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146 Cards in this Set
- Front
- Back
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What type rxn is Brochial Asthma?
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Type I
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What type rxn is allergic rhinitis/sinusitis?
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Type I
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What type rxn is Food Allergies?
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Type I
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What type rxn is Systemic Anaphylaxis?
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Type I
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What type rxn is Autoimmune Hemolytic Anemia?
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Type II
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What type rxn is AutoImmune thrombocytopenia purpura?
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Type II
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What type rxn is Goodpasture's Syndrome?
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Type II
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What type rxn is Acute Rheumatic Fever?
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Type II
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What type rxn is Hashimoto's?
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Type II
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What AB & cells are responsible for Type I rxn's?
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IgE; mast for early phase rxn and eosinophils (thru IL-5) for late phase inflammation
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What AB is rsp for Type II rxn's?
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IgG
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Blocking AcH receptors causes what? Name of the disease??
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Causes weakened contractions by IgG blocking it; Myasthenia Gravis
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Blocking TSH receptor's will cause what? Name of the resulting disease?
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Hyperthyroidism bc IgG is blocking it; Graves Disease
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What is the antigen that "self" attacks in pernicious anemia?
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the Intrinsic factor in parietal cells
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What type rxn is Diabetes?
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Type IV
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What type rxn is Rhematoid Arthritis
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Type III and Type IV
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What type rxn is Inflammatory Bowel Disease?
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Type IV
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What type rxn is SLE?
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Type III
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What is the antigen in SLE?
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DNA, nucleoproteins
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What type rxn is Post-strep Glonerulnephritis?
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Type III
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What are the 3 signals of T cell activation?
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1. Interaction of antigen & MHC with the T-cell receptor
2. Co-stimulators and adhesion molecules 3. Release of IL-2/IL-2R |
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What is CD3?
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It is apart of the 1st signaling of activating T-cells. It's activation is required. Activated once MHC-Tcell are joined
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What are the 2 co-stimulators of the 2nd signal of t-cell activtion?
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B7 with CD28 (CTLA-4) and CD40 with CD40 L
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T/F? CD28, CD40, CD40L and B7 are all constitutively expressed.
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False - only CD28 and CD40 are; B7 is upregulated on the APC once 1st T-cell signal has taken place and CD40L is expressed 24-48 hrs after the T-cell is activated
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One what cell is CD40 and CD40L located?
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CD40 - APC (B-cell, dendritic cell, or macrophage)
CD40L - the T-cell |
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What is the result of CD40 + CD40L?
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Enhances the expression of B7 on the APC's --> enhances T-cell activation, proliferation and differentiation
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What causes the integrins on T-cells to increase in affinity for their ligands on APC's?
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chemokines from the APC that goes to the T-cell
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What does a B-cell have to have to be an APC to a T-cell (causing activation)?
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CD20+
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What type rxn is Glomerulonephritis?
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Type II
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In type IV rxn what do Activated CD4 Cells release? What does that cause?
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IFN; this activated macrophages (type A cells in synovial) causing inflammation and thus tissue damage
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Which T-cell can kill directly?
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CD8 cells
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What is a granuloma?
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spherical mass of immune cells; happens with chronic type IV rxn's; the antigen is found inside to wall it off from others, but cannot kill it
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What kind of pain is a headache or irritable bowel syndrome?
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Dysfunctional pain
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What is transient pain?
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protective; no actual tissue damage but nociceptive transducers are elicited
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What type pain usually involves healing?
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Acute pain
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Shingles is what kind of pain?
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Neuropathic pain
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What kind of pain is visceral pain?
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Nocicpetive
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What kind of pain has the most nociceptors involved? The least?
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Superficial somatic pain = most
Deep, somatic pain = middle Visceral pain = least |
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What 3 ways do pharm agents interfere to treat pain?
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Interfere with...
