Pharmacology Exam I

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Rx2013
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62845
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Pharmacology Exam I
Updated:
2011-01-29 20:05:57
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Immunopharmacology
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Immunopharmacology
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  1. Primary immune system organs
    • thymus
    • bone marrow
  2. Secondary immune system organs
    • spleen
    • lymph node
  3. tertiary immune system organs
    • appendix
    • large intestine
  4. Normal RBC count
    3.6-5 million/microliter
  5. Normal platelet count
    16.2-38 million/microliter
  6. Normal WBC count
    4000-10000/microliter
  7. Monocytes are found in the
    blood
  8. Macrophages are found in the
    tissue
  9. Activated function of macrophages
    • phagocytosis
    • activation of bacteriocidal mechanisms
    • antigen presentation
  10. Activated function of dendritic cells
    • Antigen uptake in the periphery
    • Antigen presentation in lymph nodes
  11. Dendritic cells
    • a type of monocyte
    • primary immune response
  12. _______ cells are the most important antigen presenting cell because ______.
    • Dendritic cells
    • they are responsible for makin the initial response to a forgein antigen
  13. A high neutrophil count is indicative of
    a bacterial infection
  14. Neutrophil activated function
    • phagocytosis
    • activation of bactericidal mechanisms
  15. Neutrophils have a life span of ______ days because_______.
    • 1-4 days
    • they have no mitochondria and rely on glycogen in cells
  16. Eosinophil activated funciton
    killing of antibody coated parasites by creating holes in the membranes of parasites causing them to lyse
  17. Eosinophil life span
    8-12 days
  18. Basophil activated function & life span
    • secrete cytokines which cause inflammation, otherwise unknown
    • 2 days
  19. Mast cell activated function and life span
    • release of granules containing histamine and other active agents
    • 6 months - 1 year
  20. Immune cells
    • lymphocyte
    • t cells
    • b cells
    • NK cells
  21. T, B and NK cells are all types of
    lymphocytes
  22. two types of T cells
    • CD4
    • CD8
  23. Two types of immune response
    • innate
    • adaptive
  24. two types of adaptive immune response
    • cellular
    • humoral
  25. Time for innate immunity to kick in
    0-4 hours
  26. Time for early induced response to kick in
    4-96 hrs
  27. time for adaptive response to kick in
    >96 hrs
  28. Non-specific response that is the first line of defense
    Innate immune response
  29. Innate immune response cells
    • PMN
    • Monocytes
    • Mast cells
    • Basophils
    • Eosinophils
    • NK cells
  30. Cytokines
    • proteins that neutralize antigens
    • response is weak
  31. types of cytokines
    • acute phase proteins such as:
    • C reactive protein
    • fibrinogen
    • CSF
    • Lysozyme
  32. Complement
    • alternate innate pathway
    • C3 convertase binds with antigen
  33. Collectins
    • innate immunity
    • mannose binding protein
    • bind polysaccharides present on viruses
  34. Natural killer cells (NK)
    • intermediate line of defense
    • no antigen receptor
    • non-specific response
  35. Two types of adaptive immune response
    • humoral immune response
    • cellular immune response
  36. Humoral immune response is mediated by
    b cells
  37. cellular immune response is mediated by
    t cells (CD4 and CD8 cells)
  38. Antigen presenting cells
    • dendritic cells
    • macrophages
  39. IgG function
    • complement fixation
