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  1. Immediate (type 1) hypersensitivity
    • Prototype Disorder: anaphylaxis; allergies; bronchial asthma (atopic forms)
    • Immune Mechanisms: production of IgE antibody -> immediate release of vasoactive amines and other mediators from mast cells; recruitment of inflammatory cells (late phase reaction)
    • Pathologic Lesions: vascular dilation, edema, smooth muscle contraction, mucus production, inflammation
  2. Antibody-mediated (type 2) hypersensitivity
    • activate complement
    • Prototype Disorder: hemolytic anemia; Goodpasture syndrome
    • Immune Mechanism: Production of IgG, IgM -> binds to antigen on target cell/tissue -> phagocytosis or lysis of target cell by activated complement or Fc receptors; recruitment of leukocytes
    • Pathologic Lesions: cell lysis; inflammation
  3. Immune complex-mediated (type 3) hypersensitivity
    • circulating antibdoies binding to circulating antigens
    • Prototype Disorder: systemic lupus erythematosus; some forms of glomerulonephritis; serum sickness; Arthus reaction
    • Immune Mechanisms: Deposition of antigen-antibody complexes -> complement activation -> recruitment of leukocytes by complement products and Fc receptors -> release of enzymes and other toxic molecules
    • Pathologic Lesions: necrotizing vasculitis (fibrinoid necorsis); inflammation
  4. Cell-mediated (type 4) hypersensitivity
    • TH1 cells
    • Prototype Disorder: contact dermatitis; multiple sclerosis; type I, diabetes; translpant rejection; tuberculosis
    • Immune Mechanism: Activated T lymphocytes -> release of cytokines and macrophage activation; T-cell mediated cytotoxicity
    • Pathologic Lesions: Perivascular cellular infiltrates; edema; cell destruction; granuloma formation
  5. suffix - mab
    monoclonal antibody
  6. infix immediately preceeding the suffix identifies ____ of the antibody
    species source
  7. u
  8. o
    murine (mouse)
  9. a
  10. i
  11. xi
    chimeric- mostly human, but some mouse
  12. zu
    humanized - ~95% human, remaining mouse
  13. infix preceding the species infix designates the _____
  14. vi(r)
  15. li(m)
    immune system
  16. ki(n)
  17. ci(r)
  18. tu(m)
  19. muromonab - CD3
    • Ligand/Target: CD3 on T-lymphocytes
    • Indication: acute graft rejection
    • IV bolus
  20. abciximab
    • Ligand/Taget: glycoprotein IIb/IIIa receptors on platelets, vitronectin receptor
    • Indication: prevent reocclusion of coronary arteries following PTCA, unstable angina
    • Fab fragment, IV bolus prior to PTCA
  21. rituximab
    • Ligand/Target: CD20 on B lymphocytes
    • Indication: non-Hodkin's lymphoma
    • chronic lymphotcyic leukemia
    • rheumatoid arthritis
    • Wegener's Granulomatosis (WG) and Microscopic Polyangiitis
    • IV infusion, tumor lysis syndrome, severe mucocutaneous reaction
  22. ibritumomab tiuxetan
    • Ligand/Target: CD20 on B lymphocytes
    • Indication: B-cell Non-Hodgkin's lymphoma
    • radioimmunotherapy, In-111 - Y-90
    • Sever cytopenias, Maximum dose: 32mCi
  23. tositumomab
    • Ligand: CD20 on B lymphocytes
    • Indication: Non-Hodgkin's lymphoma
    • Radioimmunotherapy, I-131
    • Severe cytopenias, Category X, iodide pretreatment
  24. ofatumumab
    • Ligand: CD20 on B-lymphocytes
    • Indication: chronic lympocytic leukemia
    • cytopenias, PML, hepatities B reactivation, intestinal obstruction
    • IV infusion
  25. brentuximab vedotin
    • CD30 on malignant lymphocytes
    • Indications: Hodgkin lymphoma,
    • anaplastic large cell lymphoma (ALCL)
    • Use monomethyl aurostatin E (MMAE)
  26. alemtuzumab
    • Ligand: CD52 on leukocytes
    • Indication: B-cell chronic lymphocytic leukemia
    • Prophylactic antibiotics required
    • immunosuppression, myelosuppression
    • IV infusion
  27. ipilimumab
    • Ligand: CTLA-4 on T-lymphocytes
    • Indication: unresectable or metastatic melanoma
  28. trastuzumab
    • Herceptin
    • Ligand: Human Epidermal growth factor Receptor (HER2)
    • Indication: metastatic breast cancer
    • cardiomyopathy, IV infusion
  29. cetuximab
    • Erbitux
    • Ligand: Epidermal Growth Factor Receptor (EGFR-1; HER-1; c-Erb-1)
    • Indication: metastatic colorectal carcinoma
    • head and neck squamous cell carcinoma
    • cardiopulmonary arrest, IV infusion
  30. panitumumab
