Immunology Quiz on Immune System Concepts

Immune System

• The immune system has barrier defenses, including skin and mucous membranes.
• Gastric acid and cell membrane histocompatibility antigens (HLA) or human leukocyte antigens (HLAs) also play a role.
• Cellular immune defenses involve myelocytes producing neutrophils, basophils, eosinophils, monocytes, and macrophages, and lymphocytes producing lymphoid tissue, B cells, and T cells.
• Inflammatory responses to invasion or injury involve bradykinin, histamine, and cytokines. These trigger chemotaxis to bring RBCs and WBCs to the injured area.

Cytokine Storm

• COVID-19 can trigger a cytokine storm.
• Inflammatory signals lead to this response.
• The result can include ARDS, multi-organ failure, hyperinflammation syndrome, and death.

Immune Response

• The immune response includes T cells, B cells, complement proteins, and antibody formation.
• Interferons are chemicals secreted by cells that are infected by viruses; these prevent viral replication and suppress the replication of malignant cells.
• Interleukins are chemicals secreted by active leukocytes, influencing/activating other leukocytes.
• Tumor necrosis factor (TNF) is a chemical released by macrophages; it inhibits tumor growth and can cause tumor regression.

Antigen vs. Antibody

• An antibody is a protein produced by the body's immune system in response to an antigen.
• An antigen is a foreign substance recognized by the body.

Autoimmune Diseases

• Autoimmune diseases occur when the body attacks its own cells.
• Three theories include: the body blaming a cell infected by a virus, the immune system's inability to regulate the amount of autoantibodies produced, and genetic predisposition.

Antibody Formation

• B cells, called "memory" cells, are released in response to antigen recognition and cause antibody formation.
• This is known as "active immunity".
• Immunizations (vaccines) introduce memory cells (B cells) in advance of exposure, allowing the body to more readily respond to antigens.
• Vaccines are helpful in eradicating and controlling some infections.

Immunization Vocabulary

• Boosters are follow-up doses of a vaccine that sustain protection (e.g., COVID-19).
• Titer measures the amount of antibody produced (used to verify immunity).
• Attenuated vaccines use weakened live microbes (e.g., MMR).
• Inactivated vaccines use killed microbes (e.g., Hep A).
• Toxoid vaccines inactivate harmful toxins (e.g., Diphtheria and Tetanus vaccines).
• mRNA vaccines use genetic material to teach cells how to make a protein, which triggers an immune response (e.g., COVID-19).

Immunization Vocabulary (Continued)

• Recombinant vaccines contain parts of bacterial proteins (e.g., Hep B).
• Active immunity is produced by infection or vaccine; the body produces antibodies.
• Passive immunity involves transferring preformed antibodies (e.g., placenta, breast milk, immunoglobulin). This is used for acute or immunocompromised patients.
• Immune globulins are a source of borrowed antibodies to quickly boost immunity.

Serum Sickness

• Serum sickness occurs when the body views injected immunoglobulins (borrowed antibodies) as foreign. This triggers a counter-antibody response, leading to a massive immune response.
• Associated symptoms can include: fever, arthritis, flank pain, myalgia, and arthralgia.

Use of Immunoglobulin/Immune Sera

• A 10-year-old bitten by a stray dog requires rabies immunoglobulin and the first of five rabies vaccines.
• This case involves active and passive immunity.

Immunization Side Effects

• Common side effects include redness and discomfort, fever, aches, and arthralgias.
• Subclinical cases may indicate particular vaccine types.
• Anaphylaxis and high fevers require careful consideration and protocol.
• Immunization may be contraindicated in immunocompromised patients, or during current diarrhea, vomiting or high-dose steroid use.

Vaccine Facts

• MMR vaccine is derived from eggs.
• Live vaccines like OPV, MMR, and varicella require careful consideration for immunosuppressed patients.
• Meningococcal and influenza vaccines have specific guidelines and high-risk groups.
• Tetanus vaccines have different intervals depending on whether a wound is present.