    • placenta
    • agglutination
  40. IgA function
    secretory (mucosal) antibody
  41. IgM function
    • complement fixation
    • agglutination
    • first antibody made
  42. IgD function
    • lymphocyte differentiation
    • mucosal expansion
  43. IgE function
    • Allergic response
    • mast cell degranulation
  44. Immunoglobulin that would be used to combat the flu virus
    IgA because mucosal immunity is imparative
  45. T helper cells
    • CD4 cells
    • TH1 and TH2
  46. T cytotoxic cells
    • CD8
    • TC1 and TC2
  47. TH 1 cells exert a type 1 response with these factors
    • IL-2
    • IFN-gamma
    • cell mediated immunity dominates
  48. TH-2 exert a type 2 response with these factors
    • IL-4
    • IL-10
    • antibody mediated immunity dominates
  49. T-cytotoxic response
    • CD8
    • direct lysis of cells
  50. TC1 uses these factors
    • IL-2
    • IFN-gamma
  51. TC2 uses these factors
    • IL-4
    • IL-10
  52. APCs degrade pathogens and present it to
    T or B cells
  53. helps to present epitope to cytotoxic t cells
    MHC class I
  54. helps to present epitopes to t helper cells
    MHC class II
  55. MHC class I receptor structure
    • alpha chain has 3 loops
    • only croses membrane 1 time
    • smaller epitopes
  56. MHC II receptor structure
    • 2 proteins that cross the membrane
    • supports a larger epitope
  57. MHC I molecules
    • synthesized in the ER
    • antigen combined in the ER
    • present to cytotoxic T cells (CD8)
  58. MHC-II molecules
    • synthesized in the ER
    • combined with antigen in the golgi complex
    • presents to CD4 cells
  59. 3 types of abnormal immune response
    • hypersensitivity
    • autoimmunity
    • immunodeficiency
  60. Hypersensitivity
    • immune system over response
    • allergies
    • anaphylaxis
  61. Autoimmunity
    lack of self recognition
  62. Type 1 hypersensitivity mediated by
    IgE
  63. Type II & III hypersensitivity mediated by
    IgG
  64. Type IV hypersensitivity mediated by
    • Th1 cells
    • Th2 cells
    • CTL
  65. Examples of autoimmunity
    • rheumatoid arthritis
    • systemic lupus erythematosus
    • multiple sclerosis
    • type I diabetes
  66. Rheumatoid arthritis
    IgM antibodies against IgG Fe
  67. Systemic lupus erythematosus
    antibodies against DNA, histone, RBC and platelets
  68. Multiple sclerosis
    cell mediated immune response against myelin around nerve cells
  69. Type 1 diabetes
    cell mediated immune response against islet beta cells
  70. Immunodeficiency diseases
    • x linked agmmaglobulinemia
    • digeorge syndrome
    • ADA deficiency
  71. X linked agmmaglobulinemia
    • males only
    • failure of B cells to mature
    • no antibodies made
    • no response to infections
  72. DiGeorge syndrome
    failure in appropriate T cell response
  73. ADA deficiency
    accumulation of deoxy ATP in cells
  74. Immunosuppressive agents (7)
    • Glucocorticoids
    • Calcineurin inhibitors
    • proliferation signal inhibitors
    • mycophenolate mofetil
    • thalidomide
    • cytotoxic agents
    • immunosuppressive antibodies (MAB)
  75. Glucocorticoids
    • lympholytic properties in lymph node and spleen
    • interfere with lymphocyte cell division
    • greater effect on CMI vs. HMI
    • no effect on myeloid and erythroid stem cells
  76. Uses of prednisone (glucocorticoids)
    • idiopathic thrombocytopenic purpura
    • rheumatoid arthritis
    • autoimmune hemolytic anemia
    • asthma
    • organ/bone marrow transplant
  77. Calcineurin inhibitors
    • cyclosporine
    • tacrolimus
  78. mechanism of action for cyclosporine
    • binds to cyclophilin forming a complex and inhibiting caleneurin.