1. the rsp of primary sensory neurons to somatic or visceral sensory stimuli 2. the relaying of algesic info for peri to brain 3. the perceptual rsp to the painful stimulus |
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Which horn of the spinal cord is pain conducted to?
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dorsal horn
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What neuron does the cerebral cortex receive info from?
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3rd order neuron
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The ____ _____ nerve fiber transmits nociceptive info from the peripheral tissues.
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primary afferent
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What are the 4 processes of pain, in order?
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1. Transduction
2. Transmission 3. Perception 4. Modulation |
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What are the 3 types of transducting stimuli?
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chemical, thermal (hot & cold), mechanical
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What types of fibers are nociceptor endings most associated with?
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Type C (unmyelinated) fibers and type Adelta (thinly myelinated) fibers
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Can 1 nociceptors respond to a single stimuli or different kinds of stimuli?
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Both; bc nocieptors are heterogenous
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What are the 2 ways nociceptors can be depolarized?
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1. GPCRs - slower BUT most common
2. Ion channels - faster |
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What are TRPV's?
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Thermal receptors of pain; also called capsaicin receptors; different ones respond to different temps
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What do prostaglandins do to pain sensitization?
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Pg's lower the threshold of pain -- easier to get stimuli
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What is the difference btwn hyperalgesia and Allodynia?
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Hyperalgesia - inc response to painful stimuli (inflammation and mediators can cause this)
Allodynia - pain due to a stimulus that normally does not provoke a rxn (Pg's can cause this) |
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What causes hyperalgesia in patients with nocicpetive pain?
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1. enhance ion influx (like Na or Ca2+)
2. Reduction in the activation thershold 3. Neurogenic Inflammation (mediators released like SP, PG's, BK or cytokines) |
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What is orthodromic conduction?
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an impulse runs along an axon in its normal direction, away from the soma
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What is antidromic conduction? What is released from this impulse?
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conducting impulses in a direction opposite to the normal; Substance P is released
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Which section of the dorsal horn (gray matter) is most important in pain transmission?
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I, II, V
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What 2 neurotransmitters are released at the Primary afferent fiber --> (interneuron) --> 2nd order neuron?
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glutamate and substance P
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Glutamate (excitatory NT's) can act on which 3 receptors in regards to nociceptive pain transmission?
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Big 2 ones --> NMDA and AMPA (fast responses)
And metabotropic rcpt --> slow |
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Substance P acts on what receptor bwtn 1st order and 2nd order fibers of pain transmission?
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Metabrotropic recpts --> slow impulse
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Generic/Target of Prialt
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Ziconotide; inhibitor of N-type calcium channel (same as Gabapentin) -- without Ca2+ NT's (glutamate or SP) cannot be released from nerve
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What roles do the thalamus and hypothalamus play in pain perception?
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Thalamus - relays sensory impulses to somatosensory cerebral cortex
Hypothalamus - sends EFFERENTs out to PAG and LC |
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What roles do the PAG and LC play in pain perception?
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PAG - descends modulation of pain
LC - projects EFFERENTs down to dorsal horn - releases NE |
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What role does Raphe Magnus play in pain perception?
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Sends projections to dorsal horn to directly INHIBIT pain; releases SE and regulate release of enkephalins
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What is the order of the descending analgesic pathway?
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Hypothalamus --> PAG --> Raphe magnus --> LC --> dorsal horns
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What are 3 endogenous pathways that inhibit pain?
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1. projections from Brain Stem
2. Local inhibitory interneurons 2. Major inhibitory NT's |
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What are the 5 endogenous NT's that inhibit pain?
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SE, opoids, GABA, glycine, NE
(SE and NE can be excitatory and inhibtory) |
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What is dysesthesia?
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Abnormal or altered sensation (symptom of neuropathic pain)
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What is paresthesia?
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Numbness, tingling (symptom of neuropathic pain)
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What structural and functional changes happen as a result of neuropathic pain?
