Immunology II
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show | receive preformed Ab like IgA in breat milk, antitoxin or just Ig. rapid onset but short half life
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How is active immunity acquired, what is its onset and duration? | show 🗑
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show | tetanus toxin, botulinum toxin, HepB, Rabies
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What is a Live attenuated vaccine? What type of response does it ellicit? | show 🗑
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show | Pro: strong, often life long immunity Con: may revert to a virulent form
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show | live attenuated vaccine
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show | pathogen is inactivated by heat of chemicals, maintaing surface epitope structure. Induces humoral immunity
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What are some pros and cons for using an inactivated or killed vaccine? | show 🗑
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What type of vaccines are cholera, influenza, hepA, polio (Salk), and rabies? | show 🗑
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What is Type I hypersensitivity? What cells mediate it and how fast is the onset? | show 🗑
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Which types of hypersensitivity are Ab mediated? | show 🗑
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What is the test for Type I hypersensitivity? | show 🗑
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What are the general characteristics of Type II hypersensitivity? | show 🗑
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show | 1. Ab opsonizes cells or activates complement 2. Ab recruit neutrophils and macrophages causing tissue damage 3. ab bind to normal receptors and interfere with their fx
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What test is used for Type II hypersensitivity? | show 🗑
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What is immune complex type III hypersensitivity? | show 🗑
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What is serum sickness type III hypersensitivity? | show 🗑
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show | drugs. see fever uticaria, preoteinuria, lymphadenopathy 5-10 d after ag exposure
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show | local subacute Ab reaction. intradermal injection of Ag induces Ab which from complexes in skin. See edema, necrosis and complement activation
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What causes the Arthus reaction? | show 🗑
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What is the test for Type III hypersensitivity? | show 🗑
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What is type IV hypersensitivity? | show 🗑
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show | no because it doesnt involve Ab
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show | 4Ts: Tcells, Transplant rejection, Tb skin tests, touching (contact dermatitis)
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show | patch test (PPD)
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What is a useful pneumonic for the 4 types of hypersensitivity? | show 🗑
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show | Type I hypersensitivity
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show | immediate, anaphylactic, atopic
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What type of hypersensitivity are hay fever, allergies, eczema, hives and asthma? | show 🗑
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show | tends to be specific to tissue or site where the Ag is found
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show | Type II hypersensitivity
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What type of hypersensitivity might be associated with a vasculitis or systemic manifestations? | show 🗑
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What type of hypersensitivity mediates SLE, theumatoid arthritis, polyarteritis nodosum, Post strep GN, serum sickness, farmers lung? | show 🗑
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show | Type III hypersensitivity, this is the Arthus reaction
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show | Type IV hypersensitivity
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show | Type I hypersensitivity against plasma proteins. see uticaria, prutitis, wheezing fever
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How do you treat an allergic reaction to blood transfusions? | show 🗑
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What is the mech of a anaphylactic rejection of blood transfusion? When might it be seen and what are the Sx | show 🗑
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show | Type II hypersensitivity. Host ab against donor HLA ag and leukocytes
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show | fever, HA, chills, flushing
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What is an acute hemolytic transfusion reaction? What 2 types of hemolysis could happen? | show 🗑
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show | fever, hypotensioon, tachypnea, tachycardia, flank pain. hemoglobinemia (if intravascular), jaundice ( if extravascular)(
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What disorder has anti nuclear Ab (ANA)? | show 🗑
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What disorder has anti-dsDNA, anti-Smith ab? | show 🗑
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What disorder has antihistone Ab? | show 🗑
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show | Rheumatoid arthritis
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show | Scleroderma (CREST)
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What disorder has Anti-Scl-70 (anti DNA topoisomerase I)? | show 🗑
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What disorder has antimitochondrial Ab? | show 🗑
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show | Celiac disease
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show | Goodpasture's syndrome
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What disorder has anti-desmoglein Ab? | show 🗑
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What disorder has antimicrosomial, antithyroglobulin Ab? | show 🗑
