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week 18 (Y2) > the patient > Flashcards

the patient Flashcards

1
Q

From the pharmaceutical knowledge that you already have, what might be the issues in delivering person-centred care with children?

A

formulation and availubility and suitability of meds

licencing
off label

communication barrier

Vd

developing immune system

increased risk of ADRs

cognative abilities of child lack understanding

informed decicion making

competency and understanding

dosage forms

calculations

responsibility

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2
Q

what is pill school

A

Tablets are safer and more convenient to use (storage and sugar content)

Children are often reluctant to change and parents lack knowledge about switching tablets

Use a variety of sweets of different sizes

Children as young as 3 can attend pill school (Evelina)

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3
Q

Sources of information - children

A

BNFc

Paediatric Formulary, Guy’s and St Thomas’s, King’s College London and University Hospital Lewisham

Trust guidelines

Summary of Product Characteristics (SPC) for individual formulation
https://www.medicines.org.uk/

Neonatal and Paediatric Pharmacists Group
http://nppg.org.uk

Royal College of Paediatrics and Child Health

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4
Q

What do we need to consider when communicating with children and their parents or carers? (our views)

A

compliance with treatment LT

child friendly language

involve the child

eye contact

remove barriers, crouch to childs level

consent from child / parent esp if examination is involved

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5
Q

what does the green book tell us

A

Provides up to date details of immunisation procedures in the UK
Which immunisations, when, how frequently, indications and contraindication, mechanism of action (briefly)

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6
Q

what is active immunisation

A

The deliberate induction of an immune response

To use the natural immune defence to provide long term protection against infection

Sometimes known as “vaccination”

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7
Q

what is primary infection

A

first interaction with pathogen

response to antigen

antibodies

memory created

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8
Q

what is secondary response to pathogens / infection

A

where there is already a baseline memory

response is more rapid

more abs

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9
Q

describe the course of an infection

A

establishment of infection

induction of adaptive response

adaptive immune response

immunological memory

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10
Q

what is acquired ammunity

A

Acquired immunity, also known as adaptive immunity, refers to the immune response that the body develops over time in response to specific pathogens (such as bacteria, viruses, or parasites) or foreign substances (such as toxins). This type of immunity is characterized by its specificity and memory.

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11
Q

what is vaccination

A

Stimulate our body to develop specific immunity
Protection and memory

When we encounter a pathogen we respond
Rapidly
Effectively
Via secondary immune response

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12
Q

what can a primary response be caused by?

A

vaccination

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13
Q

what is immunoconversion

A

“Immunoconversion” typically refers to a process where a person’s immune status changes from negative to positive due to exposure to an infectious agent or vaccination.

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14
Q

what is herd immunity

A

Herd immunity occurs when a large portion of a population becomes immune to a disease, either through vaccination or previous infection. This indirect protection reduces the spread of the disease, benefiting even those who are not immune. It’s achieved when enough people are immune to disrupt the chain of transmission. Achieving herd immunity through vaccination is safer and more effective than through natural infection.

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15
Q

tell me about immunoconversion with vaccine

A

Not all people respond strongly
No vaccine is 100% effective
No problem
Herd immunity

Chance of an infected person contacting a non-immune person is low

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16
Q

tell me about risk to benefit in vaccination

A

Successful vaccination programmes rely upon engagement/compliance
If people perceive a low disease risk (unlikely to get it; not severe if they do) then they worry about risk
Risk of adverse reaction perceived worse than risk from the disease

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17
Q

what are the features of an effective vaccine

A

safe - should not cause illness or death

protective - protect against illness, resulting in exposure to live pathogen

sustained protection - protection against illness must last several years

includes neutralising antibody - some pathogens like polio infect cells that cannot be replaced. neutralising abs prevent the infection of these non replaceable cells.

induces protective T cells - some pathogens are more effected by cell mediated responses

practical considerations - low cost per dose
biological stability
ease of administration
few side effects