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inflammation and loss of support from neurotrophic factors AND up-regulation of Na+ channels (inc nerve excitiability)
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Generic/Target of Tegretol
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Carbamazepine; blocks the Na+ channels that are up-reg with neuropathic pain
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What are the reasons behind hyperalgesia or allodynia with patients that have neuropathic pain? (6)
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1. Enhanced ion influx (na, ca2+)
2. Reduction of the activation threshold (na channels) 3. Neurogenic inflammation --- 4. Production of ectopic neuronal pacemakers (na depolar on own) 5. Upreg of NMDA receptors (glutamate) 6. Decreased act. of endogenous analgesic system |
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What kind of pain is Multiple Sclerosis?
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neuropathic pain
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What is Trigeminal Neuralgia?
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5th Cranial nerve; neuropathic pain; pain felt in jaw, cheek or lip of 1 side of the face
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What is Postherapetic Neuralgia?
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When the pain stays after the rash disappears with shingles; affects one side of the body; rash can spread b4 heals (2-4 weeks)
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What is ground substance made up of?
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80% water, proteogylcans (protein core + GAGs) and glycoproteins (adhesion molecules - laminin, fibronectin)
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Where is an aggrecan extensively found? What high concentrations does it have?
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Articular cartilage; chondroitin and keratan
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What type of collagen is found in joints?
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Type 2
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What type of collagen is found in bone?
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Type 1
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Fibroblast are found in what kind of tissue?
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Connective tissue proper
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What type of connective tissue is most abundant?
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Connective tissue proper
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Fibrocartilage is found where?
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Vertebrae
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T/F Cartilage is avascular.
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TRUE!!!
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What 5 things are needed for bone anabolism?
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1. Protein Adhesion Molecules
2. Proteoglycans 3. Collagen Fibers 4. TIMPs 5. PAI |
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What proteases are needed for bone catabolism?
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Serine proteases and Latent Metalloproteinases
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Another name for compact bone? What's the % bone mass?
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Cortical bone; 80%
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Another name for spongy bone? What's the % bone mass?
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Trabecular; 20%
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Which bone type is synthesized and reabsorbed at a faster rate?
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Trabecular/spongy
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What 4 common places for bone marrow in adults?
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Hips, sternum, heads of femur and humerus
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What substance does VitD3 and PTH cause osteoBLAST to secrete?
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M-CSF
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What does M-CSF (from osteoBLAST) do?
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cause mononuclear cells to differentiate and fuse to form osteoCLAST
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Do osteoCLAST attach to bone surfaces?
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YES, thru adhesion molecules - how bone resorption initiates
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What bone cell is the most abundant?
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OsteoCYTES
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TNF and IL-2 upregulate what ligand in bone resorption?
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RANKL
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OPG can block bone resorption by binding to ____.
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RANKL
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What cell is RANK found on? RANKL?
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RANK = oseotCLASTS (immature and mature)
RANKL = osteoBLAST or stromal cell |
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PTH increases the expression of ____ and decreases ____.
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RANKL; OPG
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In small quantities of VitD3 Ca2+ and phosphate are....
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enhanced in absorption from GI tract
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What form of VitD3 circulates (from liver to kidney)
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CalciDIOL
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Inflammation at DIP is mostly ____arthitis?
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osteo
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What is a synarthrosis joint? Example?
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immobile; fibrous joint - bones of skull
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What is a amphiarthrosis joint? Example?
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slightly movable; cartilagenous joint - intervertebral discs
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What is a diarthrosis joint? Example?
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Freely movable; synovial joint - knee
MOST JOINTS OF BODY |
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Name for the big toe?
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Podagra
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Adenosine goes to ____.
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Inosine
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Guanine goes to ____.
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Xanthine
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Salavage of Hypoxanthine goes to ____, thru ____/PRPP.
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IMP; HGPRT
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1/3 of urate load comes from ____.
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Diet
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2/3rds of Uric Acid is excreted via ___ and 1/3rd via ____.
