Immunizations + Drug Toxicity

Front 1

Cytomegalovirus (CMV-IGIV)

Back 1

- pooled human plasma
- immunosuppressed of kidney or organ transplant
- Ab against virus

Front 2

Hepatitis B (HBIG)

Back 2

- pooled sera
- against HepB w/ ABSENCE of surface antigen
- combine w/ active immunization

Front 3

Immune Globulin (IGIM, IGIV)

Back 3

- pooled Ig
- less effective w/ live vaccines
- used when no other options available

Front 4

Lymphocyte Immune Globulin Antithymocyte

Back 4

- rabbits, horses
- against T cell markers
- Tx aplastic anemia
- hypersensitivity rxn

Front 5

Rabies Immune Globulin (RIGH)

Back 5

- pooled human serum from hyperimmunized human donors
- AVOID near anatomical site

Front 6

Rho (D) Immune Globulin

Back 6

- for Rho (+) mothers against Rho (-) child
- Ig from humans
- used in abortion, amniocentesis

Front 7

RSV immune Globulin (RSV-IGIV)

Back 7

- bronchopulmonary dysplasia
- neutralizing Ab
- from human donors

Front 8

Palivizumab (Synagis)

Back 8

- monoclonal Ab
- RSV

Front 9

Tetanus Immune Globulin (TIG)

Back 9

- hyperimmunized sera
- deep puncture wounds
- give Td afterwards

Front 10

Varicella Zoster (Chickenpox) Immune Globulin (VZIG)

Back 10

- pregnant women w/o previous exposure, immunocompromised
- against varicella zoster (IgG)
- IM injection

Front 11

Botulism Immune Globulin (BabyBIG, BIG-IV)

Back 11

- human sera
- prophylaxis against neurological damage
- AVOID honey in infants

Front 12

Vaccinia Immune Globulin (VIGIV)

Back 12

- pooled immune serum against vaccinia
- virus from rubbing into eyes

Front 13

Lactrodectus Mactans

Back 13

- black widow spider
- from horse
- prevent neuromuscular pain

Front 14

Crotalidae Antivenin

Back 14

- rattlesnake
- from horse, sheep also avail
- prevent coagulopathy

Front 15

Micrurus Fulvius

Back 15

- coral snake
- from horse
- prevent neurotoxic events (paralysis)

Front 16

Humoral

Back 16

- B cell activation by antigens on Ig
- stimulate TH2 cells
- plasma cells to produce Ab
- endocytosis

Front 17

T-cell Activation

Back 17

- antigen recognized by APC
- form IL-4 and TH2
- TH2 + B cells convert IgM to IgG

Front 18

Immunologic Memory (B Cell)

Back 18

- memory B cells
- amplification w/ later antigen presentation

Front 19

Immunologic Memory (T cell)

Back 19

- NO selection of T-cells w/ high affinity receptors
- activate T cells to circulate freely

Front 20

Adjuvants

Back 20

- aluminum salts/ "alum" complex w/ antigens
- phagocytosis

Front 21

BCG TICE

Back 21

- live attenuated M. bovis
- against M. tuberculosis
- bladder tumors
- AVOID w/ immunocompromised

Front 22

Haemophilus B Conjugate (Comvax)

Back 22

- capsular polysaccharide H. influenza + T cell protein antigens
- prevent meningitis
- decrease efficacy w/ immunosuppressive treatments

Front 23

Meningococcal Polysaccharide Vaccine

Back 23

- capsular polysaccharide
- Neisseria meningitis
- conjugate w/ diptheria

Front 24

Pneumoccocal Vaccine

Back 24

- capsular polysaccharide
- Streptococcus pneumonia
- for immunocompromised and > 2 yo
- avoid w/ neomycin + gelatin allergy

Front 25

Typhoid Vaccine

Back 25

- capsular polysaccharide, inactivated, live attenuated forms
- against contaminated water

Front 26

Hepatitis A (Havrix, Vaqta)

Back 26

- inactivated
- children, young adults, health care workers, international travelers
- may be from fecal route

Front 27

Heptatis B (Recombivax HB, Energerix-B, Twinrix)

Back 27

- recombinant surface antigen HBsAG
- combine w/ passive immunized hepatitis B
- health care, hemophilia, hemodialysis, organ transplant

Front 28

Influenza Virus Vaccine

Back 28

- inactivated A/B virus (Fluvirin, Fluzone)
- live attenuated (Flumist)
- for immunocompromised, geriatric, children
- AVOID live attenuated in immunosuppressed, pregnancy
- caution egg allergy

Front 29

Japanese Encephalitis Virus Vaccine (JE-Vax)

Back 29

- from mouse
- inactivated virus
- high mosquito areas

Front 30

Measles Virus

Back 30

- live attenuated
- combined w/ mumps, rubella
- from chick cell embryos
- children, asymptomatic HIV, health care workers NOT previously exposed
- AVOID w/ seizures, egg allergies, Ig, pregnancy

