Pharmocology First Aid Immunology

Front 1

Drug blocks the differentiation and activation of T cells by inhibiting calcineurin, thus preventing the production of IL-2 and its receptor.

Back 1

CYCLOSPORINE
U: suppresses organ rejection
T: viral infections and lymphoma; nephrotoxic (prevent with mannitol)

Front 2

Similar to cyclosprine, binds FK-binding protein which inhibits the secretion of IL-2 and other cytokines

Back 2

Tacrolimus (FK506)
U: organ transplant
T: SIG nephrotoxicity; periph neuropathy, HTN, pleural effusion, hyperglycemia

Front 3

You patient has a history of Gout which is being treated. Now post kidney transplant is being treated with an immunosuppressent that is causing extreme bone marrow suppression. What is it?

Back 3

AZATHIOPRINE.
M: Antibetabolite precursor of 6-mercaptopurine prevents metabolism and synthesis of nucleic acids. Toxic to lymphocytes.
T: Its active metabolite mercaptopurine is metabolized by xanthine oxidase, thus with allopurinol this builds up. More bone marrow suppression.

Front 4

CD3 mnoclonal antibody which binds to the surface of T cells and blocks cellular interaction with CD3 protein responsible for T cell signal transduction

Back 4

MUROMONAB-CD3 (OKT3)
U: kidney transplant
T: cytokine release syndrome, hypersensitivity reaction

Front 5

Binds to mTOR which inhibits the Tcell proliferation in response to IL-2.

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SIROLIMUS (rapamycin)
U: kidney transplant in combo with cyclosporine and corticosteroids
T: Hyperlipidemia, thrombocytopenia, leukopenia

Front 6

Inhibits de novo guanine synthesis and blocks lymphocyte production

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MYCOPHENOLATE MOFETIL

Front 7

Monoclonal Ab with high affinity for the IL-2 receptor on activated T cells

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DACLIZUMAB

Front 8

Recombinant cytokine which binds IL-2 and is used in RCC and metastatic melanoma

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Aldesleukin

Front 9

Filgrastim

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Granulocyte colony stimulating factor used to recover bone marrow

Front 10

Sargramostim

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granulocyte macrophage colony stimulating factor used to recover bone marrow

Front 11

Alpha-IFN is especially helpful in fighting off several viruses and cancers, name a couple

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HEP B and C; kaposi's sarcoma, leukemias, malignant melanoma

Front 12

Beta-IFN is used in this disease that effects the CNS and spinal chord causing plaques to form. It is seen in 20-40yr women, and presents with vision disturbances, limb weakness and other symptoms.

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Multiple sclerosis

Front 13

Gamma-interferon is critical in the activation and differentiation of monocytes to macrophages to epithelioid cells to giant cells. The last two work in concert with fibroblasts and lymphocytes in maintaining...

Back 13

Granulomas. Thus IFN gamma is key to those who suffer from chronic granulomatous disease. Its natural role is also key in TB, histoplasmosis, syphilis, leprosy, cat scratch fever, sarcoidosis, crohn's, berylliosis

Front 14

Oprelvekin (IL-11) and Thrombopoietin are both used to treat...

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Thrombocytopenia

Front 15

Berylliosis

Back 15

occupational lung disease - associated with beryllium mining or fluorescent light bulbs. chronic allergic-type lung response resulting in granulomas. Results in restrictive lung pattern and decreased diffusion capacity.

Front 16

Lymph drainage of rectum (lower part), anal cacal above pectinate line goes to...

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Internal iliac node

Front 17

Lymph drainage of anal canal below the pectinate line goes to...

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Superficial inguinal node

Front 18

Lymph drainage of testes goes to...

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Superficial and deep plexuses and then to para-aortic nodes

Front 19

Lymph drainage of scrotum and labia goes to...