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18
Q

what are the 4 vaccine types

A

Live, attenuated vaccines
Inactivated vaccines
Toxoids
Sub-unit vaccines

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19
Q

what are live attenuated vaccines

A

measles, mumps, polio sabin vaccine, rubella, TB, yellow fever

adv - strong immune response - lifelong immunity with fw doses

dis - refrigerated storage may mutate to virulent form

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20
Q

what are inactivated or killed vaccines

A

cholera, influenza, hep A, plague, polio salk vaccine, rabies

adv - stable, safer, no fridge

dis - weaker immune response, booster usually required

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21
Q

what are toxioid vaccines

A

diphtheria
tetanus

adv - immune system becomes primed and recognises bacterial toxins

dis -

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22
Q

what are subunit vaccines

A

Heb B
pertussis
strep pneumonia

adv - specific antigens lower chance of ADRs

dis - hard to develop

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23
Q

what is attenuation

A

To weaken
Reduce pathogenicity of microbe

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24
Q

Grow organism under abnormal culture conditions meaning

A

Grow virus in non-human cells

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25
tell me about edward jenner
Milk maids resistant to small pox Late 18th Century Cowpox (Vaccinia virus) Disease of cows (zoonotic in humans) Poorly pathogenic in humans Protects human from small pox A natural attenuation
26
1967: WHO Global campaign to eradicate smallpox
The Soviet Union first suggested a global effort, and donated >80% of vaccine needed. A freeze-dried vaccine employed Storable without refrigeration (1 month stability). This was delivered with a bifurcated needle (low dose and could be sterilized).
27
attenuation in TB
Abnormal culture BCG strain of M. bovis - doesn’t cause TB but has preserved antigenicity Variable protection offered (0-80%: Malawi-UK) Schedule of immunisation is now risk-based Genetic Modification More rapid and reliable than above
28
what are most anti varial vaccines rn
live and attenuated Induce strong immune responses Promote life-long immunity
29
what mecahnisms can live and attenuated induce
Tc
30
in killed virus vaccines, what is not incuced and why
no replication → no intracellular proteins No MHC I presentation → no Tc generation
31
live and attenuated vaccines risk
Risk of reversion Type 3 Sabin vaccine (OPV) differs at 10 of 7429 nt → neurovirulent strain (vaccine-induced disease) (risk 1 in 2.4 x 106) Can cause disease Young, old, immuno-suppressed Vaccinated people can transmit the attenuated vaccine organism Storage problems
32
tell me about polio sabin vs salk vaccine
eradication using sabin was unlikely, so we returned to using the salk vaccine
33
how are toxin vaccines made
For diseases caused by exotoxins Diphtheria (Corynebacterium diphteriae) Tetanus (Clostridium tetani) Toxin purified and inactivated Physical or chemical means Complete detox needed w/o loss of epitope structure Toxoid can still seroconvert Neutralising Abs
34
how are sub unit vaccines made
Avoids use of whole pathogens Immunise with key components of the pathogen Alone they don’t cause disease Response to them protects Streptococcus pneumoniae →Pneumonia Polysaccharide from capsules inhibit phago Poor at stimulating Pneumococcal polysaccharide vaccine (PPV) Pneumococcal conjugate vaccine (PCV)
35
tell me about peptide vaccines
Reductionist Vaccinate with part of a protein Problem Peptides are short and don’t fold Reduced ability of Abs to bind due to loss of conformation Poor at humoral stimulation Provides relatively effective hepatitis B vaccines Recombinant peptides can be used
36
tell me about DNA vaccination
A surprise Insert cloned DNA for a gene Animals respond (B&T) to the encoded protein DC-dependent
37
considerations in vaccines
Administration Route can be crucial i.m. injection may not protect so well against infection at mucosal surfaces You must induce protection at the relevant site Salk vaccine (IPV) Injectable, killed Sabin vaccine (OPV) Oral, live attenuated Induction of mucosal immunity required Oral-faecal spread
38
what is an adjuvant
An adjuvant is a substance added to vaccines to enhance the body's immune response to the vaccine antigen, which is the component of the vaccine that triggers the immune system. Adjuvants work by stimulating the immune system, leading to a stronger and more long-lasting immune response to the vaccine.
39
tell me about adjuvant features
Non-specifically enhances immune response to Ag with which it is mixed Used for non-living vaccines Must be Safe Bio-degradable Stable Chemically defined efficient
40
what are the two ways in which adjuvants act
Act in two ways Activate the responding cells of the immune system Alter the delivery by affecting the rate or route of delivery e.g. promote DC involvement and delivery to local draining lymph nodes
41
challenges in vaccination
Mutating pathogens Influenza HIV New and re-emerging diseases TB SARS New coronavirus Zika
42
what is Ab
antibody
43
what is mAb
monoclonal antibody
44
what happened in 1975
Kohler & Milstein, Cambridge Developed MONOCLONAL ANTIBODY TECHNOLOGY
45
what are monoclonal antibodies
Monoclonal antibodies (mAbs) are laboratory-produced molecules that are designed to mimic the immune system's ability to fight off harmful pathogens such as viruses or cancer cells. They are called "monoclonal" because they are made by identical immune cells that are clones of a unique parent cell. Here's how they are typically created: Isolation: Scientists isolate a specific type of immune cell (called a B cell) from an organism that has been exposed to the target antigen, such as a virus or cancer cell. Fusion: They then fuse the isolated B cell with a cancerous myeloma cell to create a hybrid cell called a hybridoma. This hybridoma has the ability to produce antibodies in large quantities. Production: The hybridoma cells are cultured in the laboratory, where they multiply and produce large amounts of identical antibodies, known as monoclonal antibodies. Monoclonal antibodies are highly specific to the target antigen they were designed to recognize