Front 31

Mumps Virus

Back 31

- live attenuated
- chick cell embryos
- parotiditis
- AVOID w/ pregnant, neomycin + egg allergies, Ig
- may interact with the mumps immunoglobulin (2 weeks before or 3 months after)

Front 32

Rubella Virus (German measles)

Back 32

- live attenuated virus
- human diploid cell culture
- infants, adolescents, non-pregnant
- AVOID w/ pregnant, nursing, neomycin allergy

Front 33

Polio Virus

Back 33

- inactivated
- monkey kidney cell culture

Front 34

Rabies

Back 34

- inactivated human cell
- diploid cell culture
- 3 dose series
- may be used with RIGH

Front 35

Smallpox vaccine (Dryvax)

Back 35

- live attenuated
- cow
- immunity to variola
- AVOID in immunocompromised
- vesicular rxn

Front 36

Varicella Vaccine (Varivax)

Back 36

- live attenuated
- human lung cells
- AVOID w/ pregnancy, immunocompromised
- AVOID giving w/ VZIG at same time

Front 37

Yellow Fever Vaccine

Back 37

- live attenuated
- chick embryo cell
- AVOID w/ egg allergy, immunocompromised

Front 38

Human Papillomavirus Recombinant Vaccine

Back 38

- 4 antigens (quadrivalent)
- prevent cervical cancer, genital warts
- female 9-26 yo

Front 39

Rotavirus Vaccine (Rotavix, Rotateq)

Back 39

- lab strained attenuated
- prevent rotaviral gastroenteritis
- immunized family member against the infected family member

Front 40

Zoster Vaccine

Back 40

- live attenuated
- against shingles (neuro)
- shingles > 60 yo

Front 41

DTaP

Back 41

- toxoid
- diptheria, tetanus, acellular antigen of Bordetella pertussis
- AVOID >7 yo

Front 42

Rejection of allographs (2)

Back 42

- presentation of antigen to T cells
- amplification of cytotoxic T cells

Front 43

Acute rejection

Back 43

- foreign object recognized immediately

Front 44

Chronic rejection

Back 44

- foreign object recognized several months after

Front 45

Glucocorticoids (Prednisone)

Back 45

- decrease circulating lymphocytes
- decrease IL-2
- NO effect on bone marrow function
- for acute rejection

Front 46

Azathioprine (Imuran)

Back 46

- inhibit DNA/RNA synthesis
- block amplification of T-cell attack
- INeffective after rejection has occurred
- for kidney allotransplantation
- may use w/ glucocorticoids

Front 47

Basiliximab (Simulect),
Daclizumab (Zenapax)

Back 47

- IgG block IL-2 receptors --> block IL-2 activation --> block mTOR pathway --> no IL-2 proliferation
- prevents renal transplant rejection
- Basiliximab = mouse/human IgG
- Daclizumab = human IgG

Front 48

Cyclosporine (Sandimmune, Neoral)

Back 48

- hydrophobic peptide binds to cyclophilin --> block activation of T cell --> block Calcineurin pathway --> block IL-2/3 synthesis
- induce TGF-B
- monitor blood levels
- reacts w/ CYP3A4
- reduce Diabetes type 1
- HTN, hirsuitism, tremor, gum hyperplasia

Front 49

Tacrolimus (Prograf)

Back 49

- macrolide
- bind to FK-binding protein (FKBP) --> block calcineurin pathway --> no IL-2/3 synthesis
- HTN, hirsuitism, gum hyperplasia, hyperkalemia, hyperglycemia

Front 50

Sirolimus (Rapamune)

Back 50

- macrolide
- block IL-2 receptors --> inhibit cell-cycle progression --> inhibit mTOR pathway --> no IL-2 proliferation
- synergistic w/ Cyclosporine
- for kidney + heart allographs
- AVOID w/ liver transplant --> thrombosis
- edema, lipid disorder, GI dysfxn, UTI, anemia, thrombocytopenia

Front 51

Mycophenolate Mofetil (Cellcept)

Back 51

- NO purine synthesis
- inhibit MP-dehydrogenase --> no DNA --> no gene --> no IL-2 proliferation
- for kidney + liver allograph
- GI effects

Front 52

Muromonab-CD3 (Orthoclone OKT-3)

Back 52

- selective monoclonal Ab
- target CD-3 molecule --> block antigen recognition, cell signaling, proliferation
- block cytotoxic T cell fxn
- use w/ glucocorticoids

Front 53

Antithymocyte Globulin

Back 53

- nonselective polyclonal Ab
- from rabbit, horse
- acute transplant rejection from multi-target attack of lymphocytes
- CAUTION: anaphylaxis, serum sickness

