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FoCM > Week 2 > Flashcards

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
Q

Protein Synthesis inhibitors

A

50S ribosome

30S ribosome

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26
Q

Metabolic inhibitors

A

Sulfonamides

Trimethoprin

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27
Q

Difference between Penicillins and cephalosporins

A

Cephalosporins have 6 membered ring, penicillins have 5

Cephalosporins have 2 R groups

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28
Q

Penicillin binding protein

A

Enzymes that catalyze last step of cell wall synthesis

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29
Q

PBP and Beta lactam

A

B-Lactam is structurally analagous to D-Ala-D-Ala –> react with PBP and create intermediate so cell wall is not fully synthesized

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30
Q

Beta lactamase

A

Breaks bond in Beta lactam ring

Molecule disabled

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31
Q

Beta lactamase inhibitor

A

Binds to beta lactamase so it can’t function

Extends life of beta-lactam drug

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32
Q

Natural penicillin

A

Narrow spectrum

Streptococci, treponema

Penicillin G, VK

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33
Q

Anti-staphylococcal

A

Narrow spectrum

Staph-MSSA only

Has beta-lactamses

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34
Q

Amino penicillins

A

Broad spectrum - Gram+ (not MRSA), some gram(-)

Augmentin

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35
Q

Ureido penicillin

A

Piperacillin+tazobactam

Very broad spectrum (enhanced gram- incl. Pseudomonas)

36
Q

1st generation Cephalosporin

A

Narrow (Gram +)
Staphylococci, streptococci

Cefazolin
Cephalexin

37
Q

2nd generation Cephalosporins

A

Broader than 1st gen, includes anaerobes

38
Q

3rd generation cephalosporin

A

Broad, enhanced gram-

Pseudomonas

Ceftriaxone - does not cover pseudomonas

39
Q

4th generation cephalosporins

A 
Very broad spectrum
Enhanced gram(-), includes Pseudomonas

Cefepime

40
Q

5th generation cephalosporins

A

Ceftaroline

Broad spectrum, MRSA coverage

Binds to altered target site on MRSA

41
Q

Monobactams

A

Inhibits gram negatives only

Poor PBP binding of gram+

Penicillin allergies

42
Q

Carbapenems

A

Stable to most Beta-lactamases

Very broad, used rarely to avoid resistance

43
Q

Beta lactam adverse effects: Common

A

GI: Nausea/loose stools

Taking drug for a while/high doses

44
Q

Beta lactam uncommon/rare adverse effects

A

Uncommon: Hypersensitivity - Non IgE mediated rash

Rare: Hypersensitivity - anaphylaxis

45
Q

Vancomycin

A

Large, tricyclic glycopeptide

Cell wall inhibitor - binds to D-ala-D-ala so it cant bind to PBP

Step before Beta lactam

46
Q

Vancomycin spectrum and target

A

Only active vs gram (+)

Drug of choice for MRSA

Clinical resistance is low

47
Q

Vancomycin ADME

A

A: Not absorbed orally
D: Does not cross BBB
M: Negligible
E: Kidney

Monitor drug concentration, keep 10-20ug/mL

48
Q

Vancomycin toxicity

A
  1. Nephrotoxicity
  2. Red-man syndrome
    - Flushing, erythema, angioedema
    - Not IgE
  3. Ototoxicity
49
Q

Daptomycin

A

Cell membrane inhibitor

Gram(+) via Ca dependent interaction w/membrane

MRSA -
Alternative to Vancomycin

50
Q

Polymyxins

A

Binds with negative LPS –> permeability changes, leakage, cell death

Gram(-)

Last resort for MDR-organisms

51
Q

Polymyxins Adverse Effects

A

Nephrotoxicity
Neurotoxicity

Topical combination products are safe

52
Q

Most common Fluoroquinolones

A

Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Gemifloxacin (Factive)

53
Q

Fluoroquinolone

MoA, Spectrum, Resistance, PK/PD

A

MoA: Inhibit DNA gyrase and topoisomerase
- blocks DNA replication, inhibit nucleic acid synthesis