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Superficial inguinal nodes

Front 20

Cytokine that causes the differentiation of a CD4 + Helper T cell into a Th2 Helper cell

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IL-4

Front 21

Cytokine that causes the differentiation of a CD4 + Helper T cell into a Th1 Helper T cell

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IL-12

Front 22

Main functions of Th1 cell

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Make IL-2, IFN-gamma and activate macrophages & CD 8+ T cell

Front 23

Main functions of Th2 cell

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Make IL-4, IL-5, IL-10 and help B cells make Ab (IgE>IgG)

Front 24

Main inhibitor of Th1 cells

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IL-10

Front 25

Main inhibitor of Th2 cells

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IFN-gamma

Front 26

Cell surface proteins
Helper T Cells

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CD4, CD28, CD40L...TCR, CD3

Front 27

Cell surface proteins
Cytotoxic T cells

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CD8...TCR, CD3

Front 28

Cell surface proteins
B cells

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IgM, CD19, CD20, CD21 (receptor for EBV)...B7, CD40, MHCII

Front 29

Cell surface proteins
Macrophages

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CD14, receptors for Fc and C3b...MHCII, CD40

Front 30

Cell surface proteins
NK cells

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Receptors for MHCI, CD16 (binds Fc of IgG), CD56

Front 31

Cell surface protein found on all human cells except mature RBCs

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MHCI

Front 32

Deficiency of C5-C8 leads to...

Back 32

Neisseria bacteremia

Front 33

Main role of IFNs is to induce the production of ribonucleases...this prevents what and directly inhibits what?

Back 33

Places uninfected cells in an antiviral state. Ribonucleases inhibit viral protein synthesis by degrading viral mRNA (but not host mRNA)

Front 34

Passive immunity is conferred by receiving preformed antibodies (IgA in breast milk for example). Acronym for other exposures that can be treated with antibody injection?

Back 34

To Be Healed Rapidly:
T: Tetanus toxin
B: Botulinum toxin
H: HBV
R: Rabies virus

Front 35

Name that type of hypersensitivity reaction!
Reaction to bee sting, food/drug allergy resulting in quick uriticaria

Back 35

TYPE I, Anaphylaxis

Front 36

Name that type of hypersensitivity reaction!
Results in low B12 as a result of missing intrinsic factor.

Back 36

Type II. Pernicious anemia

Front 37

Name that type of hypersensitivity reaction!
Idiopathic thrombocytopenic purpora

Back 37

Type II.

Front 38

Name that type of hypersensitivity reaction!
Erythroblastosis fetalis

Back 38

Type II. The most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity.
The less common form is called Rh incompatibility, which can cause very severe anemia in the baby.

Front 39

Name that type of hypersensitivity reaction!
Rheumatic fever

Back 39

Type II

Front 40

Name that type of hypersensitivity reaction!
Bullous pemphigoid

Back 40

Type II. Blisters.

Front 41

Name that hypersensitivity reaction!
Pemphigus vulgaris

Back 41

Type II. 50% of cases begin with blisters in the mouth, followed by skin blisters. Skin lesions may come and go. Multiple causes. ACE Inhibitors, Chelating agents such as penicillamine. Mostly middle aged +.

Front 42

Name that hypersensitivity reaction!
Goodpasture's syndrome

Back 42

Type II.

Front 43

Name that hypersensitivity reaction!
SLE

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Type III

Front 44

Name that hypersensitivity reaction!
RA

Back 44

Type III

Front 45

Name that hypersensitivity reaction!
Grave's and Myasthenia Gravis

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Type II

Front 46

Name that hypersensitivity reaction!
Polyarteritis nodosum

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Type III.

Front 47

Name that hypersensitivity reaction!
Post Strep Glomerulonephritis

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Type III.

Front 48

Name that hypersensitivity reaction!
Hypersensitivity Pneumonitis

Back 48

Type III.

Front 49

Name that hypersensitivity reaction!
Type I DM

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Type IV

Front 50

Name that hypersensitivity reaction!
MS

Back 50

Type IV

Front 51

Name that hypersensitivity reaction!
Guillain-Barre Syndrome

Back 51

Type IV

Front 52

Name that hypersensitivity reaction!
Hashimoto's thyroiditis

Back 52

Type IV

Front 53

Name that hypersensitivity reaction!
GVHD

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Type IV

Front 54

Name that hypersensitivity reaction!
Contact dermatitis (ivy, nickel allergy)

Back 54

Type IV

Front 55

Name that hypersensitivity reaction!
PPD

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Type IV

Front 56

Congenital decreased production of B cells resulting in recurrent bacterial infections after 6 months of age...

