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Week 2 Flashcards

1
Q

Type I hypersensitivity

A

Immediate - IgE

Antigen exposure –> Th2 activation –> IL-4 and IgE –> IgE + mast cells –> Release of mediators (After repeat exposure)

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2
Q

Histamine

A

Immediately released

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3
Q

Late phase (activated mast cell)

A

Release of prostaglandins and leukotrienes

And Cytokines (TNF-a, IL-4, IL-5)

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4
Q

Type II hypersensitivity

A

Tissue/organ specific

Antibody/antigen complex –> Complement activation –> inflammation and tissue injury (neutrophils, ROS)

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5
Q

Drug induced hemolytic anemia

A

Drug (hapten) binds to RBC –> induces pathway for hapten Ab generation –> Ab bind to RBC –> lysis or phagocytosis or complement activated phagocytosis

Occurs when hapten binds to own cell

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6
Q

Grave’s disease

A

Hyperthyroidism

Antibodies bind to TSH receptor –> constitutive release of thyroid hormones

Can pass from mother to to child

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7
Q

Rheumatic fever

A

Group A Streptococcal pyogenes

Streptococcal cell wall stimulates Ab response –> antibodies cross react with heart tissue antigens

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8
Q

Type III hypersensitivity

A

Soluble immune complex - systemic

Complex becomes larger –> complement mediated recruitment of activation of inflammatory cells

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9
Q

Serum sickness - Type III hypersensitivity

A

Patients given bolus of foreign antibody (against specific disease eg. tetanus) –> antibodies made against antigen –> antigen:antibody complexes form –> type III hypersensitivity

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10
Q

Arthus reaction

A

Inject antigen –> antigen:antibody complexes form –> complement activation –> inflammation (neutrophil recruitment)

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11
Q

Systemic Lupus Erythematosus

A

Systemic auto immune disease (Type III hypersensitivity)

Making antibodies against nuclear antigens –> Ag-Ab complexes –> Complement levels decrease –> kidneys affected

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12
Q

Type IV Hypersensitivity (DTH)

A

Antigen introduced –> Processed by APC –> Th1 recognition –> macrophage activation

CD4 or CD8

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13
Q

Contact hypersensitivity

A

DTH

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14
Q

Active immunization

A

Immunized individual acquires immunity to specific antigen

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15
Q

Passive immunization

A

Preformed antibodies providing temporary protection

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16
Q

T independent antigen

A

Repeating epitopes that cross link Ig receptors on B cells

Activates B cell without use of T cell

No memory, no H chain switching, no affinity maturation

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17
Q

Conjugate vaccine

A

Add T-I antigen to carrier protein –> internalized and presented by B cell –> t cell activation –> B cell activation –> Ab secreted

