Immune Stimulation

Question 1

conditions where immune modulation is the goal

Answer 1

immune deficiency, chronic infection, chemo, immunological disorders (MS), cancer, myelogenous blood disorders

Question 2

antigen specific modulators

Answer 2

active and passive immunization

Question 3

non-antigen specific modulators

Answer 3

adjuvants (BCG, cytokines, alum, liposomes), macrophage activation, cytokines (IL-2, IFNs), passive immunoglobulins (monoclonal Abs), and drugs

Question 4

filgrastim

Answer 4

G-CSF stimulating factor (neutrophils); used for neutropenia or in conjunction with chemotherapy

Question 5

filgrastim dosing

Answer 5

injectable

Question 6

filgrastim side effects

Answer 6

fever, cough, bone pain, reactions at injection site; severe effects are splenic rupture, sickle cell crisis, acute respiratory distress

Question 7

IFN-alpha2a, 2b (type I IFNs)

Answer 7

help with viral infections like hepatitis C; recombinant human proteins that are administered weekly (IM or subQ)

Question 8

type I IFN mechanism

Answer 8

act by inducing IFN-sensitive genes with different antiviral activities, direct effect on viral replication, indirectly elicits T cell response

Question 9

type I IFN side effects

Answer 9

injection site reaction, flu-like symptoms, depression, breathing problems, leukopenia, neutropenia

Question 10

epoetin alpha

Answer 10

EPO; can be used for anemia; increases level of RBCs

Question 11

epoetin alpha dosing

Answer 11

injected 3 times weekly

Question 12

epoetin alpha side effects

Answer 12

hypertension, headaches, thrombotic events, sensitivity reactions, stroke, death

Question 13

contraindications for epoetin alpha

Answer 13

bone-marrow based cancers and acute myelogenous leukemia

Question 14

aldesleukin (IL-2)

Answer 14

immunostimulant that can be used in cases of metastasis

Question 15

IL-2 mechanism

Answer 15

recombinant human IL-2; must be closely managed during and post IV infusion; induces proliferation of T cells and enhances effector functions

Question 16

IL-2 side effects

Answer 16

flu-like symptoms, hypotension, drowsiness, vascular/capillary leak syndrome, pulmonary brain edema

Question 17

sargramostim

Answer 17

GM-CSF for macrophages and neutrophils via STAT pathway

Question 18

sargramostim side effects

Answer 18

infusion site reactions, hypotension, tachycardia, joint pain, headaches, hair loss, edema, shortness of breath, thrombocytopenia

Question 19

sargramostim warnings

Answer 19

fluid retention with respiratory, cardio, renal, and hepatic symptoms

Question 20

IFN-beta1

Answer 20

relapsing-remitting MS; avonex, betaseron

Question 21

IFN-beta1 dosing

Answer 21

subQ every other day

Question 22

IFN-beta1 mechanism

Answer 22

acts via IFN receptors to regulate expression of antiviral genes and immune enhancing genes including for cytokines and MHC antigens

Question 23

IFN-beta1 side effects

Answer 23

flu-like symptoms, depression, rash, anaphylaxis

Question 24

lenalidomide/thalidomide

Answer 24

affect cytokine release

Question 25

lenalidomide uses

Answer 25

multiple myeloma, myelodysplastic disorders with del(5q)

Question 26

lenalidomide side effects

Answer 26

diarrhea, rash, fatigue, leukopenia, thrombocytopenia, blood clots, liver toxicity

Question 27

thalidomide uses

Answer 27

multiple myeloma, erythema nodosum leprosum

Question 28

thalidomide side effects

Answer 28

teratogen, drowsiness, nerve damage, birth defects

Question 29

bacillus-calmette guerin

Answer 29

live attenuated vaccine derived from mycobacterium bovis used for TB vaccine in other countries and invasive bladder cancer

Question 30

bacillus-calmette guerin side effects

Answer 30

granulomatous lesions at sites, swollen lymph nodes

Question 31

Rho(D) immune globulin

Answer 31

passively blocks immune system from recognizing Rh differences; used to treat Rh antigen incompatibility

Question 32

Rho(D) immune globulin side effects

Answer 32

fever, headaches, pain at site, erythrocyte breakdown

Question 33

immediate drug allergy (type I)

Answer 33

vasoactive mediators; IgE-mediated acute allergic reactions causing mast cell degranulation

Question 34

autoimmune reaction (type II)

Answer 34

cell destruction; IgG or IgM response to modified host proteins (from drug) which causes cell lysis or Ab-toxicity

Question 35

examples of type II reactions

Answer 35

lupus from hydralazine, hemolytic anemia from methyldopa, or thrombocytopenia purpura from quinidine

Question 36

serum sickness (type III)

Answer 36

complement deposition; immune complexes containing IgG and is a multisystem complement-dependent vasculitis due to Ab's against the drug; arthritis, fever, lymph nodes swollen

Question 37

examples of serum sickness

Answer 37

sulfonamides, thiouracil, anticonvulsants, antibody therapeutics

Question 38

cell-mediated reactions (type IV)

Answer 38

contact dermatitis from topically-applied drugs