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Bruton's agammaglobulinemia. XR defect in tyrosine kinase gene (BTK) resulting in low levels of all classes of Ig. Normal pro-B cells in marrow.

Front 57

Congenital aplasia of thymus associated with 22q11 deletion resulting in decreases T cells...

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DiGeorge syndrome. Parathyroids fail to develop as well due to shared embryonic origin (3,4th pharyngeal pouches). Tetany present. Recurrent viral and fungal infections. Heart and great vessel defects.

Front 58

Congenital defects in all early stem-cell differentiation resulting in recurrent viral, bacterial, fungal, and protozoal infections...

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SCID - B and T cells. Multiple causes, most common is defective IL2 receptors (Xlinked), also could be failure to synthesize MHCII antigens or adenosine deaminase deficiency

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Adenosine deaminase

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purine metabolism. It is needed for the breakdown of adenosine from food and for the turnover of nucleic acids in tissues.

Front 60

Defect in CD40 ligand on CD4 T helper cell would result in what immune deficiency?

Back 60

B cell hyper IgM syndrome due to inability of class switching which would occur if CD40L on T cell binded to B cell cell CD40 receptor. Severe pyogenic infections. High IgM, very low IgG, IgA, and IgE.

Front 61

X linked defect in B cell activation associated with increased IgE and IgA levels and an inability to mount an IgM response to capsular polysacchardies of bacteria includes a triad of symptoms WIPE.

Back 61

Wiskott-Aldrich syndrome. WIPE W: Wiskott
I: recurrent Infection
P: thrombocytopenic Purpora
E: Eczema

Front 62

Neutrophils fail to respond to chemotactic stimuli because of IFN-gamma production failure by Th cells presenting with coarse Facies, cold (noninflammed) staph abcesses, retained primary teeth, increased IgE and dermatologic problems

Back 62

Job's syndrome.
FATED
Facies, Abcesses, Teeth, IgE, Dermatologic problems

Front 63

Defect in LFA-1 integrin (CD18) proteins on phagocytes results in recurrent bacterial infections, absent pus formation, neutrophilia, and delayed separation of umbilical cord

Back 63

Leukocyte adhesion deficiency

Front 64

AR defect in microtubular function and lysosomal emptying of phagocytic cells presenting with recurrent pyogenic infections by staph and strep, partial albinism, and peripheral neuropathy

Back 64

Chediak-Higashi Syndrome

Front 65

Defect in microbicidal activity of neutrophils owing to lack of NADPH oxidase activity or similar enzymes, Opportunistic infections ( aureaus, e coli, aspergillus) Dx with negative nitroblue tetrazolium dye reduction test

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Chronic granulomatous disease...treat with IFN-gamma

Front 66

Name the associated disorder:
Anti-IgG

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AKA Rheumatoid factor, Rheumatoid arthritis

Front 67

Name the associated disorder:
Anticentromere

Back 67

Scleroderma (CREST)

Front 68

Name the associated disorder:
Anti-Scl-70

Back 68

Scleroderma (diffuse)

Front 69

Name the associated disorder:
Antimitochondrial

Back 69

primary biliary cirrhosis

Front 70

Name the associated disorder:
Antigliadin, antiendomysial

Back 70

Celiac Disease

Front 71

Name the associated disorder:
Anti-basement membrane

Back 71

Goodpasture's syndrome

Front 72

Name the associated disorder:
Anti-desmoglein

Back 72

Pemphigus vulgaris

Front 73

Name the associated disorder:
Antimicrosomal, antithyroglobulin

Back 73

Hashimoto's thyroiditis

Front 74

Anti-Jo-1

Back 74

Polymyositis, dermatomyositis

Front 75

Anti-SSA (Anti-Ro)

Back 75

Sjogren's, also seen in SLE that is reactive to UV light, this is passed on to infants through the placenta causing SLE infants

