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What are the major functions of the immune system?
- recognition of and DEFENSE against certain foreign substances
- establishment of IMMUNOSURVELLIANCE
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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
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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
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Smallpox
- Type: live nonpathogen (vaccinia virus)
- Administration: subcutaneous
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Polio (Salk)
- Type: Killed (IPV; inactivated polio virus)
- Administration: subcutaneously
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Polio (Sabin)
- ***we don't use anymore b/c strain can mutate***
- Type: live attenuated (OPV: oral polio virus)
- Administration: orally
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MMR
- Measles, mumps, rubella
- Type: all live attenuated
- Administration: subcutaneously
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DTaP
- diptheria: toxoid, intramuscularly
- tetanus: toxoid, intramuscularly
- pertusis: killed (inactivated), intramuscularly
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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
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Tetanus
- Clostridium tetanigram 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
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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
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Haemophilus influenzae type B (HiB)
- Type: glycoconjugate - not live
- Administration: intramuscularly
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Hepatitis A
- Type: killed, inactivated
- Administration: intramuscularly
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Hepatitis B
- Type: recombinant subunit --> DNA grown in bacterial cultures
- Administration: intramuscularly
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Varicella
- Varivax - live attenuated chicken pox
- Zostavax - live attenuated shingles
- Administration: subcutaneously
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Pneumococcal conjugate (PCV)
- Type: glyconconjugate; 12-valent pneumococcal conjugate vaccine (PCV13)
- Administration: intramuscularly
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Pneumococcal polyvalent (PPV)
- Type: extracted polysaccharide (PPV)
- Administration: intramuscular/subcutaneous
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Meningococcal (MPSV4)
- Type: extracted polysaccharide (MPSV4)
- Administration: subcutaneously
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Meningococcal (MCV4)
Type: protein conjugate (MCV4)Administration: intramuscularly
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Influenza
- Type: killed/extracted
- Administration: intramuscularly
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Influenza (Flu-Mist)
- Type: live, cold-adapted
- Administration: intranasal
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Human Papilloma Virus
- Type: recombinant subunit
- Administration: intramuscularly
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Rotavirus (Rota Teq)
- Type: live, nonpathogen, reassortment vaccine--> actual live virus
- Administration: orally
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Rotavirus (Rotarix)
- Type: live attenuaged vaccine
- Administration: orally
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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
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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
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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
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H1 antagonists (classical antihistamines)
- prevents histamine receptor activation
- diphenhydramine (Benadryl)
- cetirizine (Zyrtec)
- desloratidine (Clarinex)
- fexofenadine (Allegra)
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H2 antagonists antihistamines
- lower acid production
- cimetidine (Tagmet)
- ranitidine (Zantac)
- famotidine (Pepcid)
- nizatidine (Axid)
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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
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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
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Cox-1
makes right amount of prostaglandins
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Cox-2
drives inflammation and prevents ulcers
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non-selective COX-1 and COX-2 inhibitor NSAIDS
- asprin (acetyl-salicylic acid; ASA)
- ibuprofen (Motrin; Advil)
- naproxen (Naprosyn; Aleve)
- declofenac (Voltaren)
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selective COX-2 inhibitors
- celecoxib (Celebrex) - has the warning
- rofecoxib (Vioxx) and valdecoxib (Bextral) --> increase cardiac death
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6 steps (in order) of the HIV Life Cycle
- binding and fusion
- reverse transcription
- integration
- transcription
- assembly
- budding
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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
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Reverse Transcription
HIV enzyme reverse transcriptase converts single stranded HIV RNA to double-stranded HIV DNA
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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
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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
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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
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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
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anti-retorviral drugs
- reverse transcriptase inhibitors
- zidovudine (Retrovir; AZT; azidothymidine)
- stavudine (Zerif; d4T)
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protease inhibitors
- interferes with HIV protease or protein cutting
- saquinavir (Fortovase)
- ritonavir (Norvir)
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fusion inhibitors
- block the docking of the virus your cells
- enfurvitide (Fuzeon) - given simultaneously
- maraviroc (Selzentry)
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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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