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urine; GI tract
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___ degrades UA into allantoin.
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Uricase (humans lack this enzyme)
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Direct Phase of Gout Attack is...and involves ____.
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Cellular; IL-1
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Indirect Phase of Gout Attack is...and includes the ____ system and the ___ system.
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Humoral; Complement and Kinin (BK)
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pro-IL-1B ---> (____) ---> IL-1B
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Carpase/ICE
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Which two enzymes are key mediators with the affected chondrocyte metabolism in OA?
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Nitric Oxide and cytokines
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Which cytokine induces the formation of TNF, IL-1 and IL-6 in OA?
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IL-17
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Which 3 cytokines are the most elevated in OA?
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TNF, IL-1, and IL-6
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In OA IL-1 and TNF (IL-6) suppress ___ and ____, while stimulating ____.
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proteoglycans, collagen / MMP
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MMP and ___ are 2 key mediators that damage that are released from chondrocytes after being affected.
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Aggrecanases
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Hypersensitivity rxn's type __ and __ can worsen OA? How?
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II and IV; II brings neutrophils to the area (inflamm) and IV releases IFN, inc chondrocytes activation
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PAMPs and DAMPs are ____? Which receptor recognizes them?
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Inducers; TLR's
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T/F. Chronic Inflammation can recurit the adaptive immune response.
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TRUE
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What is the hallmark of acute inflamm resp? Of chornic?
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Increase vascular permeability = acute
tissue destruction = chronic |
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Where does recruitment of leukocytes to the site of inflammation occur?
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Post cap venule
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LFA-1, VLA-4 and MAC-1 are?
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Integrins
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___ convert integrins to high affiinity.
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Chemokines
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VCAM-1 and ICAM-1 are up-regulated by what?
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cytokines
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How are selectins activated?
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Cytokines
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What are the 4 chemotatic substances?
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LTB-4, C3a, C5a, and IL-8
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What induce cells to secrete chemokines?
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Cytokines
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PECAM-1 is mainly used in what?
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Diapedesis (transmigration)
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What does myeloperoxidase do? Where is it found?
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it breaks up hydrogen peroxide; in oxygen dependent lysosomes
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What are the 3 plasma derived mediators?
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Kinin, clotting system, C3a/C5a/C5b
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What are the 2 cellular derived mediators (performed)?
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Histamine, SE, proteases, and neuorpeptides (SP)
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Of the clotting system, what are the 3 mediators that cause inflammation?
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Thrombrin, fibrinopeptides and plasmin
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What is the Hageman factor?
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Factor 12 of the clotting system --> leads to formation of thrombrin (can produce PG's, PAF and NO)
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What 4 systems does Hageman factor initiate?
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Complement, Kinin, plasminogen, and coagulation
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Which Histamine receptor causes the most inflammation?
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H-1 (some H-2)
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Lysosomes contain 2 types of granules...
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one with MMP and larger one with myeloperoxidase
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What is the triple response?
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A - redness
B - Wheal C - flare (caused by histamine) |
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Substance P is released from antidromic impulses and from type __ fibers
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C
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What receptor does SP act on
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NK1 - neurokinin
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What makes up eicosanoids/autoacoids?
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Prostaglandins and leukotrienes
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COX-1 affects what 4 areas?
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GI tract, Platelets, Renal tract, and blood vessels
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COX-2 affects what 2 areas?
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Blood vessls and renal tract
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COX-1 has a ____ affect on BV's permeability
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small
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Which leukotrienes cause instense bronchoconstriction?
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LTC4,LTD4, and LTE4
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ZYFLO is a ____ inhibitor.
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5-LO
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Are most cells involved in inflammation? Why or why not?
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YES; bc PAF (proinflam) is synthesized in many cells
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After Aarchidonic Acid what happens to get to LTB-A4?
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---> FLAP ---> 5-LO ---> LTB-A4 ---> LTC4 and LTB4
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