1. What are the major functions of the immune system?
    • recognition of and DEFENSE against certain foreign substances
    • establishment of IMMUNOSURVELLIANCE
  2. Why is the study of immunology important to pharmacists?
    • understand how the body works/reacts with certain vaccines, drugs, diseases, etc.
    • treat symptoms or underlying pathology
    • basic health and well-being
    • drugs/vaccines (patient counseling)
    • public health service
    • education/research
  3. Name some vaccines
    • DTaP = diptheria, tetanu, pertussis
    • MMR = measles, mumps, rubella
    • influenza - vaccine only contains 3 strains of flu and you don't get the flu by the vaccine; do not give to pregnant women
    • Flumist (live attenuated influenza vaccine) spray 1/2 up both nostrils; patients over 50 and pregnant women should not use
    • hepatitis B
  4. Smallpox
    • Type: live nonpathogen (vaccinia virus)
    • Administration: subcutaneous
  5. Polio (Salk)
    • Type: Killed (IPV; inactivated polio virus)
    • Administration: subcutaneously
  6. Polio (Sabin)
    • ***we don't use anymore b/c strain can mutate***
    • Type: live attenuated (OPV: oral polio virus)
    • Administration: orally
  7. MMR
    • Measles, mumps, rubella
    • Type: all live attenuated
    • Administration: subcutaneously
  8. DTaP
    • diptheria: toxoid, intramuscularly
    • tetanus: toxoid, intramuscularly
    • pertusis: killed (inactivated), intramuscularly
  9. Diptheria
    • Corynebacterium diptheriae
    • gram positive, rod-shaped, anaerobe bacteria
    • causes death, exudation, and aerobic pseudomembrane in the pharynx
    • becomes very large and can obstruct the airway
    • Toxoid vaccine: characteristics of a toxin, but not toxic - will prevent the disease, but will not prevent death
  10. Tetanus
    • Clostridium tetani
    • gram positive, anaerboic bacillus
    • causes tetanus exotoxin = poison in the jaw ("lock jaw")
    • can cause the diaphragm to be locked in contaction and death in full inspiration --> this is caused by the release of acetylcholine
    • GABA and glycine is blocked when pH has tetanus
    • toxoid vaccine will not prevent the disease but will give the body antibodies to prevent poisoning --> take the poison out of an infected patient/specimen and treat it with fermaldehyde to produce toxoid
  11. Pertusis
    • Bordetella pertusis - "whooping cough"
    • gram-negative cocbacillus (slide shows purple stain instead of red)
    • pertussis toxin causes lung infection; patient coughs and then try to get air back into the lungs (whooping)
    • microorganism in vaccine prevents infection
    • AP = acellular pertussis --> causes much, much less of the violent side effects but still does the job
  12. Haemophilus influenzae type B (HiB)
    • Type: glycoconjugate - not live
    • Administration: intramuscularly
  13. Hepatitis A
    • Type: killed, inactivated
    • Administration: intramuscularly
  14. Hepatitis B
    • Type: recombinant subunit --> DNA grown in bacterial cultures
    • Administration: intramuscularly
  15. Varicella
    • Varivax - live attenuated chicken pox
    • Zostavax - live attenuated shingles
    • Administration: subcutaneously
  16. Pneumococcal conjugate (PCV)
    • Type: glyconconjugate; 12-valent pneumococcal conjugate vaccine (PCV13)
    • Administration: intramuscularly
  17. Pneumococcal polyvalent (PPV)
    • Type: extracted polysaccharide (PPV)
    • Administration: intramuscular/subcutaneous
  18. Meningococcal (MPSV4)
    • Type: extracted polysaccharide (MPSV4)
    • Administration: subcutaneously
  19. Meningococcal (MCV4)
    Type: protein conjugate (MCV4)Administration: intramuscularly
  20. Influenza
    • Type: killed/extracted
    • Administration: intramuscularly
  21. Influenza (Flu-Mist)
    • Type: live, cold-adapted
    • Administration: intranasal
  22. Human Papilloma Virus
    • Type: recombinant subunit
    • Administration: intramuscularly
  23. Rotavirus (Rota Teq)
    • Type: live, nonpathogen, reassortment vaccine--> actual live virus
    • Administration: orally
  24. Rotavirus (Rotarix)
    • Type: live attenuaged vaccine
    • Administration: orally
  25. Antitoxins
    • gives patients antibodies when disease is active in the body
    • they are preformed antibodies usually from horse serum