Vaccine Facts (Continued)

• Pneumococcal vaccines are given to children and adults over 65 or with risk factors.
• HPV vaccine is for 11-12-year olds.
• Rotavirus is only used in infants under 1 year old.
• Steroid or high-dose anti-inflammatory therapy requires careful timing and consideration.

Vaccine – Sample Question

• A health care provider can ensure proper Hep B immunity using a serum antibody level test.

Vaccine – Sample Question Think

• A possible contraindication for MMR vaccine in a 5-year-old is if the child is caring for a grandmother who recently completed a round of chemotherapy for BRCA.

Neoplasm/Cancer

• A neoplasm is a tumor/cancer.
• Neoplasm/cancers are composed of abnormal cells that are different from surrounding normal cells; these cells rapidly divide.
• Cancer cells can form a neoplasm and can travel and metastasize.

Antineoplastic Agents

• Antineoplastic agents target abnormal cancer cells, but normal cells can be affected.
• Cancer cells are different from normal cells and rapidly divide.
• Some drugs reduce abnormal cell survival while others boost the immune system to fight abnormal cells.
• Newer agents like Imatinib (Gleevec) target abnormal cell enzymes; fewer healthy cell effects.

Adverse Effects of Antineoplastics

• Common side effects include mucous membrane irritation, hair loss, nausea/vomiting, abnormalities in ova and sperm production, teratogenicity, bone marrow suppression (myelosuppression), and pancytopenia (all cells affected).
• IV irritation and toxicity are also possible.

Myelosuppression

• Myelosuppression (bone marrow suppression) is delayed for a few weeks.
• Decreased RBCs can lead to fatigue; to counter this, give epoetin alfa (Epogen).
• Decreased WBCs can lead to risk of infection. To counter this, give Filgrastim (Neupogen).
• Decreased platelets can increase bruising and bleeding risk; soft bristle toothbrushes and electrical razors are indicated.

Chemotherapy-Induced Nausea

• Anti-emetics are used to treat chemotherapy-induced nausea and vomiting.
• Common antineoplastic drugs include Dronabinol (Marinol), Ondanestron (Zofran), Aprepitant (Emend), Prochlorperazine (Compazine), Promethazine (Phenergan), Alprazalom (Xanax) and Lorazepam (Ativan), and Metoclopramide (Reglan).
• Nurse tip: consider distraction, positioning, mouth/oral care, food and fluid choices.

Vesicant Chemo Meds

• Vesicant chemo meds are caustic to tissues.
• IV complications must be carefully monitored when administering.

Chemotherapy During Pregnancy

• Studies show little to no negative health effects on infants of pregnant persons receiving chemotherapy.
• More research is needed.

Categories of Chemo Medications

• Alkylating agents: Create cytotoxic effects by reacting with cell RNA, DNA, or other cellular proteins (example: Cisplatin, Cyclophosphamide, Busulfan). These are toxic to cells that are dividing rapidly. They are good for slow growing cancers, like lymphoma, reproductive cancers, but are also toxic to liver and kidneys. They are often contraindicated in pregnancy.
• Antimetabolites: Inhibitors of DNA production and cell division in fast dividing cells (example: Fluorouracil, Methotrexate, Cladribine, Gemcitabine). Also toxic to kidneys and liver, and often contraindicated in pregnancy.
• Antineoplastic antibiotics: Insert themselves between base pairs in the DNA chain and disrupt DNA synthesis, affecting cells that divide rapidly (example: Doxorubicin, Valrubicin, Mitomycin). Affects all organs and systems (renal, hepatic, heart, lungs). Contraindicated in pregnancy.
• Mitotic inhibitors: Used for different tumors/leukemias (Example: Vincristine). Can be nephrotoxic. Contraindicated in pregnancy.
• Hormone modulators: Useful for reproductive cancers; block estrogen as it is a food source for cancerous tumors (Example: Anastrazole, Tamoxifen, Letrozole)
• These medications typically have many potential side effects and thus are frequently given in combination.

Famous Side Effects

• Vincristine (Oncovin): peripheral neuropathy.
• Cyclophosphamide (Cytoxan): hemorrhagic cystitis.
• Doxorubicin (Adriamycin): cardiomyopathy.
• Busulfan (Myleran): pulmonary toxicity.

