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Immune * Flashcards

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1
Q

Prevention of infection *

A

Live attenuated viruses provide broader, longer lived immunity compared to inactivated types
IgG may not ensure local mucosal protection (IgA)
Three schedules for childhood vaccines- 0-6, 7-18 catch up for 4mth-18 years, one schedule for adult 19 and older

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2
Q

ACIP guidelines for vaccine *

A

Doses may be given 4 days prior/later than specified date
Give live virus vaccine at least 28 days apart
Space vaccine injections 1 inch apart no need to aspirate
Reimmunization is not harmful
Reduced doses should not be given
Recognize response to AE
Vaccine failure can occur with improper transport and storage
May have accelerated schedule for travel
Major contraindications is anaphylaxis
Any dose vaccine not given at recommended age should be given at next encounter
Combination vaccine preferred over separate injections

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3
Q

Dtap/Tdap*

A

Diphtheria and tetanus toxoid pertussis DTaP-acellular pertussis for those less than 7 years
Tdap-for those greater than 7 years
Controlling pertussis in young infants may depend on giving booster to older children/adults
Tetanus prophylaxis as part of wound care
Inactivated
4-5 doses of DTap, then Tdap at 11-12 years
Booster every 10 years or presence of wound
Tdap to be given during each pregnancy at 27-37 weeks

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4
Q

Polio *

A

Polio vaccine- only in US, concern for polio resurgence
Inactivated

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5
Q

Haemophilus influenza *

A

HI type B vaccine-pneumonia, epiglottis
Inactivated

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6
Q

Hepatitis *

A

Hepatitis A-prevent transmission to adults
Hepatitis B- given at birth/infant
HPV, complete series by 6 months, post vaccine serology 9-12 months of age or 1-2 months post last dose
Hep Bs ag and antihep Bs, may need 3 or 4 doses
Inactivated

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7
Q

HPV*

A

For females and males
Contraindicated in pregnancy
Inactivated

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8
Q

Influenza vaccine *

A

Inactivated
Formulation based on epidemiological data, annual

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9
Q

Meningococcal *

A

Inactivated
For Neisseria meningitis
Pneumococcal- PCV 13 covers 13 serotypes
PCV 23 for children greater than 2 years at high risk

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10
Q

Considerations for inactivated vaccine *

A

Fever and local reaction may occur within 24-72 hours
Anaphylaxis to prior dose, neomycin, polymyxin B or strepmycin contraindicated in IPV
Allergies to vaccine components/yeast contraindicate for HBV, IPV
Moderate to severe infection contraindicated for HPV/HIB vaccine

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11
Q

Considerations for live vaccine *

A

Consult with ID if immunocompromised
Cannot given with IGIV therapy

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12
Q

Bacillus calmette guerin vaccine*

A

Live
To prevent spread of TB not routinely used in US

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13
Q

MMR *

A

Live
Measles- more responsible for adverse reactions
Mumps
Rubella- given to females greater than 13 years who do not have documented immunity
Children need 2 doses at 12-15 months and 4-6 years

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14
Q

Varicella *

A

Live
Localized pain, erythema; some may develop rash

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15
Q

Rotavirus *

A

Live
History of intussusception or SCID is contraindicated

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16
Q

Small pox *

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A

Live
Given only for risk of outbreak

17
Q

Yellow fever vaccine *

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A

Given for travel to countries when it is endemic or pandemic

18
Q

Passive immunity *

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A

Derived from sera of pooled human IG, illness borne IG, antibodies from animal or monoclonal antibodies
For those with immunodeficiency or have issues making antibodies
For non immunized or under immunized patients exposed to certain infectious diseases
CMV immune globulin
Hep B immune globulin
Immune globulin intravenous
Rabies immune globulin
Respiratory syncytial virus
Tetanus immune globulin
Varicella zoster immune globulin

19
Q

RSV prophylaxis *

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A

Palivizumab for infants at risk for adverse outcomes of RSV
Infants born before 29 weeks during RSV season until they are 12 months
Children born less than 32 weeks who are less than 2 years and who have chronic lung disease
Infant up to 12 mths old with hemodynamically significant cyanotic or complicated continental heart disease
Infants up to 12 months old with neuromuscular disorder or congenital anomalies compromising respiratory secretion

20
Q

Herpes zoster *

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A

Shingles, shingrix
Indicates for shingles and post therapeutic neuralgia
Immunocompotent age 50
2 doses 2-6 months apart

21
Q

Covid 19 *

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A

Convalescent plasma
Vaccine-pzier and Moderna, J&J

22
Q

Immunosuppressants *

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A

Reduce the activity efficiency of the immune system to treat auto immune diseases or to lower the bodies ability to reject organ transplant
Regiments typically consist of 2 to 4 agents with different mechanisms of action that disrupt the various levels of T cell activation
Three parts of immune activation
-Part one-T cells trigger at the CD3 receptor complex spine antigen on the surface of an antigen presenting cell
-part two-costimulation- where is CD 80 and CD 86 on the surface of the APC engage Cd 28 on T cells this activates many pathways, including calcium calcneurin pathway, this activation triggers of production of IL2 that binds to IL2 receptors on the surface of T cells
-part 3- activation of the cell cycle via the mammalian target of rapamycin and leading to T cell proliferation
More potent actors- monoclonal antibodies
Maintenance-less potent but long term protection