Front 54

Gene Therapy

Back 54

replace, supplement, alter genetic makeup to restore, correct, or enhance certain biological functions

Front 55

Two types of Gene Delivery

Back 55

1) Non-Viral
2) Viral

Front 56

Non-Viral Delivery and its Variations

Back 56

- insert complexed DNA into cell
- cationic lipids (liposomal preparations) = micelles for endocytosis

- cationic carbohydrates = lysine + DNA interactions

- cationic proteins/polypeptides = receptor ligands

(NOT limited to genomic size)

Front 57

Viral Delivery Types

Back 57

- Retrovirus vectors
- Adeno-assn Viral vectors

Front 58

Retrovirus vectors

Back 58

- RNA virus
- high yield
- MULTIPLE gene insertions
- high immunogenic potential

Front 59

Adeno-associated Viral Vectors

Back 59

- DNA virus
- low yield
- SELECTIVE gene insertion
- low immunogenic potential

Front 60

Herpes Simplex Virus

Back 60

- DNA virus
- ONLY into genome of neurons
- low immunogenic potential
- for neurodegenerative disease

Front 61

Mechanisms of Gene Therapy

Back 61

1) Tcp and tsl to replace missing protein
2) tcp and tsl to replace protein w/ novel function
3) production of "anti-sense" RNA

Front 62

EDTA

Back 62

- chelation by Pb
- in pocket w/ (-) charged carboxyl groups
- given as Ca salt EDTA

Front 63

Dimercaprol

Back 63

- 2 sulfhydryl groups
- sulfhydryl groups allow solubility for excretion by biliary tract
- increases the retention of Hg

Front 64

Succimer

Back 64

- 2 sulfhydryl and 2 carboxyl groups
- greater solubility compared to dimercaprol

Front 65

Ferroxamine

Back 65

- Fe complex w/ C=O and hydroxylamine
- inject deferoxamine (lacks Fe) to bind to Fe in blood to form ferroxamine

Front 66

Penicillamine

Back 66

- sulfhydryl, amine, carboxyl group
- treats Wilson's disease (Copper overload)

Front 67

Unithiol

Back 67

- 2 sulfhydryl groups, 1 SO3H group
- increased solubility by SO3H

Front 68

Lead Toxicity Exposure

Back 68

- paints, batteries
- Gi + respiratory route

Front 69

Lead Toxicity Treatment

Back 69

- CaNa2EDTA (parenteral)
- succimer (oral admin)

Front 70

Lead Toxicity Mechanism

Back 70

- sulhydryl groups interfere w/ divalent cations (Ca, Zn, Fe)

Front 71

Lead Organ Toxicity

Back 71

- CNS cognitive effects
- alter behavior
- lead palsy
- anemia (lack Fe into heme)
- interstitial fibrosis, gouty arthritis
- Hypertension
- teratogenic, decrease sperm count

Front 72

Mercury Toxicity Exposure

Back 72

- organic + inorganic forms
- accumulation in fish
- GI
- inhalation

Front 73

Mercury Toxicity Mechanism

Back 73

- sulfhydryl group
- organometatalic alterations to alter toxicity

Front 74

Mercury Organ Toxicity

Back 74

- teratogenic
- motor and behavioral disturbances
- renal failure by inorganic Hg salts

Front 75

Mercury Toxicity Treatment

Back 75

- succiner, unithiol (increase solubility)
- AVOID dimercaprol (causes increase retention of Hg)

Front 76

Arsenic Toxicity Exposure

Back 76

- manufacturing process
- Gi
- respiratory

Front 77

Arsenic Toxicity Mechanism

Back 77

- interacts with sulfhydryl
- oxidized As gas --> hemolytic

Front 78

Arsenic Organ Toxicity

Back 78

- GI
- acute hypotension
- pancytopenia, hemolysis
- delirium, encephalopathy
- peripheral neuropathy
- carcinogenic

Front 79

Arsenic Toxicity Treatment

Back 79

- dimercaprol
- unithiol (parenteral)

Front 80

Which two heavy metals toxicities may be treated with unithiol?

Back 80

Mercury and Arsenic

Front 81

How to treat CO poisoning?

Back 81

100% O2 ventilated chamber

Front 82

Anion Gap Equation

Range

Back 82

(Na + K) - (HCO3 + Cl)

12-16 mEq/L

Front 83

Drugs causing anion gap

Back 83

- ASA
- metformin
- methanol
- glycols
- isoniazid
- Fe

Front 84

Non-drug causes of anion gap

Back 84

- diabetic ketoacidosis
- renal failure
- shock-induced acidosis

Front 85

Drugs causing hyperkalemia

Back 85

- K supplements
- BB
- Digitalis
- potassium-sparing diuretics

Front 86

Drug causing hypokalemia

Back 86

- B agonists
- caffeine (transient)
- theophylline (transient)
- insulin
- thiazides
- loop diuretics

Front 87

Components to calculate serum osmololity and the overall range

Back 87

Na, glucose, BUN

range = 280-290

Front 88

What is Emesis used for?
What products to avoid with Emesis (IPECAC)?