46
what cells procuce abs
Antibodies, or immunoglobulins (Ig), are produced by B cells, a type of white blood cell. B cells recognize foreign molecules called antigens and produce antibodies tailored to bind to and neutralize these antigens, helping to eliminate pathogens and provide immunity.
47
How many different Abs does each Ab-producing cell make?
Each antibody-producing cell, known as a B cell, produces only one specific type of antibody, determined by its unique genetic arrangement.
48
mAb technology
Take a B cell, grow it and harvest the mAb They die by apoptosis
49
structure and function of Abs
heavy inner chain light outside chain hinge region attaching two heavy regions antigen binding region on tips of heavy and light chain
50
what is the fab region of abs
tips of heavy and light chains antigen binding toxin neutralisation opsonisation
51
what is opsonisation
Opsonization is the process of marking pathogens for destruction by immune cells through the binding of antibodies or opsonins to the pathogen's surface. This facilitates recognition and engulfment by immune cells, aiding in the pathogen's destruction.
52
what is the Fc region of an Ab
bottom straight halves of the two heavy chains complement activation ADCC phagocytosis
53
what is ADCC Abs
ADCC stands for Antibody-Dependent Cellular Cytotoxicity. It's a process where certain immune cells, such as natural killer (NK) cells, recognize and kill target cells that have been bound by antibodies.
54
what is complement activation
Complement activation is a key component of the immune response that involves a group of proteins called the complement system. This system consists of over 30 proteins that work together to help clear pathogens from the body, enhance inflammation, and regulate the immune response. 3 main methods
55
mAb therapy examples
Specific Targeted Effective “Magic Bullet”
56
Problems with Ab therapy (monoclonal)
Passive therapy Transfer of immunity to a recipient to give instant protection No long lasting memory (unlike active immunisation) Cost of production Specificity? HAMA Human anti-mouse antibodies mAbs are antigens from mice They elicit an immune response “serum sickness”
57
what is Ab engineering
Antibody engineering involves modifying or designing antibodies for various purposes, such as therapeutics and diagnostics. Techniques include optimizing antibody properties, creating hybrid antibodies, humanizing antibodies, generating monoclonal antibodies, designing bispecific antibodies, and producing antibody fragments. These approaches have revolutionized antibody-based products and continue to drive advancements in biotechnology and medicine
58
what is CDR grafting
CDR grafting is a technique in antibody engineering where the complementarity determining regions (CDRs) from one antibody are transferred to the framework regions of another antibody. This process allows for the creation of antibodies with improved properties, such as enhanced binding affinity or altered antigen specificity. (CDRs) are regions within the variable domains of antibodies that directly interact with antigens.
59
Ab engineering examples
Genetically modified mouse e.g. Xenomouse (Amgen) Knock-out of mouse heavy & light chain loci Graft human Ig loci Immunise Mice produce HUMAN mAbs Phage Abs Human Ig genes in a library Ab-like molecules displayed on surface of phage Grown in bacteria
60
what are antigens, one word
bivalent meaning they have two identical antigen-binding sites.
61
what are bispecific Abs
Bispecific Abs Abs are bivalent Engineered to recognise two different Ags
62
what is orthoclone OKT3
Orthoclone is a brand name for a monoclonal antibody product called muromonab-CD3, which was developed for use in transplantation medicine. Muromonab-CD3 is a mouse-derived monoclonal antibody that targets the CD3 antigen, a protein found on the surface of T cells, a type of white blood cell involved in the immune response. Muromonab Fully murine mAb Mouse anti-human CD3 (a T cell Ag) Used to treat transplant rejection Depletes T cells
63
what is a murine mAb
A murine monoclonal antibody (mAb) is a type of monoclonal antibody that is derived from mice. Murine monoclonal antibodies are produced by fusing mouse B cells, which produce antibodies, with immortalized myeloma cells, resulting in hybridoma cells that can continuously produce specific antibodies.
64
Remicade, what is it used for
Infliximab lixi ‘-li-’ = immune system target ‘-xi-’ = Chimaeric mAb Anti-TNF (a cytokine) Used to treat Rheumatoid arthritis and other inflammatory conditions
65
what is a chimaeric mAb
A chimeric monoclonal antibody (mAb) is a type of monoclonal antibody that is engineered by combining genetic elements from different species, typically from mice and humans. Specifically, the variable regions of the antibody, which determine its antigen-binding specificity, are derived from a mouse antibody, while the constant regions, responsible for effector functions and stability, are of human origin.
66
what is rituxan
Rituximab ‘-tu-’ = tumour target ‘-xi-’ = Chimaeric mAb Anti-human CD20 (a B cell Ag) Used to treat non-Hodgkin’s lymphoma (a B cell tumour)
67
what is herceptin
Trastuzumab ‘-tu-’ = tumour target ‘-zu-’ = humanised mAb Anti-HER2 receptor (a growth factor receptor) Used to treat SOME breast cancer
68
summary mAbs
can be efficient therapeutics have problems associated with use strategies developed for avoiding problems
69
mAbs the future of therapeutics?
lots of investment watch and wait listen to the news for the latest

week 18 (Y2) (3 decks)

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