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show | polymyositis, dermatomyositis
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What disorder has Anti-SS-A (anti-Ro) Ab? | show 🗑
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show | Sjogren's syndrome
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show | Mixed connective tissue disease
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show | Autoimmune hepatitis
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show | Type I DM
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What disorder has cANCA? | show 🗑
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show | other vasculitides, prominently microscopic polyangitis
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What do bacteria cause if a person lacks T cells? | show 🗑
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show | encapsulated: Strepto, staphylo, haemophilus, Moraxella
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show | staphy, pseudomonas
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What types of bacteria are people without complement vulnerable to? | show 🗑
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What types of viruses are people without T cells vulnerable to? | show 🗑
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What types of viruses are people without B cells vulnerable to? | show 🗑
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show | Candida, PCP
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What types of fungi/parasites are people without B cells vulnerable to? | show 🗑
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What types of fungi/parasites are people without granulocytes vulnerable to? | show 🗑
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Overall that is the tendency of T cell vs B cell deficiencies in infections? | show 🗑
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show | 1. Burton's agammaglobulinemia 2. Hyper IgM syndrome 3. Selective IgG deficiency 4. Common variable immunodeficiency
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What is the defect and inheritance in Burton's agammaglobulinemia? | show 🗑
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show | recurrent bacterial infections after 6 months (decr maternal IgG) due to opsonization defect. absence of thymic shadow
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What labs are seen in Burton's agammaglobulinemia? | show 🗑
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show | defective CD40L on TH= can't class switch
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show | severe pyogenic infections early in life
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show | incr IgM, very Decr IgG, A, E
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What is the defect in selective Ig deficiency? | show 🗑
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What is the presentation of selective Ig deficiency? What reaction is especially worrisome? | show 🗑
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show | IgA deficiency is most common. failure to mature into plasma cells. decr secretory IgA
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show | defect in B cell maturation. many causes
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What is the presentation of common variable immune deficiency? | show 🗑
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What labs are seen in common variable immune deficiency? | show 🗑
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show | q. Thymic aplasia (DigGeorge) 2. Il-12 receptor deficiency 3. Hyper IgE syndrome (Job's syndrome) 4. chronic mucocutaneous candidiasis
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show | 22q11 delection; failure to develop 3rd and 4th pharyngeal pouches
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show | tetany(hypocalcemia), reccure viral/fungal infections, CHD, great vessel defects
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show | thymus and parathyroid fail to develop. decr T cells, decr PTH, decr ca2+. absent thymic shadow on CXR
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show | decr Th1 response
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What is the presentation of IL-12 receptor deficiency? | show 🗑
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What labs are seen in IL-12 receptor deficiency? | show 🗑
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What is the defect in Hyper-IgE syndrome (Job's syndrome)? | show 🗑
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show | FATED: coarse Facies,cold, staphylococcal Absesses, retained primary Teeth, incr IgE, dermatologic problems (eczema)
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What labs are seen in Hyper-IgE syndrome (Job's syndrome)? | show 🗑
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show | T-cell dysfunction
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What is the presentation of chronic muccocutaneous cadidiasis? | show 🗑
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What are 3 major B and T cell combined immune deficiencies? | show 🗑
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show | several types: defective IL-2 rector (most common and X linked), adenosine deaminase deficiency, failure to synthesize MHC II Ag
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show | recurrent viral, bacterial, fungal and protozoal infections. no thymic shadow, no germinal centrers in LN bipsy, no B cells on PBS
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What is the Tx for severe combined immunodeficiency (SCID)? | show 🗑
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What labs are seen in severe combined immunodeficiency (SCID)? | show 🗑
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show | defects in ATM gene which codes for DNA repair enzymes
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What is the presentation of ataxia-telangiectasia? | show 🗑
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show | decr IgA
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show | X linked recessive defect. progressive deletion of T and B cells
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show | Triad TIE: thrombocytopenia purpura, infections, eczema
