6) Immune Flashcards
Order of Hymenoptera:
= flying insects w/ stingers & 2nd leading cause of anaphylaxis
Anaphylaxis effects what 2 systems the most:
Usually only:
= Respiratory & Heart/Vascular systems
(Urticaria can appear like blistering burns)
Systemic only or can be all the above affected
Reaction from frequent
Keep a temp if:
= <102F keep it & w/o antipyretic
CD8
release perforin
Specific cell medicated T cells
Naive CD4 & 8
CD8 takes note & shows bad guy & replicates for bigger macrophage army
Allergic reaction:
Categories:
= exaggerated immune response to a foreign substance
= Mild, Moderate, & life-threatening reaction!
B Lymphocytes/B-Cells) “Naive” B-cells:
B-Cells “school” @:
= cells that have not yet encountered any antigens
“Haven’t graduated yet”
= bone marrow
B Lymphocytes/B-Cells) mature @:
After maturation:
= ”B Bone” Differentiate & mature w/ antigen exposure in the bone marrow
= Estab/ colonies “chill” in peripheral lymp tissue
B Lymphocytes/B-Cells) maturing:
Plasma B-Cell:
Memory B-Cell:
= encountering an antigen, differentiates into 1 of 2 types of cells “graduates & goes into army for “MOS”
= “Grunts” bread down into antibodies (5-7days life) Exposed Respond, Replicate
= “CIA” Look out cells >10K eyes out for 1 “suspect”
Artificially Acquired Immunity
Acquired through vaccinations
Dead virus
Designed to give us protection from exposure to an antigen at some point in the future
Assessment) Allergic reactions can be:
Mild Category:
Moderate Category:
Severe Category:
= local or systemic
= Affecting a local area. May rq only Benadryl
= spread through the body might rq Epi
= Anaphylaxis rq Epi (multi system w/ hypoBP)
B cells if bad:
makes Memory B cells & Plasma cells make (job make antibodies)
Basophils:
Release histamine and heparin
“Like med” body makes heparin for +permabillty local
CD4 / Helper T if bad :
releases &memory T cells cytokines & presents to naive B cells
Dendritic cells:
Have many surface projections
Type of phagocytic cell
Specialized antigen presenting cell “Tells T-cells”
Abundant in the skin and mucosal linings of the lungs & GI tract
Once activated, they migrate to lymph nodes to activate T-cells
T-Cells ~found in Lymph area
Eosinophils:
= Essential in triggering inflammatory response in allergic reactions (Combat parasites)
“All about parasites” Involved in allergic reactions
Signal other cells for increasing capillary permeability
Granulocytes:
Mast Cells:
= Neutrophils, Eosinophils, Basophils
= Contain granules rich in histamine and heparin that are released during degranulation
H1 Receptor Location & Effects:
H2 Receptor Location & Effects:
H3 Receptor Location & Effects:
H4 Receptor Location & Effects:
= Smooth Ms & endothelial cells| acute reaction
= Gastric Partial cells | Secretion of gastric acid
= CNS | Modulation of neurotransmission
= Mast, Eosin/phil, & Tcells | Immune Reg/s
HIV cellular effect:
= Kills Helper cells
Honey Bee: Barbed stinger: leaves sac w/ stinger (SAC has more antigen & Histamine)
Sac pumps if still attached so remove w/ card
Killer bees in west texas
Fire Ants: bite then sting u
Alkilitic venom only 1-2 reported deaths
Wasps & Hornets non barbed stingers
How many times must an individual come into contact with an allergen for an anaphylactic reaction to occur?
More than once.
Humoral Specific Immunity
“Seal Team 6”
Branch of immune system that may occur after reexposure to a particular antigen
Occurs in the extracellular fluid
Permanent defense system against a specific antigen resulting in an attack by antibodies
This involves antibodies!!!!
Degranulation releases (histamine kills)
Hymenoptera are
a species of insects, some winged, that sting.