    • botulism antitoxin
    • Diptheria antitoxin
    • Digibine [ovine (sheep) FAB] - heart drug that only uses a fragment of the antigen antibody
  26. Antivenins
    • used when patients needs treatment for a poison from a venous bite and it gives antibodies that will go to the venous cells and prevent spreading
    • Polyvalent Crotalidae antivenin - Rattlesnake, Water Moccasin, Copperhead
    • Latrodectus macatans antivenin - black widdow spiders
  27. Antidote for life-threatening allergic reactions (anaphylaxis)
    • cannot be taken orally
    • epinephrine (adrenaline) and Epi-pen (given IM) - allow drug to remain there for 10 seconds to ensure drug reaches muscle
  28. H1 antagonists (classical antihistamines)
    • prevents histamine receptor activation
    • diphenhydramine (Benadryl)
    • cetirizine (Zyrtec)
    • desloratidine (Clarinex)
    • fexofenadine (Allegra)
  29. H2 antagonists antihistamines
    • lower acid production
    • cimetidine (Tagmet)
    • ranitidine (Zantac)
    • famotidine (Pepcid)
    • nizatidine (Axid)
  30. Leukotrienes receptor antagonists
    • leukotrienes: powerful bronchoconstrictors that are arachodonic acid derivatives; prostaglandins are also arachodonic acid derivatives
    • blocks leukotriene receptors and increase capillary permeability
    • zarfirlukast (Accolate)
    • montelukast (Singulair) - also used for allergies/Hay Fever
  31. Mast cell stabilizing drugs
    • mast cells: pro-inflammatory cells
    • Prevent release of granules of mast cells
    • cromolyn sodium (Intal, Crolom - hay fever, redness and itchiness; Nasalcrom, Gastrocrom) -->less likely to release mast cells; stops exocytosis of granules
    • nedocromil (Tildae) - spray into lungs
  32. Cox-1
    makes right amount of prostaglandins
  33. Cox-2
    drives inflammation and prevents ulcers
  34. non-selective COX-1 and COX-2 inhibitor NSAIDS
    • asprin (acetyl-salicylic acid; ASA)
    • ibuprofen (Motrin; Advil)
    • naproxen (Naprosyn; Aleve)
    • declofenac (Voltaren)
  35. selective COX-2 inhibitors
    • celecoxib (Celebrex) - has the warning
    • rofecoxib (Vioxx) and valdecoxib (Bextral) --> increase cardiac death
  36. 6 steps (in order) of the HIV Life Cycle
    • binding and fusion
    • reverse transcription
    • integration
    • transcription
    • assembly
    • budding
  37. Binding and Fusion
    • binds to CD4 receptor and one of two co-receptors on the surface of a CD4+ T-lymphocyte
    • fuses with host cell
    • virus releases two strands of RNA into host cell
  38. Reverse Transcription
    HIV enzyme reverse transcriptase converts single stranded HIV RNA to double-stranded HIV DNA
  39. Integration
    • HIV DNA enters host cell's nucleus, where HIV enzyme integrase "hides" the HIV DNA within the host's DNA (provirus)
    • Provirus can remain inactive for several years, producing few or no new compies of HIV
  40. Transcription
    • When host cell receives signal to become active, provirus uses a host enzyme RNA polymerase to create copies of the HIV genome, as well as mRNA
    • mRNA used as a blueprint to make long chains of proteins
  41. Assembly
    • HIV enzyme protease cuts long chains of HIV proteins into smaller individual proteins
    • as smaller HIV proteins come together with copies of HIV's RNA genetic material, new virus particle is assembled
  42. Budding
    • newly assembled virus pushes out "buds" from the host cell
    • new virus steals part of the cell's outer envelope, which is studded with protein/sugar combos - HIV glycoproteins
    • HIV glycoproteins necessary for virus to bind CD4 and co-recpetors
    • now can move on to infect other cells
  43. anti-retorviral drugs
    • reverse transcriptase inhibitors
    • zidovudine (Retrovir; AZT; azidothymidine)
    • stavudine (Zerif; d4T)
  44. protease inhibitors
    • interferes with HIV protease or protein cutting
    • saquinavir (Fortovase)
    • ritonavir (Norvir)
  45. fusion inhibitors
    • block the docking of the virus your cells
    • enfurvitide (Fuzeon) - given simultaneously
    • maraviroc (Selzentry)
  46. integrase inhibitor
    • block integration of proviral DNA that reverse transcriptase makes with the genome
    • raltegravir (Isentress) - it is a protease inhibitor as well
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