Hypercalcemia

• Hypercalcemia involves elevated calcium levels in the blood and urine;
• Symptoms include psychiatric problems, kidney stones, abdominal pain, and bone/joint pain.
• "Stones, bones, groans and moans" is a common mnemonic.

Newer Medications

• Celecoxib (Celebrex), an anti-inflammatory, and Dalteparin (Fragmin), a low-molecular-weight heparin, block angiogenesis, slowing blood flow to tumors.

Immune Stimulants

• Interferons (alpha, beta, and gamma): can cause flu-like symptoms.
• Interleukins (e.g., aldesleukin, Proleukin): can cause flu-like symptoms.
• Colony-stimulating factors (e.g., filgrastim, pegfilgrastim): can cause GI distress, weakness, and bone pain.

Immune Suppressants

• Work to block inflammatory reactions and decrease initial damage to cells.
• Used in organ transplants, cancers, and autoimmune diseases.
• Classes include immune modulators, T and B cell suppressors, Interleukin receptor antagonists, and monoclonal antibodies.

Immune Modulators

• Block cytokine release and cause immune suppression.
• Includes Fingolimod (Gilenya), Lenalidomide (Revlimid), Thalidomide, Apremilast (Otezla).

T and B Cell Suppressors

• Cyclosporine, Tacrolimus (Prograf), Mycophenolate (Cellcept), Abatacept (Orencia), Pimecrolimus (Elidel).
• These drugs are used to prevent organ transplant rejection, treat rheumatoid arthritis, and psoriasis.
• Can cause infection and are hepato/renally toxic.

Interleukin Receptor Antagonist

• Block interleukin-1 receptors to prevent cartilage degradation in rheumatoid arthritis.
• Example: Anakinra (Kineret).

Monoclonal Antibodies

• Disable specific T cells, deactivate TNF, and bind to antigens on tumor cells.
• Used to treat a variety of conditions, including COVID-19, metastatic cancer, renal transplant rejection, MS, Crohn's, asthma, and RA, lymphoma.
• Examples: Rituximab (Rituxan), Infliximab (Remicade), Adalimumab (Humira), Ustekinumab (Stelera).
• Can cause acute pulmonary edema, fluid retention, and flu-like symptoms

Corticosteroids

• Used for anti-inflammatory properties.
• Chronic use may cause mood swings, increased infection risk, fluid retention, hyperglycemia, GI distress (melena), hirsutism, weight gain, easy bruising, and osteoporosis. Important considerations include timing of administration (typically in the AM with food), that these drugs can prolong healing, avoidance of abrupt discontinuation, and close monitoring of blood sugars (even in non-diabetics).

Anabolic Steroids

• Anabolic steroids are not the same as corticosteroids; they are synthetic testosterone used to promote muscle growth, and can be used in people with chronic wasting conditions like AIDS.

Adrenal Crisis

• Patients who have been on corticosteroid therapy and suddenly stop the drug may experience an adrenal crisis because their adrenal glands cannot produce enough hormones of their own.
• Symptoms include acne, hypertension, rapid healing (water retention), physiological exhaustion, shock, hyperglycemia, and water retention.

Autoimmune Diseases

• Autoimmune diseases are diseases in which the body's immune system attacks its own tissues.
• Examples include Graves' disease, rheumatoid arthritis, Hashimoto's thyroiditis, type 1 diabetes, pernicious anemia,.

Rheumatoid Arthritis

• Common treatment options include monoclonal antibodies (e.g., infliximab), traditional chemo meds (e.g., methotrexate), corticosteroids.
• Monitoring for complications is crucial.

Humira

• Humira is a medication used to treat psoriasis and other similar conditions.
• It can cause serious infections and increase the possibility of getting lymphoma or other cancers.
• Side effects should be carefully monitored.

Question - Specific

• Specific questions and answers relating to administration, side effects, and specific diseases are included in the notes.

Test your knowledge of key concepts in immunology with this quiz covering barriers, chemotaxis, antibodies, and immunity types. Explore topics like the role of interferons, autoimmunity, and vaccine function. Perfect for students learning about the immune system in a biology course.