    • Ligand: Epidermal Growth Factor Receptor (EGFR-1; HER-1; c-Erb-1)
    • Indication: colorectal carcinoma
    • IV infusion, dermatologic toxicity
  31. bevacizumab
    • Ligand: VEGF
    • Indication: metastatic colorectal carcinoma
    • glioblastoma
    • metastatic renal cell carcinoma
    • nonsquamous non-small lung cancer
    • GI perforation, wound dehiscence, hemorrhage, IV infusion
  32. ranibizumab
    • Ligand: VEGF-A
    • Indication: neovascular ("wet") age related macular degeneration (AMD)
    • fragment from E. coli, intravitreal
  33. basiliximab
    • Ligand: binds to alpha-subunit (CD25) of IL-2 receptors (IL-2R antagonist)
    • Indication: immunosuppressant
    • IV infusion
  34. belimumab
    • Ligand: binds to B-lymphocyte stimulator (BLyS)
    • Indication: systemic lupus erythematosus
  35. infliximab
    • Ligand: TNF-alpha
    • Indication: rheumatoid arthritis
    • psoriatic arthritis
    • plaque psoriasis
    • ankylosing spondylitis
    • ulcerative colitis
    • Crohn's disease
    • IV infusion, TB, Fungal, T-cell lymphoma, heart failure
  36. adalimumab
    • Ligand: TNF-alpha
    • Indication: rheumatoid arthritis
    • juvenile idiopathic arthritis
    • psoriatic arthritis
    • ankylosing spondylitis
    • Crohn's Disease
    • plaque psoriasis
    • Sub-Q q2w, TB
  37. golimumab
    • Ligand: TNF-alpha
    • Indication: rheumatoid arthritis
    • psoriatic arthritis
    • ankylosing spondylitis
    • Sub-Q q1m, TB
  38. certolizumab pegol
    • Ligand: TNF-alpha
    • Indication: Crohn's Disease, RA
    • Fab, PEG, Sub-Q, infection
  39. toclizumab
    • Ligand: IL-6 receptor
    • Indication: rheumatoid arthritis, juvenile ideiopathic arthritis
    • serious infections, IV infusion q4w
  40. ustekinumab
    • Ligand: p40 protein subunit of IL-12 and IL-23
    • Indication: plaque psoriasis
    • Sub-Q, infections
  41. omalizumab
    • Ligand: IgE, Fc-epsilon receptor blocker
    • Indication: asthmas
    • Sub-Q
  42. palivizumab
    • Ligand: respiratory syncytical virus (RSV)
    • Indication: prophylaxis against RSV infection in pediatric
    • IM: November through April
  43. natalizumab
    • Ligand: alpha 4 subunit of alpha-4-beta-1 and alpha-4-beta-7 integrins expressed on the surface of leukocytes
    • Indication: multiple sclerosis
    • IV infusion, PML
  44. eculizumab
    • Ligand: complement protein C5
    • Indication: paroxysmal nocturnal hemoglobinuria (PNH)
    • IV infusion, meningococcal infections, encapsulated bacteria, rebound hemolysis
  45. canakinumab
    • Ligand: IL-1beta
    • Indication: Cryopyrin-associated Periodic Syndromes (CAPS) - NLRP3 gene overexpression
    • Sub-Q q8w, infections
  46. denosumab
    • Ligand: RANKL (receptor activator of nuclear factor kappa B Ligand)
    • Indication: bone loss, osteoporosis
    • prevention of skeletal-related events with bone metastases from solid tumors
    • Sub-Q
  47. etanercept
    • Ligand: TNF-alpha
    • Indication: rheumatoid arthritis
    • polyarticular-course juevenile rheumatoid arthritis
    • ankylosing spnodylitis
    • plaque psoriasis
    • psoriatic arthritis
    • dimeric fusion protein: TNFR with Fc of IgG
    • Sub-Q
  48. abatacept
    • Ligand: CD80 and CD86 (B7.1 and B7.2)
    • Indication: rheumatoid arthritis
    • selective co-stimulation modulator: fusion protein, CTLA-4 linked to modified Fc of IgG
    • - decrease TNF, IFN, IL-2, TNF antagonist nor anakinra should not be used
  49. belatacept
    • Ligand: CD80 and CD86 (B7.1 and B7.2)
    • Indication: renal transplantation
    • extracellular domain of CTLA-4 with Fc blocks T-cell activation
    • PTLD- do not use with EBV seronegative or with serostatus, infections, malignancies, do not use in liver transplant, PML
    • IV infusion
  50. alefacept
    • Ligand: CD2 on T-lymphocytes
    • Indication: plaque psoriasis
    • CD2 binding portion of LFA-3 with Fc of IgG
    • blocks LFA-3 binding, Fc (CD16) activates ADCC, opsonization of T-cell
    • IM or IV, Not for HIV
  51. rilonacept
    • Ligand: IL-1beta
    • Indication: Cryopyrin-Associated Periodic Syndromes (CAPS)
    • orphan drug, IL-1RI, IL-1RAcP with Fc of IgG
    • Sub-Q, q1w
  52. aflibercept
    • Ligand: VEGF
    • Indication: neovascular ("wet") age-related macular degeneration (AMD)
    • VEGF receptor 1, 2 with Fc of IgG, q8w
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