccine injections at the same site causing immune complex formation in the subcutaneous tissue. Results in localized redness, hemorrhage, & eventual necrosis

Question 27

What is the treatment for Type III Hypersensitivity reactions?

Answer 27

- NSAIDs - Corticosteroids

Question 28

What metal can actually cause Type 4 hypersensitivity reactions?

Answer 28

- Nickel

Question 29

What characterizes a Host vs Graft infection?

Answer 29

- MHC-1 on the grafted organ attracts T-cells and macrophages. **Host body attacks grafted organ/tissue**.

Question 30

What characterizes a Graft vs Host infection?

Answer 30

- MHC-1 on host cell is attacked by grafted tissue lymphocytes (usually bone marrow). **Grafted tissue attacks all of host organs**.

Question 31

What is an example of a mild Type 4 reaction? What about a severe type 4 reaction?

Answer 31

- Mild = poison ivy - Severe = Graft vs Host

Question 32

What are autoantigens? What are autoantibodies?

Answer 32

- Self-antigens that induce an immune response - Antibodies that attack autoantigens

Question 33

What are the 4 theories of autoimmunity?

Answer 33

1. Exposure to antigens previously sequestered from the immune system. 2. Molecular mimicry - pathogen similar to host tissue (streptococcus pyogenes attacking heart valves causing rheumatic fever) 3. Inappropriate expression of MHC II on cells that don't normally express it (islet β cells = DM) 4. Hygiene hypothesis

Question 34

What is the most common symptom of rheumatic diseases caused by autoimmunity?

Answer 34

- Joint pain

Question 35

What characterizes the pathophysiology of SLE?

Answer 35

- Autoantibodies attacking DNA structure. - Affects sites of rapid cell turnover.

Question 36

What symptom is present in 30-50% of SLE cases? Why?

Answer 36

- Butterfly Rash - Rapid cell turnover occuring on the face from sunshine exposure.

Question 37

What is the first symptom noticed with multiple sclerosis?

Answer 37

- Muscular Weakness

Question 38

What is the pathophysiology of multiple sclerosis?

Answer 38

- T-cell & autoantibody targeting of myelin sheath prevent normal neuron signaling.

Question 39

What is the pathophysiology of myasthenia gravis?

Answer 39

- Autoantibodies attacking ACh receptors at the NMJ's.

Question 40

How do glucocorticoids work?

Answer 40

- Suppression of immune response by interfering with the cell cycle of B & T cells.

Question 41

What are the side effects of glucocorticoid use?

Answer 41

- Immunodeficiency - Exogenous Cushing's Syndrome

Question 42

What are glucocorticoids used for?

Answer 42

- Adrenal Insufficiency (Addison's disease) - Allergic & inflammatory reaction suppression - Asthma - Transplantation

Question 43

What is Calcineurin?

Answer 43

- Protein necessary for T-cell signaling & activation.

Question 44

What two Calcineurin Inhibitors were discussed in lecture? What were these used for?

Answer 44

- Cyclosporine (peptide abx)- Transplants, GVHD, autoimmune disorders. - Tacrolimus (macrolide abx) - topical dermatitis & psoriasis

Question 45

At lower doses what is azathioprine used for? What about at higher doses?

Answer 45

- Immunosuppressive - Antineoplastic

Question 46

How does Azathioprine treat autoimmune disorders? What is the main side effect?

Answer 46

- Interference with purine metabolism blocks over-proliferation of cells. - Leukocytopenia from bone marrow suppression

Question 47

What is the metabolism pathway of Azathioprine?

Answer 47

Azathioprine → *Xanthine Oxidase* → 6-Mercaptopurine → 6-Thioguanine Nucleotides

Question 48

What is the primary side effect of cyclophosphamide? What type of agent is it?

Answer 48

- Severe Immunosuppression - Alkylating Agent

Question 49

What is the metabolism pathway of cyclophosphamide?

Answer 49

Cyclophosphamide → *CYP450s* → Acrolein & Phosphoramide Mustard (tissue toxicity & cell death)

Question 50

What is a hybridoma?

Answer 50

- Petri dish plasma cells fused with an immortal cell line used to create monoclonal antibodies

Question 51

Which monoclonal antibody suffix is indicative of mostly human origin antibodies?

Answer 51

-umab or -zumab

Question 52

Which monoclonal antibody suffix is indicative of more chimera (human-mouse) antibodies?

Answer 52

-imab or -ximab

Question 53

What is Omalizumab?

Answer 53

- Anti-IgE MAb used for severe asthma