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Pharm > Immunology Lecture > Flashcards

Immunology Lecture Flashcards

1
Q

What is a Type 1 Antibody Mediated Adverse Drug Reaction

A

IgE
Soluble antigen
Mast cell activation

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2
Q

Example of Type 1 Antibody Mediated Adverse Drug Reaction

A

Penicillin (Beta-lactams)

urticaria
angioedema
bronchospasm
anaphylaxis

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3
Q

what is a type 2 antibody mediated ADR

A

IgG
Cell or matrix associated antigen
FcR+ cells (phagocytes, NK cells)

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4
Q

Example of Type 2 ADR

A

Beta lactams, Rifampicin, Sulfa antibiotics

Haem. anaemia
thrombocytopaenia

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5
Q

What is a Type 3 ADR (antibody mediated)

A

IgG
Soluble antigen
FcR+ cells, complement

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6
Q

Type 3 ADR (antibody mediated) example?

A

Vaccination: serum sickness (fever, vasculitic rash, joint inflam.)

Beta-lactams, sulfa antibiotics, minocycline: Arthus reaction

Hypersensitivity vasculitis

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7
Q

Is Type 4 ADR antibody mediated or cell-mediated?

A

Cell

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8
Q

what is a Type 4a ADR

A

IFN-y, TNF-a (Th1 cells)

antigen presenting cell or direct T. cell activation

Macrophage activation

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9
Q

example of Type 4a ADR

A

Tuberculin reaction, contact dermatitis

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10
Q

What is a Type 4b ADR?

A

IL-4, IL-5, IL-13 (Th2 cells)

apc/direct T cell stim

Eosinophils

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11
Q

Example of Type 4b ADR

A

DRESS
Macpap exanthema with eosinophilia

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12
Q

What is a Type 4c ADR

A

Perforin/Granzyme B

Cell-associated antigen/direct T cell stim.

T cells

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13
Q

Eg of Type 4c ADR?

A

SLS/TEN, bullous exanthema, Fixed Drug Eruption, Hepatitis

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14
Q

What is a Type 4d ADR

A

CXCL8, GM-CSF (T cell)

APC or direct T-cell activ.

Neutrophils

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15
Q

Eg of Type 4d ADR

A

AGEP
Behcets disease

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16
Q

ADR associated with carbamazapine

A

macpap eruption/DRESS/ SJS/TEN

17
Q

What is the most common class of drugs causing hypersensitivity reactions?

A

NSAIDS

18
Q

ADR associated with ACE-inhibitors

A

Angioedema (vasodilatory effect, not immune-mediated)

19
Q

What are some examples of Type 4 ADRs?

A

Severe cutaneous adverse drug reactions (SCAR) can either be confined to skin or multisystem

Mobilliform eruptions (mild common)

Stevens-Johnson syndrome and Toxic epidermal necrolysis

Drug rash with eosinophilia and systemic symptoms

Lichenoid drug eruptions

Acute generalised exanthematous pustulosis (AGEP)

20
Q

Examples of drugs causing SCAR

A

Rifampicin: DRESS commonest, LDE, SJS/TEN
Pyrazinamide: SJS/TEN, but also DRESS
Isoniazid: DRESS, LDE, SJS/TEN
Ethambutol: DRESS, SJS/TEN
Ethionamide: DRESS AND SJS/TEN
Cotrimoxazole: DRESS, SJS/TEN

21
Q

Drugs that cause DILI

A

TB drugs: Isoniazid +/- Rifampicin, Pyrazinamide
Sulfonamides
Azoles
Amox/Clavulanate
Anti-convulsants
NSAIDS
Herbal medicines

22
Q

Genes associated with DILI susceptibility to anti-TB therapy, Diclofenac, and Co-amoxyclav

A

anti- TB: N-acetyletransferase 2 and CYP2E
Diclofenac - cytokine polymorphisms
Co-amoxyclav - HLA

23
Q

Drugs causing acute interstitial nephritis

A

Antibiotics (penicillins, cephalosporins, quinolones, sulfa drugs [Bactrim])
Rifampicin
NB - Herbal remedies
NSAIDS
Diuretics (thiazides and furosemide)
Allopurinol
Phenytoin

24
Q

Biopsy findings in insterstitial nephritis

A

Interstitial oedema
Diffuse interstitial infiltrate’s of inflammatory cells - especially T-cells and eosinophils

25
Q

The pathogenesis of acute interstitial nephritis

A

Immunologically mediated hypersensitivity reaction to a antigen, classically from a drug or infectious antigen
- not dose dependent
- often associated with extra-renal manifestations

26
Q

Extra-renal manifestations of Drug induced AIN

A

Rash
Joint Pain
Eosinophilia
Eosinophiliuria

27
Q

Time onset of drug AIN after starting the drug

A

Usually within 3 weeks, can vary up to 2 months or later with an NSAIDS

28
Q

Rifampicin induced AIN

A

Generally occurs after abx is reintroduced after an interval
NOT normally associated with eosinophilia
Flu-like symptoms, flank pain, HPT, oliguria, ARF are common
Can see acute tubular necrosis

29
Q

Management of drug induced AIN

A

Cessation of causative drug results in quick recovery and complete resolution of renal disorder
If there is no improvement with a few days: consider renal biopsy and give High dose prednisone

Pharm (17 decks)

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