Interferon:
virus alarm
Made from infected cell to warn other cells of virus
A chemical that is released from a virus-invaded cell that provides nonspecific resistance to neighboring unaffected cells.
Interferes with viral replication
Acts as a “Whistle Blower”
warning healthy cells to prepare for a viral attack.
Mast Cells:
Baso & Mast cells for anaphylaxis via degranulation
Antibodies bind to Baso & Mast cells w/ to cause degranulation
Granules releasees w/ Heparin & Mast
Histamine release
Mast biggest vasodiolater
Part of innate
= Contain granules rich in histamine and heparin that are released during degranulation
Mild Reaction Rx
Non-anaphylactic Reaction: Pruritus, rash/urticaria
NO respiratory distress,
NO hypotension: Supplemental O2 as needed
Remove offending agent if present (stinger)
ECG, IV therapy
Simple itching and urticarial rashes may be treated with antihistamines alone:
Diphenhydramine Adults: 25 – 50 mg IV/IO/IM
Pediatrics: 1 mg/kg max 25 & 25(50)
most severe type of an allergic reaction:
2 most common causes of anaphylactic death:
= Anaphylaxis (True life-threatening emergency)
= #1: Injected PCN & #2: Bee/Wasp stings
Natural Immunity aka
Innate Immunity
Genetically predetermine, breast milk passes antigens &/or via placenta
It is present at birth and has no relation no relation to previous exposure to a particular antigen
Neutrophils
(Most abundant WBC) Highly mobile phagocytic specialists that engulf and destroy unwanted material
Focuses on bacteria
Non specific response
1st Line of Defense: Skin, Mucus membranes, Stomach acid (External)
2nd Line of Defense: Inflammatory response (Cap + permeability)
Nonspecfic against antigen complement system
Membrane attax complex :
attack membrane to create “Leak channel”
This is another nonspecific defense system against antigens
Activated by two ways:
Classical Complement Pathway: Exposure to antibodies produced against a specific microorganism
Primary mechanism: Alternate Complement Pathway
Exposure to a specific carbohydrate chain found on the surface of a microbe
Nonspecific Response “Cellular/Innate Immunity”
Macrophages “Phagocytosis” “army grunts”
T-Lymphocytes (cover both sides)
Pin/Tape worms:
most common & live in ass & goes out to lay egg & make itchy (w/ kid 1-10 has pinworms)
Presenting cells
Immune system:
= eat cell then replicate antigen “flag”
pruritus
Itching
Severe Reaction Rx
Pruritus, rash/urticaria, wheezes and/or hypotension: Supplemental high flow O2
Maintain patent airway (ET if needed)
Epinephrine 1:1,000 every 3-5 minutes (Priority)
Adults & Pediatrics 0.01 mg/kg IM up to a max of 0.3 mg to 0.5mg
Albuterol/Atrovent Neb
Remove offending agent if present (stinger)
ECG, IV/IO, initiate IV bolus of 20 mL/kg (up to 4 L may be needed to maintain circulation)
Diphenhydramine
B/P still hypotensive after IM Epi?
IV Epi: 1 mg in 1000 mL IV bag » 2-10 mcg/min –
1:10 in 1L gives 1mcg per Ml w/ 10gtts give 1mcg/mL
Solu-Medrol or Dexamethasone
Should a patient experiencing an allergic reaction with no signs of respiratory distress or shock receive epinephrine?
True.
Urticaria commonly show 1st @:
least most common & uncommon sites:
= ABDMN
= head least most common | hands, & feet
Specific / Adaptive response
Phagocytes, Neutrophils, Macrophages & Dendritic cells.