Front 76

Name the associated disorder:
Anti-U1 RNP (ribonucleoprotein)

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Mixed connective tissue disease

Front 77

Name the associated disorder:
Anti-smooth muscle

Back 77

Autoimmune hepatitis

Front 78

Name the associated disorder:
Anti-glutamate decarboxylase

Back 78

Type 1 DM

Front 79

Name the associated disorder:
c-ANCA

Back 79

Wegener's granulomatosis

Front 80

Name the associated disorder:
p-ANCA

Back 80

Other vasculitides

Front 81

HLA subtype and associated disease:
A3

Back 81

Hemochromatosis

Front 82

HLA subtype and associated disease:
B27

Back 82

PAIR: Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter's syndrome

Front 83

HLA subtype and associated disease:
B8

Back 83

Grave's

Front 84

HLA subtype and associated disease:
DR2

Back 84

MS, hay fever, SLE, Goodpastures

Front 85

HLA subtype and associated disease:
DR3

Back 85

DM type 1

Front 86

HLA subtype and associated disease:
DR4

Back 86

RA, DM type 1

Front 87

HLA subtype and associated disease:
DR 5

Back 87

Pernicious anemia, Hashimotos thyroiditis

Front 88

HLA subtype and associated disease:
DR7

Back 88

Steroid responsive nephrotic syndrome

Front 89

Allograft

Back 89

from nonidentical individual of same species

Front 90

syngeneic graft

Back 90

from identical twin or clone

Front 91

Hyperacute rejection occurs within _____ and is due to _____.

Back 91

minutes, antidonor antibodies in the transplant recipient

Front 92

Acute rejection occurs within ____ and is due to ______, it is reversible with _______.

Back 92

weeks, cytotoxic T lymphocytes reacting against foreign MHCs, cyclosporine and OKT3.

Front 93

Chronic rejection occurs within _____ and is due to ______ it is often irreversible.

Back 93

months to years, T cell and Ab mediated vascular damage (obliterative vascular fibrosis). Class I MHC nonself is perceived by CTLs as class I MHC self presenting a non self antigen.

Front 94

Graft versus Host Disease

Back 94

Graft T cells proliferate and reject the host foreign cells resulting in severe organ dysfunction - maculopapular rash, jaundice, hepatosplenomegaly and diarrhea.

Front 95

uses perforin and granzymes to induce apoptosis of virally infected cells and tumor cells

Back 95

NK cells
They are triggered by the absence of Class I MHC cell on surface and by nonspecific action.
IL12, IFN beta and gamma enhance its activity.

Front 96

CD14

Back 96

Endotoxin/LPS (gram -) receptor on macrophages, presence of these things directly stimulate.

Front 97

main Ab in secondary response, most abundant, only one that crosses the placenta, acts as an opsinin, neutrilizes bacteria and viruses

Back 97

IgG

Front 98

Blocks the attachment of bacteria and viruses to the mucous membranes

Back 98

IgA, can't fix complement, monomer or dimer

Front 99

Ab in primary response, fixes complement, antigen receptor on B cells

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IgM, monomer or dimer

Front 100

IL-1

Back 100

Fever, acute inflammation, chemokines that recruit leukocytes, activates endothelium expression of adhesion molecules

Front 101

IL-2

Back 101

produced by Th cells to stimulate growth of helper and cytotoxic T cells

Front 102

IL-4

Back 102

produced by Th2 cells and causes increased growth of B cells and class switching from IgE to IgG

Front 103

IL-5

Back 103

Produced by Th2 cells resulting in Increased production & activation of eosinophils, differentiation of B cells, and IgA class switching

Front 104

IL-6

Back 104

Th cells and Macs produce it resulting in increased production of acute phase reactants and Igs

Front 105

IL-10

Back 105

Break at 10! Made by Treg cells and they down regulate actions of activated T cells

Front 106

IgM, IgG bind to fixed antigen on enemy cell leading to lysis by complement or phagocytosis

Back 106

Type II Hypersensitivity, direct and indirect coombs tests.