Broad spectrum: Gram +/-, atypicals, TB

Oral absorption

54
Q

Fluoroquinolone adverse effects

A

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
Q

50S ribosomal unit protein synth inhibitor

A

Macrolides
Oxazolidinones
Lincosamides
Chloramphenicol

56
Q

30S ribosomal unit protein synth inhibitor

A

Aminoglycosides

Tetracyclines: Doxycycline

57
Q

Aminoglycoside/Tetracycline MoA

A

Bind to 30S ribosome

Prevent binding of incoming charged tRNA

58
Q

50S subunit drug MoA

A

Bind to 50S subunit and block peptide bond formation

59
Q

Macrolides

A

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
Q

Macrolides clinical use

A

STI: Chlamydia, Gonorrhea
RTI: Pharyngitis, otitis, CAP

61
Q

Macrolide adverse effects

A

GI (higher than most classes)

May increase QTc interval

62
Q

Erythromycin Drug interactions

A

P450 inhibitor

63
Q

Oxazolidinones (Linezolid)

A

Inhibits protein synthesis at early stage

Narrow spectrum: Gram+

Alt for MRSA

64
Q

Linezolid Adverse effects

A

GI
Skin rashes

Serotonin syndrome: SSRI’s use blocked because MAO inhibition by drug

65
Q

Lincosamide: Clindamycin

A

50S inhibitor
Broad spectrum: Gram(+), anaerobes, toxoplasma

Adverse effects: Diarrhea, C.difficile colitis

Older drug

66
Q

Chloramphenicol

A

50S binding –> block peptide bond formation

Broad spectrum: Gram(+), (-) anaerobes

67
Q

Chloramphenicol adverse effects

A

Reversible bone marrow suppression

Aplastic anemia

Gray baby syndrome

68
Q

Aminoglycosides

A

Irreversible binding to 30S –> enzyme modification

Spectrum: Gram (-), synergistic activity with gram(+) cell wall agents

High dose, extended interval

Require serum level monitoring

69
Q

Aminoglycoside toxicity

A

Nephrotoxicity (5-25%)
-5-7 days

Ototoxicity (1-5%)

Neuromuscular blockade

70
Q

Tetracycline

A

Doxycycline, tigecycline (MDR)

Bind to 30S, block initiation complex

Broad spectrum: Gram(+/-)

71
Q

Tetracycline adverse effects

A

GI
Photosensitivity
Bad in children

72
Q

Tetracycline drug interaction

A

Cations impair absorption

May decrease effect of oral contraceptives

73
Q

Sulfonamide

A

Folate inhibitors

Used in combination

Block purine production and nucleic acid synthesis

Broad spectrum: Gram(+/-)

74
Q

Nitrofurantoin

A

Inhibits several enzyme systems: Acetyl CoA –> inhibit metabolism

Gram(-) - E.coli

Bladder infections

GI, rash, pulmonary

75
Q

Guanosine analogs

A

Acyclovir
Valacyclovir
Famciclovir

Chain termination (inhibits DNA chain elongation)

Genital herpes

Valacyclovir = acyclovir prodrug

Famciclovir: HIgher doses, less frequent

76
Q

CMV antivirals

A

Ganciclovir: similar to acyclovir

Valganciclovir (Ganciclovir prodrug)

77
Q

CMV antivirals adverse effects/drug interactions

A

GI, insomnia/confusion, rash

Bone marrow toxicity, mutagenic/embryotoxicity

Interact with myelosuppressive agents, seizure potential

78
Q

Foscarnet MoA, spectrum/use

A

Inhibits DNA polymerase - pyrophosphate analog

CMV, Acyclovir resistant HSV

79
Q

Foscarnet Adverse effects/interactions

A

Nephrotoxicity
Bone marrow toxicity
Electrolyte imbalance

80
Q

Cidofovir

A

Cytosine nucleotide analog

Inhibits DNA polymerase

CMV, acyclovir resistant HSV

81
Q

Cidofovir adverse effects

A

Nephrotoxicity
Bone marrow toxicity
Carcinogenic, mutagenic

82
Q

Adamantanes

A

Influenza antiviral

Inhibit viral uncoating

Influenza A only

83
Q

Adamantanes ADR

A

CNS: dizzy, nervous, insomnia

GI

Teratogenic, embryotoxic

84
Q

Sialic acid analogs

A

Inhibit viral neuraminidase: clumping of virions

Influenza A/B

85
Q

Sialic acid analog ADR

A

Zanamivir: Cough
Oseltamivir: GI
Peramivir: Skin

FoCM (6 decks)

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