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What labs are seen in Wiskott-Aldrich syndrome? | show 🗑
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show | 1. Leukocyte adhesion deficiency (type 1) 2. Chediak-Higashi syndrome 3. Chronic granulomatous disease
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What is the defect in leukocyte adhesion deficiency (type 1)? | show 🗑
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What is the presentation of leukocyte adhesion deficiency (type 1)? | show 🗑
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show | neutrophilia
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show | AutoRec. defect in lysosomal trafficking gene (LYST). causes microtubule dysfunction and phagosome/lysosome fusion
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What is the presentation of Chediak-Higashi syndrome? | show 🗑
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What is the defect in chronic granulomatous disease? | show 🗑
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What is the presentation of chronic granulomatous disease? | show 🗑
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show | negative nitroblue tetrazolium dye reduction test
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show | from self
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What is a syngeneic graft? | show 🗑
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show | from nonidentical twin
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show | from a different species
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show | within minutes onset. Type II hypersensitivity (Ab mediated) due to presence of preformed anti donor Ab in transplant recipient
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What are the major features of hyperacute transplant rejection? | show 🗑
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What is the onset and pathogenesis of acute transplant rejection? | show 🗑
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What are the features of acute transplant rejection? | show 🗑
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What is the onset and pathogenesis of chronic transplant rejection? | show 🗑
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What are the features of chronic transplant rejection? | show 🗑
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What is the onset and pathogenesis of Graft-versus-host transplant rejection? | show 🗑
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show | maculopapular rash, jaundice, hepatosplenomegaly, diarrhea. usually seen in BM and liver transplant (these organs are rich in lymphocytes). potentially beneficial in BM transplant
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What is the mech of cyclosporine? | show 🗑
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show | surpresses organ rejection. also in select AIDs
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show | predisposes to viral infection and lymphoma. nephrotixic (prevented with mannitol diuresis), gout
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What is the mech of tacrolimus (FK506)? | show 🗑
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What is the clinical use of tacrolimus? | show 🗑
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What is the SE of tacrolimus (FK506)? | show 🗑
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show | inhibits mTOR. inhibits T-cell proliferation in response to IL-2
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What is the clinical use of sirolimus (rapamycin)? | show 🗑
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show | hyperlipidemia, thrombocytopenia, leukopenia
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show | MAB with high affinity for IL-2 receptor on activated T cells
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What is the mech of azathioprine? | show 🗑
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show | kidney transplants, AIDs (including GN and hemolytic anemia)
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show | bone marrow surpression, active metabolite mercaptopurine is metabolized by xanthine oxidase so toxicites might be incr by allopurinol
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What is the mech of muromonab-CD3 (OKT3)? | show 🗑
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What is the clinical use of muromonab (OKT3)? | show 🗑
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show | cytokine release syndrome, hypersensitivity reaction
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What is aldesleukin used for (IL-2)? | show 🗑
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What is Eryhtropoetin used for? | show 🗑
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show | recovery of bone marrow
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show | recovery of bone marrow
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What is alpha interferon used for? | show 🗑
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show | multiple sclerosis
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What is gamm interferon used for? | show 🗑
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What is Oprelvekin (IL-2) used for? | show 🗑
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What is thrombopoetin used for? | show 🗑
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What is the target and use of muromonab-CD3 (OKT3)? | show 🗑
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What is the target and use of daclizumab? | show 🗑
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show | target: digoxin use: antidote for digoxin intox
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What is the target and use of infliximab? | show 🗑
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show | target: TNF-alpha use: Crohn's, RA, psoriatic artritis
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What is the target and use of abciximab? | show 🗑
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show | target: erb-B2 use: HEr-2 overexpressing breast cancers
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show | target: CD20 use: B-cell non-Hodgkin's lymphoma
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What is the target and use of omalizumab? | show 🗑
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