Engulf and destroy
Antigen Presenting Cells (Specific Response) “Helps protein & presents flag to T-B cells”
T cells tell B cells to build antigens
Rq cytokines
Specific Response “Humoral Immunity”
Built special force team
“Antibodies” B-Lymphocytes
Ige “I Give Epi” antibody response for anaphylaxis
IGG most abundant (most Gs)
Make memory cells & Antibodies as look outs POGs
Antibody Rq T-Lymphocytes
Cd8 helper
T Lymphocytes (T-cells) Nonspecific process
- Dendritic or Macrophage (antigen presenting cell)
Exposes Helper T-Cell - Macrophage & T-cell release cytokines
- In response to cytokines, T-cells clone itself
- The cloned T cells produce different cytokines that activate B cells & Cytotoxic T cells
- CD8 Flys out in search to bad cells & binds for perforin
- Cytotoxic T cells will bind with an infected cell Infected cell Cytotoxic T Cell
Virus cell killers:
= NKA & T cells (NKA innate: Natural Killer Cells)
Part of the innate immune system
1st line of defense against viral infections
Have the ability to recognize and kill abnormal cells
Release chemicals that lyse the membranes of cells
Release perfuocytes
Perfusing: goes into hypertonic
“Hole Punch” cell
What are allergens?
Foreign substances that cause an abnormal immune system response known as an allergic reaction.
What are the two key categories of symptoms that specifically indicate anaphylaxis?
Respiratory compromise and shock.
What do antibodies do?
They search for an antigen, combine with it, and destroy it.
What do mast cells release after exposure to an allergen in which IgE antibodies are released?
Histamine.
What effect does the release of histamine have on the bronchioles?
Bronchoconstriction.
What effect does the release of histamine have on the vasculature?
Vasodilation.
What explains the cause of histamine and heparin release in response to an antigen?
IgE antibodies have attached to basophils and mast cells, resulting in degranulation.
What is a grave finding indicative of a severe allergic reaction?
Hypotension.
What is a nonspecific response by the immune system that directly attacks a foreign substance called?
Cellular immunity.
What is a possible side effect of epinephrine use?
Chest pain.
What is a potentially life-threatening condition involving the head, neck, face, and upper airway?
Angioedema.
What is a severe form of an allergic reaction called?
Anaphylaxis.
What is the biggest contributor to the development of anaphylaxis?
Histamine.
What is the desired physiologic reaction after administering a vaccine with live, attenuated viruses?
The immune system will create specific antibodies to the viruses in the vaccine.
1st med admin/d to a PT having an anaphylactic reaction?
High-concentration oxygen.
What is the initial exposure of an individual to an antigen referred to as?
Sensitization.
What is the medical term for hives?
Urticaria.
What is the most common route of entry for an allergen in an anaphylactic reaction?
Injection.
What is the recommended epinephrine dose for an infant or small child?
0.01 mg/kg.
What is the standard dose of diphenhydramine for anaphylaxis?
25-50 mg.
What is the term for a nonspecific response by the immune system that attacks foreign substances?
Cellular immunity.
What is true about corticosteroid use in anaphylaxis treatment?
Corticosteroids can reduce the inflammation associated with anaphylaxis.
What is true about using antihistamines in the treatment of anaphylaxis?
Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.
What symptoms might you expect in a patient experiencing anaphylaxis after eating seafood?
Laryngeal edema, Cyanosis, Bronchospasm, but not Hypertension.
What treatments would best halt the spread of urticaria and reverse bronchoconstriction associated with an allergic reaction?
Epinephrine & diphenhydramine.
What type of immunity is acquired through the administration of a vaccine?
Active Acquired immunity.
What type of immunity is demonstrated when B cells produce antibodies specific to an antigen?
Humoral immunity.
Vaccine is what type of immunity
Active Acquired immunity.
anaphylaxis is what shock category?
Distributive.
Antibody considered most plentiful in human body?
IgG.
antibody responsible for causing a anaphylaxis
IgE.
Why is diphenhydramine administered in anaphylaxis?
It is nonselective, Blocks histamine receptors> inhibiting histamine release of mast cells& basophils.
2ndary response is quicker than primary response b/c
2ndary response uses memory cells, which immediately release antibodies specific to the antigen.
Some people can have temp histamine response:
ranuld syndrome