    • caleneurin is responsible for T cell factor IL-2
  79. Cyclosporine use
    • alone or with glucocorticoids
    • organ transplant
    • severe dry eye syndrome
  80. Cyclosporine metabolism
    cyp 450
  81. toxicities with cyclosporine
    • neprphrotoxic
    • HTN
    • hyperglycemia
    • hepatotoxic
  82. Tacrolimus
    • macrolide antibiotic
    • same mechanism as cyclosporin
    • 10-100x more potent
  83. Sirolimus and Everolimus
    • binds FKBP with mTOR inhibiting T and B cell proliferation
    • CYP450
    • for uveoretnitis (with cyclosporine)
  84. Toxicities of Sirolimus and everolimus
    • myelosupression
    • hepatotoxicity
    • diarrhea
    • no nephrotoxicity
  85. Mycophenolate mofetil
    inhibits B and T cell proliferation by purine synthesis inhibition
  86. mycophenolate mofetil uses
    • solid organ transplant
    • rheumatoid arthritis
    • IBD
  87. Toxicities of mycophenolate mofetil
    • GI
    • headache
    • HTN
    • neutropenia
  88. Thalidomide
    • immunomodulator
    • inhibits TNFalpha reducing phagocytosis by neutrophils
    • increased IL-10
    • enhanced CMI
  89. uses for thalidomide
    • angiogenesis inhibition
    • antinflammatory
    • multiple myeloma
    • solid tumor
    • lupus
  90. Toxicity of thalidomide
    • teratogenesis
    • peripheral neuropathy
    • rash
    • dvt
  91. Cytotoxic agents
    • azathioprine
    • cyclophosphamide
    • leflunomide
    • hydroxychloroquine
  92. Azathioprine
    • mercaptopurine prodrug
    • interferes with purine metabolism
  93. Azatathioprine uses
    • renal allografts
    • rheumatoid arthritis
    • chron's
    • MS
  94. toxicity of azathioprine
    • leukopenia
    • thrombocytopenia
    • hepatic dysfunction
    • increased alkaline phosphatase
  95. cyclophosphamide
    • one of the most efficacious immunosuppressors
    • destroys resting and dividing lymphoid cells
    • good for SLE & autoimmune hemolytic anemia
    • causes n/v
  96. Leflunomide
    • inhibitor of pyrimidine synthesis
    • good for RA
    • increases liver enzymes, renal impairment
    • teratogenic
  97. Hydroxychloroquine
    • affects intracellular antigen processing and loading of epitope on MHC class II
    • RA and SLE
  98. Fingolimod
    • for relapsing MS
    • reduces lymphocyte migration to the brain
    • decreased heart rate and increase bp
    • fetal harm
  99. Anti-lymphocyte or thymocite antibodies
    • used in transplants
    • MAb more effective
    • bone marrow transplants with cyclosporine
    • cause local pain, erythema & type 3 hypersensitivity
  100. Immunoglobulin
    • IGIV prepared from healthy volunteers
    • kawasaki disease (coronary aneurysm)
    • lupus
    • idiopathic thrombocytopenic purpura
  101. monoclonal antibodies ending in umab or zumab
    MAb is humanized
  102. monoclonal antibodies ending in ximab or imab
    antibody is chimeric
  103. adalimumab
    • TNFalpha
    • autoimmune disease
  104. Basiliximab
    • CD25
    • transplant rejection
  105. Daclzumab
    • CD25
    • transplant rejection
  106. efalizumab
    • CD11a
    • Psoriasis
  107. Infliximab
    • TNFalpha
    • arthritis and chron's
  108. Mepolizumab
    • IL-5
    • hypereosinophilic syndrome
  109. Natalizumab
    • alpha 4 integrin
    • MS
    • Chron's
  110. Omalizumab
    • IgE
    • Allergy
  111. Ranibizumab
    • VEGF-A
    • Macular degeneration
  112. How many major types of immunoglobulins can be made during the development of an immune response?
    A. 7
    B. 4
    C. 5
    D. 3
    E. 1
    C. 5
    (this multiple choice question has been scrambled)
  113. Which of the following molecules are associated with helper type 1 cells?
    A. CD4
    B. CD4 & IL-2
    C. CD8
    D. CD8 & IL-2
    E. IL-2
    B. CD4 & IL-2
    (this multiple choice question has been scrambled)
  114. Which of the following is not true?
    A. innate immune response is mdeiated by acute phase proteins and complement pathway
    B. MHC class II is required for antigen presentation to cytotoxic T cells
    C. development of innate response is usually followed by adaptive response
    D. MHC class I binds with peptide in the ER
    E. A type of WBC leads to development of the T cell immune response
    B. MHC class II is required for antigen presentation to cytotoxic T cells
    (this multiple choice question has been scrambled)
  115. Which one is associated with MS?
    A. Antibodies against histones
    B. cell mediated immune response against myelin around nerve cells.
    C. antibodies against RBCs
    D. CMI against insulin produceing islet beta cells
    E. antibodies against DNA
    B. cell mediated immune response against myelin around nerve cells.
    (this multiple choice question has been scrambled)
  116. Which one of the following monoclonal antibodies target CD25 and can be used for transplant rejection?
    A. mepolizumab
    B. omalizumab
    C. ranibisumab
    D. basiliximab
    E. natalizumab
    D. basiliximab
    (this multiple choice question has been scrambled)

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