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18
Q

Conjugate vaccine examples

A

Hib, PCV14, Meningococcal

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19
Q

4 methods of resistance

A

Enzymatic degradation

Altered target

Decreased uptake

Increased efflux

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20
Q

Concentrated dependent killing

A

Higher concentration = more rapid, complete cell kill. Decreased resistance

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21
Q

Time dependent killing

A

Saturation of killing occurs at low multiples of MIC

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22
Q

Cell wall inhibitors

A

Beta-lactams

Glycopeptides

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23
Q

Cell membrane inhibitors

A

Daptomycin

Polymyxins

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24
Q

Nucleic acid inhibitors

A

Fluoroquinolones

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25
Protein Synthesis inhibitors
50S ribosome 30S ribosome
26
Metabolic inhibitors
Sulfonamides | Trimethoprin
27
Difference between Penicillins and cephalosporins
Cephalosporins have 6 membered ring, penicillins have 5 Cephalosporins have 2 R groups
28
Penicillin binding protein
Enzymes that catalyze last step of cell wall synthesis
29
PBP and Beta lactam
B-Lactam is structurally analagous to D-Ala-D-Ala --> react with PBP and create intermediate so cell wall is not fully synthesized
30
Beta lactamase
Breaks bond in Beta lactam ring Molecule disabled
31
Beta lactamase inhibitor
Binds to beta lactamase so it can't function Extends life of beta-lactam drug
32
Natural penicillin
Narrow spectrum Streptococci, treponema Penicillin G, VK
33
Anti-staphylococcal
Narrow spectrum Staph-MSSA only Has beta-lactamses
34
Amino penicillins
Broad spectrum - Gram+ (not MRSA), some gram(-) Augmentin
35
Ureido penicillin
Piperacillin+tazobactam Very broad spectrum (enhanced gram- incl. Pseudomonas)
36
1st generation Cephalosporin
Narrow (Gram +) Staphylococci, streptococci Cefazolin Cephalexin
37
2nd generation Cephalosporins
Broader than 1st gen, includes anaerobes
38
3rd generation cephalosporin
Broad, enhanced gram- Pseudomonas Ceftriaxone - does not cover pseudomonas
39
4th generation cephalosporins
``` Very broad spectrum Enhanced gram(-), includes Pseudomonas ``` Cefepime
40
5th generation cephalosporins
Ceftaroline Broad spectrum, MRSA coverage Binds to altered target site on MRSA
41
Monobactams
Inhibits gram negatives only Poor PBP binding of gram+ Penicillin allergies
42
Carbapenems
Stable to most Beta-lactamases Very broad, used rarely to avoid resistance
43
Beta lactam adverse effects: Common
GI: Nausea/loose stools Taking drug for a while/high doses
44
Beta lactam uncommon/rare adverse effects
Uncommon: Hypersensitivity - Non IgE mediated rash Rare: Hypersensitivity - anaphylaxis
45
Vancomycin
Large, tricyclic glycopeptide Cell wall inhibitor - binds to D-ala-D-ala so it cant bind to PBP Step before Beta lactam
46
Vancomycin spectrum and target
Only active vs gram (+) Drug of choice for MRSA Clinical resistance is low
47
Vancomycin ADME
A: Not absorbed orally D: Does not cross BBB M: Negligible E: Kidney Monitor drug concentration, keep 10-20ug/mL
48
Vancomycin toxicity
1. Nephrotoxicity 2. Red-man syndrome - Flushing, erythema, angioedema - Not IgE 3. Ototoxicity
49
Daptomycin
Cell membrane inhibitor Gram(+) via Ca dependent interaction w/membrane MRSA - Alternative to Vancomycin
50
Polymyxins
Binds with negative LPS --> permeability changes, leakage, cell death Gram(-) Last resort for MDR-organisms
51
Polymyxins Adverse Effects
Nephrotoxicity Neurotoxicity Topical combination products are safe
52
Most common Fluoroquinolones
Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Moxifloxacin (Avelox) Gemifloxacin (Factive)
53
Fluoroquinolone MoA, Spectrum, Resistance, PK/PD
MoA: Inhibit DNA gyrase and topoisomerase - blocks DNA replication, inhibit nucleic acid synthesis Broad spectrum: Gram +/-, atypicals, TB Oral absorption
54
Fluoroquinolone adverse effects
GI: Loose stools CNS: HA, lightheadedness, nervousness Skin: Photosensitivity Boxed warning: Tendonitis/rupture, peripheral neuropathy, dysclycemia Not good for children or prego chicks (unless benefit > risk)
55
50S ribosomal unit protein synth inhibitor
Macrolides Oxazolidinones Lincosamides Chloramphenicol
56
30S ribosomal unit protein synth inhibitor
Aminoglycosides Tetracyclines: Doxycycline
57
Aminoglycoside/Tetracycline MoA
Bind to 30S ribosome Prevent binding of incoming charged tRNA
58
50S subunit drug MoA
Bind to 50S subunit and block peptide bond formation
59
Macrolides
Azithromycin (Zithromax) Inhibit protein synthesis Bacteriostatic, time dependent killing, anti-inflammatory Low level resistance (efflux pump) High level resistance (target site modification) Broad spectrum: Gram+, Neisseria, Treponema Choice for atypicals
60
Macrolides clinical use
STI: Chlamydia, Gonorrhea RTI: Pharyngitis, otitis, CAP
61
Macrolide adverse effects
GI (higher than most classes) May increase QTc interval
62
Erythromycin Drug interactions
P450 inhibitor
63
Oxazolidinones (Linezolid)
Inhibits protein synthesis at early stage Narrow spectrum: Gram+ Alt for MRSA
64
Linezolid Adverse effects
GI Skin rashes Serotonin syndrome: SSRI's use blocked because MAO inhibition by drug
65
Lincosamide: Clindamycin
50S inhibitor Broad spectrum: Gram(+), anaerobes, toxoplasma Adverse effects: Diarrhea, C.difficile colitis Older drug
66
Chloramphenicol
50S binding --> block peptide bond formation Broad spectrum: Gram(+), (-) anaerobes
67
Chloramphenicol adverse effects
Reversible bone marrow suppression Aplastic anemia Gray baby syndrome
68
Aminoglycosides
Irreversible binding to 30S --> enzyme modification Spectrum: Gram (-), synergistic activity with gram(+) cell wall agents High dose, extended interval Require serum level monitoring
69
Aminoglycoside toxicity
Nephrotoxicity (5-25%) -5-7 days Ototoxicity (1-5%) Neuromuscular blockade
70
Tetracycline
Doxycycline, tigecycline (MDR) Bind to 30S, block initiation complex Broad spectrum: Gram(+/-)
71
Tetracycline adverse effects
GI Photosensitivity Bad in children
72
Tetracycline drug interaction
Cations impair absorption May decrease effect of oral contraceptives
73
Sulfonamide
Folate inhibitors Used in combination Block purine production and nucleic acid synthesis Broad spectrum: Gram(+/-)
74
Nitrofurantoin
Inhibits several enzyme systems: Acetyl CoA --> inhibit metabolism Gram(-) - E.coli Bladder infections GI, rash, pulmonary
75
Guanosine analogs
Acyclovir Valacyclovir Famciclovir Chain termination (inhibits DNA chain elongation) Genital herpes Valacyclovir = acyclovir prodrug Famciclovir: HIgher doses, less frequent
76
CMV antivirals
Ganciclovir: similar to acyclovir Valganciclovir (Ganciclovir prodrug)
77
CMV antivirals adverse effects/drug interactions
GI, insomnia/confusion, rash Bone marrow toxicity, mutagenic/embryotoxicity Interact with myelosuppressive agents, seizure potential
78
Foscarnet MoA, spectrum/use
Inhibits DNA polymerase - pyrophosphate analog CMV, Acyclovir resistant HSV
79
Foscarnet Adverse effects/interactions
Nephrotoxicity Bone marrow toxicity Electrolyte imbalance
80
Cidofovir
Cytosine nucleotide analog Inhibits DNA polymerase CMV, acyclovir resistant HSV
81
Cidofovir adverse effects
Nephrotoxicity Bone marrow toxicity Carcinogenic, mutagenic
82
Adamantanes
Influenza antiviral Inhibit viral uncoating Influenza A only
83
Adamantanes ADR
CNS: dizzy, nervous, insomnia GI Teratogenic, embryotoxic
84
Sialic acid analogs
Inhibit viral neuraminidase: clumping of virions Influenza A/B
85
Sialic acid analog ADR
Zanamivir: Cough Oseltamivir: GI Peramivir: Skin

FoCM (6 decks)

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