PHM 603 Week 1 and 2

Question 1

Immunomodulator

Answer 1

Agents that have the capacity for both positive and negative actions. (bacteria and their products on the immune system)

Question 2

Immunostimulant

Answer 2

Stimulate the immune response (certain drugs)

Question 3

Immunoadjuvants

Answer 3

Most effective when used in combination with antigen administration (used in vaccines)

Question 4

Immunosuppressants

Answer 4

Substances that are able to suppress the immune system

Question 5

Biological response modifiers

Answer 5

Colony stimulating factors, Interleukins, Interferons, MDP, potent immunopharmacology

Question 6

Immunopotentiator

Answer 6

Boosts a failing immune system

Question 7

Naturally Acquired Active immunity

Answer 7

Infection in host

Question 8

Artificially Acquired Active immunity

Answer 8

Vaccines, both live and inactivated

Question 9

Naturally Acquired Passive immunity

Answer 9

IgG transferred from mother to child through pregnancy or nursing

Question 10

Artificially Acquired Passive immunity

Answer 10

Transfer of immunoglobulins from another host by intentional administration to prevent or treat disease

Question 11

Measles

Answer 11

2019 outbreak. 73% of cases were in NYS

Question 12

Allergy

Answer 12

immunologic responses to environmental or endogenous antigens resulting in disease or hypersensitivity

Question 13

Autoimmunity

Answer 13

Disturbance in immunologic tolerance with response to auto-antigens (auto-antigens are usually ignored by host’s immune system)

Question 14

Alloimmunity

Answer 14

Immune system of host mounts an immunologic response to tissue of another individual (Transplantation, transfusion)

Question 15

Type 1 hypersensitivity

Answer 15

-IgE
-Soluble antigen
-Mast cell activation
Examples: Allergic rhinitis, asthma, anaphylaxis
Treatment: Epinephrine, oxygen therapy, antihistamines, IV replacement fluids if hypotensive, IV hydrocortisone to treat late phase reactions
-Can skin test to determine cause

Question 16

Type 2 hypersensitivity

Answer 16

-IgG
-Cell or matrix associated antigen
-FcR cells (phagocytes, NK cells), platelets
Examples: Hemolytic anemia (erythroblastosis fetalis), thrombocytopenia

Question 17

Type 3 hypersensitivity

Answer 17

-IgG
-Soluble antigen
-FcR cells complement, blood vessels
Examples: Serum sickness, arthus reaction, wheat/gluten allergy, drug induced lupus

Question 18

Type 4a hypersensitivity

Answer 18

-IFNgamma, TNFalpha, TH1 cells
-Antigen presented by cells or direct T-cell stimulation
-Macrophage activation, chemokines, cytokines, cytotoxins
Examples: Tuberculin reactions, contact dermatitis

Question 19

Type 4b hypersensitivity

Answer 19

-IL-5, IL-4/IL-13, TH2 cells
-antigen presented by cells or direct T-cell stimulation
-Eosinophils, cytokines, inflammatory mediators
Examples: Chronic asthma, chronic allergic rhinitis, maculopapular exanthema with eosinophilia

Question 20

Type 4c hypersensitivity

Answer 20

-Perforin/granzyme B (CTL)
-Cell associated antigen or direct T-cell stimulation
-T-Cells
-Examples: Contact dermatitis, maculopapular and bullous exanthema hepatitis, toxic epidermal necrolysis (TEN), Stevens-Johnson (SJS)

Question 21

Type 4d hypersensitivity

Answer 21

-CXCL-8, IL-17 GM-CSF (T-cells)
-Soluble antigen presented by cells or direct T-cell stimulation
-Neutrophils, cytokines, inflammatory mediators
Examples: AGEP, Behcet’s disease

Question 22

Who may be predisposed to have more/worse hypersensitivity reactions?

Answer 22

-female>male
-History of asthma, allergic rhinitis, or atopic dermatitis may develop more severe reaction
-Illness: AIDS, Epstein-Barr, lymphocytic leukemia
-Previous drug allergic reaction
-Taking a higher dose/ frequency/ route of administration

Question 23

Penicillin

Answer 23

-Type 1 reactions may occur
-Cross reactivity common with cephalosporines (5-15%), but aztreonam has weak cross reactivity
-Avoid carbapenems in penicillin allergy

Question 24

Desensitization

Answer 24

Used to prevent type 1 reactions but can cause serum sickness

Question 25

Symptoms of erythroblastosis fetalis

Answer 25

-Hemolytic anemia
-High output heart failure (death)
-Enlarged liver and spleen
-Generalized swelling

Question 26

Drugs known to cause serum sickness

Answer 26

Animal serums, cefaclor, insulin, iron dextran, intravenous immunoglobulin, monoclonal antibodies, penicillins, sulfonamides

Question 27

Anergy and anergy testing

Answer 27

-Lack of cell mediated response
-Use “recall antigens” such as tuberculin, candida, trichophyton, or mumps to see if a reaction occurs over 48 hours. Usually used as a control for another skin test like PPD

Question 28

Maintenance immunosuppressive agents

Answer 28

Calcineurin inhibitors
-Cyclosporine
-Tacrolimus
Inhibition of Lymphocyte Proliferation
-Mycophenolate Mofetil
-Mycophenolic Acid
Non-Specific Immunosuppressive Agents
-Glucocorticoids (Prednisone, Methylprednisone)

Question 29

Cyclosporine

Answer 29

Goal trough levels: 50-400ng/mL

Neoral: microemulsion capsules

Gengraf: emulsion capsules

Sandimmune: castor oil capsules/ castor oil complex (IV)

Side effects: Hyperlipidemia, nephrotoxicity, tremor, headache, HTN

Question 30

Tacrolimus

Answer 30

Goal trough levels: 3-20ng/mL

Immediate release: Prograf

Extended release: Astagraf XL, Envarsus, IV Prograf

Side effects: Diarrhea, nausea, nephrotoxicity, tremor, headache, insomnia

Question 31

Mycophenolic Acid

Answer 31

MMF (Cellcept) and MPS (Myfortic) are not interchangeable

Required renal dose adjustment

Interacts with oral contraception and makes it less effective