Back 88

- Emesis for GI decontamination
- avoid: convulsants, anti-emetics, petroleum products, corrosive agents

Front 89

Cathartics (PEG-electrolyte)

Back 89

- eliminate undissolved tablets
- whole bowel irrigation

Front 90

Gastric lavage

Back 90

- dissolves many electrolytes
- removes via nasogastric/orogastric tube
- endotracheal cuff/suction

Front 91

activated charcoal

Back 91

- ONLY binds enteric hydroPHOBIC toxins
- ineffective w/ acids and bases, metals, ions

Front 92

Peritoneal dialysis

Back 92

- avoids clotting problems associated w/ hemodialysis
- requires a catheter attached to abdomen

Front 93

Hemodialysis

Back 93

- most common dialysis
- requires a large needle
- must be done in hospital
- may cause clotting

Front 94

hemoperfusion

Back 94

- filter the blood
- effective but more complications than hemodialysis
- SE: coagulopathy, removal of proteins, acid/base disturbances

Front 95

How to treat salicyclate poisoning?

Back 95

- HCO3
- dialysis if bicarbonate ineffective

Front 96

Amphetamine Toxicity Symptoms

Back 96

- acute psychosis
- HTN, tachycardia
- seizures
- hyperthermia (vasoconstrictive)
- rhabdomyolysis

Front 97

Amphetamine Toxicity Treatment

Back 97

- BDZ or anesthetic drugs (seizures)
- neuromuscular blockade (against hyperthermia)

Front 98

Anticholinergic Toxicity Symptoms

Back 98

- dry mouth
- tachycardia
- warm dry skin (NOT hyperthermia)
- Ileus
- mydriasis
- increase sweating

Front 99

Anticholinergic Toxicity Treatment

Back 99

- physostigmine
- BDZ

Front 100

Antidepressant Toxicity Symptoms

Back 100

- anticholinergic
- hypotension (alpha blockade)
- agitation, seizures
- increase QRS interval

Front 101

Antidepressant Toxicity Treatment

Back 101

- NO physostigmine (worsens seizures)
- NaHCO3 (Na blockade to decrease QRS interval)
- BDZ (seizures)

Front 102

Aspirin Toxicity Symptoms

Back 102

- tinnitis
- metabolic acidosis
- hyperventilation
- hyperthermia (less than amphetamines)
- hypoprothrombinemia
- coma

Front 103

Aspirin Toxicity Treatment

Back 103

- IV fluids, bicarbonate
- GI decontaminated methods
- gastric lavage
- activated charcoal
- bowel irrigation
- hemodialysis

Front 104

Beta blocker Toxicity Symptoms

Back 104

- hypotension
- agitation
- seizures

Front 105

Beta Blocker Toxicity Treatment

Back 105

- IV glucagon (hypotension)
- BDZ (seizures)

Front 106

CCB toxicity symptoms

Back 106

- cardiac arrhythmias
- hypotension

Front 107

CCB toxicity treatment

Back 107

- bowel irrigation
- Ca infusion (Ca gluconate)

Front 108

Digoxin toxicity symptoms

Back 108

- NV
- changes in visual field
- bradycardia
- ventricular fibrillation

Front 109

Digoxin toxicity treatment

Back 109

- Digibind (binds to excess Digoxin)
- atropine (bradycardia)
- correct K levels

Front 110

Ethanol Toxicity Symptoms

Back 110

- CNS depressant
- visual field disturbances (methanol)
- oxalate-induced renal failure (ethylene glycol)

Front 111

Ethanol toxicity treatment

Back 111

- IV fluids
- bicarbonate
- dopamine
- endotracheal intubation (respiratory arrest)
- Fomepizole (inhibit alcohol metabolism to aldehydes)

Front 112

Chitosan

Back 112

- polyCATIONic hydrogel
- from acid hydrolysis of CRAB SHELLS
- soluble in weak organic acids
- stable w/ polyanions

Front 113

Chitosan effects

Back 113

- gene transfection
- ion-exchange resin for detoxification
- template for HIV chemoprophylaxis
- hypocholesterolemia (block uptake of bile acids)

Front 114

Alginate

Back 114

- ANION (negatively charged)
- polymeric mannuronic and guluronic acids
- from BROWN SEAWEED
- crosslinks w/ polymeric chains w/ Ca --> rigid hydrogel

Front 115

Alginate Effects

Back 115

- gene transfection
- heal wounds
- flash release of drugs
- excipient for women's health products
- cell/enzyme immobilization
- diagnostic and forensic matrix