23
Q

Antithymocyte globulins *

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A

Class- polyclonal antibodies
MOA- cause complete depletion of T cell circulating and apoptosis of activated T cells
Uses- prevention of rejection of allograft transplant in use with other immunosuppressants, severe rejection episodes, corticosteroid resistant acute rejection
Premedication with steroids, APAP, antihistamines
ADE- prolong use can result in profound immunosuppression, increased risk of infection, post transplant lymphoproliferative disease

24
Q

Basiliximab (simulect) *

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A

Class- chimeric murine/human monoclonal antibody
MOA- binds to alpha chain on IL 2 receptor on activated T cells, interferes with proliferative cells
Uses- acute rejection in renal transplant in combo with cyclosporine, and corticosteroids, for reduce graft function, decreased risk of calcineurin inhibitor renal toxicity, and rejection prophylaxis
ADE- well tolerated, HTN, GI distress, increased risk for OI, lymphoproliferative disease

25
Alemtuzumab (campath) *
Class- humanized monoclonal antibodies MOA- bind to T and B cells, results in depletion of both lymphoid lines Uses- tx for chronic lymphocytic leukemia, MS, transport for induction and anti rejection for acute and antibody mediated Initial therapy/prophylaxis for PCJ pneumonia, and herpes
26
Rituximab (rituxin) *
Class- chimeric monoclonal antibody MOA- causes B cell depletion by inducing B cell lysis, blocking cell activation and maturation Uses- B cell lymphoma, PTLD, RA ADE- BLACK BOX WARNING reactivation of JC virus leading to progressive multifocal leukoencephalopathy, hepatic B reinfection
27
Bortezomib (velcade) *
Class- proteasome inhibitor MOA- cell cycle arrest, apoptosis of normal plasma cells and decrease antibody production Uses- multiple myeloma, certain lymphomas, antibody mediated rejection ADE- rare
28
IVIG *
Class- immune globulin MOA- exact mechanism unknown, mutifactoral Uses- induction for highly sensitized patients, antibody mediated rejection, autoimmune diseases ADE- HA, fevers, chills, myalgia, BP issues, aseptic meningitis, ARF, VTE
29
Calcineurin inhibitors *
Drugs- cyclosporine (neoral, sandimmune), tacrolimus (astagraf, envarsus, prograf) MOA- blocks signal transduction through calcium-Calcineurin pathway to impair T cell activation Uses- cyclosporine-prevention of transplant rejection in kidney, liver, heart, GVHD, tacro-preferred drug, GVHD, maintenance prevention of rejection ADE- nephrotoxicity, HTN, HA, tremor, hirsutism, gingival hyperplasia D-D numerous Prograf requires therapeutic drug monitoring Need anti infective prophylaxis
30
Constimation blockers *
Drugs- betacept (nulojix) MOA-interfere with immune signaling that activated T cell activation pathway Uses- kidney transplant in combo with basiliximab, mycophenalate, corticosteroids, can also be used as substitute for Calcineurin inhibitors ADE- PTLD Contraindicated in those with seronegative to Epstein bare virus
31
mTOR inhibitors *
Drugs- sirolimus (rapamycin, rapamune), everolimus (zortress) These drugs inhibit the protein mTOR and block the signal transduction pathway activated by signal three advancement into the cell cycle, and T cell proliferation is prevented Multi drug regiments used to decrease the dose of calcineurin inhibitors and reduce kidney adverse effects CYP34A metabolites, many drug to drug interactions Both agents required drug monitoring through trough levels Sirolimus has longer half life Sirolimus also used in cardiology where it coats stents and are used to reduce recent stenosis of vessels by reducing proliferation of endothelial cells Everolimus used an oncology to treat cancer such as breast, kidney and neuroendocrine, but doses are much higher
32
Anti proliferatives *
Drugs- azathioprine (imuran-prototype) mycophenalate (cellcept), mycophenalate sodium (myfortic) MOA- inhibit various targets in signaling pathway cascade, reduces immune cell proliferation and cytotoxic immune response Uses- as adjunct therapy for anti rejection ADE- GI distress, bone marrow suppression, increased risk of infection.
33
Corticosteroids *
Drugs-methylprednisolone (medrol, solumedrol), prednisolone ( orapred, prelone), prednison MOA- unknown, T lymphocytes affected Uses- anti rejection, autoimmune, combination for acute rejection, GVHD ADE- GI distress, hypertension, hyperglycemia, change in mood, long term-osteoporosis
34
Monoclonal antibodies end in -mab also contains XI in the name of they are chimerized and zu if humanized *
35
Belimumab (benlysta) *
Class- fully human monoclonal antibody MOA- PCOS binding of soluble BLyS to B cell receptor this inhibit B cell survival Uses- lupus, renal and heart transplant with antibody mediated rejecting, maintenance anti rejection Contraindicated in MDD/SI and other immunosuppressant use, live vaccine
36
Eculizumab (soliris)*
Class- recombinant humanized monoclonal antibody MOA- selectively binds to complement protein C5 inhibiting cleavage of C5a/b preventing terminal complement of complex C5b-9 generation Uses- hemolytic uremic syndrome, AMR in renal transplant ADE- HA, nasopharyngitis, back pain, nausea BLACK BOX WARNING increased risk for meningococcal infection wait 2 weeks after dose of medication to receive vaccine or give prophylactic antibiotics
37
Tofacitinib (xeljanz) *
Class- Janus kinase inhibitor (JAK) MOA- JAK plays a role in immune cell function, proliferation and survival and this is inhibited Uses- RA, psoriatic arthritis, UC ADE- increased risk of URI, diarrhea, HA D-D- cyp2c19, and CYP3A4

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